.
Indinavir is an antiviral drug used to treat HIV infection, and is in a class of medications known as protease inhibitors.
Interactions with Herbs
St. John’s
wort (Hypericum perforatum)
Studies have shown that taking indinavir together with St. John’s wort results in
increased breakdown and dramatically reduced blood levels of indinavir.1
2 Therefore, people taking indinavir should not take St. John’s wort.
Indinavir is a protease inhibitor used to treat people with HIV infection. A pharmacological study gave indinavir to healthy volunteers for two days.3 On day 3, volunteers added 900 mg of St. John’s wort extract per day. At the end of the study, it was found that St. John’s wort led to a significant reduction in serum levels of indinavir. Until more is known, people taking indinavir or other antiretroviral drugs for HIV infection should avoid using St. John’s wort.
Interactions with Foods and Other Compounds
Food
Taking indinavir with a meal high in calories, protein, and fat dramatically reduces the
absorption of the drug.4 One controlled trial showed that taking indinavir with a
high-fat breakfast greatly reduced blood levels of the drug, while two types of low-fat meals
had no effect.5 Therefore, indinavir should be taken either with a low-fat meal or
on an empty stomach.
Summary of Interactions for Indinavir
| Depletion or interference | None known |
|---|---|
| Adverse interaction | None known |
| Side effect reduction/prevention | None known |
| Supportive interaction | None known |
| Reduced drug absorption/bioavailability | Food St. John’s wort |
For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.
References:
1. Piscitelli SC, Burstein AH, Chaitt D, et al. Indinavir concentrations and St. John’s wort. Lancet 2000;355:547–8 [letter].
2. Moore LB, Goodwin B, Jones SA, et al. St. John’s wort induces hepatic drug metabolism through activation of the pregnane X receptor. Proc Natl Acad Sci USA 2000;97:7500–2.
3. Piscitelli SC, Burstein AH, Chaitt D, et al. Indinavir concentrations and St. John’s wort. Lancet 2000;355:547–8 [letter].
4. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1772–6.
5. Yeh KC, Deutsch PJ, Haddix H, et al. Single-dose pharmacokinetics of indinavir and the effect of food. Antimicrob Agents Chemother 1998;42:332–8.
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