How to Manage 10 Blujepa Interactions: Statins, St. John’s Wort, and More

Blujepa (gepotidacin) is making headlines as the first new oral antibiotic for uncomplicated urinary tract infections (UTIs) in decades. For many people, this is welcome news. It’s a fresh option to help treat an all-too-common infection. It's also the first new antibiotic to be FDA approved for uncomplicated gonorrhea in decades.

As with most new medications, though, there’s more to the story. Blujepa doesn’t exist in a vacuum. If you’re already taking other prescriptions, over-the-counter (OTC) medications, or supplements, Blujepa may interact with them in ways that change how well it works — or how your body reacts to it.

The good news is that these risks are manageable. By understanding which medications may cause problems and working closely with your healthcare professional, you can make sure Blujepa is both safe and effective for you.

Blujepa interactions at a glance

Blujepa has many possible interactions. Most of them happen because Blujepa is broken down by a specific enzyme (protein) in the liver. If another medication blocks this enzyme, Blujepa levels can build up, likely leading to more side effects. If another drug speeds it up, Blujepa may be cleared too quickly, potentially making it less effective. Blujepa can affect other medications, too.

Common or notable Blujepa interactions include:

• Azole antifungals, such as ketoconazole

• HIV antivirals, such as ritonavir (Norvir)

• Other antibiotics, such as clarithromycin

• Antiarrhythmics (heart rhythm medications), such as amiodarone (Pacerone)

• Antidepressants, such as amitriptyline

• Antipsychotics, such as quetiapine (Seroquel)

• Antianxiety medications, such as alprazolam (Xanax)

• Statins, such as simvastatin (Zocor, FloLipid)

• Certain blood thinners, such as apixaban (Eliquis)

• Organ transplant medications, such as cyclosporine (Gengraf, Neoral)

• Antiseizure medications, such as phenytoin (Dilantin)

• Anticholinergic medications, such as oxybutynin

• Cholinergic medications, such as donepezil (Aricept, Adlarity)

• Digoxin (Lanoxin)

• Several cancer medications

• St. John’s wort

• Grapefruit juice

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Here, we’ll provide more information about 10 noteworthy Blujepa interactions, plus practical tips to help you manage them. Keep in mind that this list isn’t all-inclusive.

1. Certain antifungals and antivirals, such as ketoconazole and ritonavir

Many antifungals and antivirals slow down the liver enzymes that process Blujepa. This can raise the amount of Blujepa in your blood, increasing the risk of side effects such as nausea, diarrhea, or heart rhythm changes.

Notable interacting antifungals include:

• Oral ketoconazole

• Fluconazole (Diflucan)

• Itraconazole (Sporanox)

• Voriconazole (Vfend)

• Posaconazole (Noxafil)

Antivirals to keep in mind include:

• Ritonavir (Norvir) — and ritonavir-containing combination products, such as Paxlovid

• Cobicistat (Tybost) — and cobicistat-containing combination products, such as Genvoya

• Lopinavir, one of the active ingredients of Kaletra

In general, it’s best to avoid taking these medications with Blujepa. If you need to treat another infection alongside gonorrhea or your UTI, make sure to share an updated medication list with your prescriber. They can check for safer alternatives. If these combinations can’t be avoided, you may need closer monitoring with blood work or an electrocardiogram (ECG).

EXPERT PICKS: WHAT TO READ NEXT

• A new antibiotic: Familiarize yourself with the basics of Blujepa (gepotidacin) for uncomplicated urinary tract infections (UTIs).

• Did you receive a prescription for Blujepa? Pharmacists provide tips to get the most out of your medication.

• Blujepa vs. Macrobid: Macrobid (nitrofurantoin) is a mainstay antibiotic for UTIs. So how does Blujepa stack up to it?

2. Mental health medications, such as Xanax

Certain antidepressants, antipsychotics, and antianxiety medications don’t pair well with Blujepa, either. Combining them may increase the risk of side effects from Blujepa or the other medication. In some cases, Blujepa may interfere with how the other medication works. Examples include:

• Amitriptyline

• Clomipramine (Anafranil)

• Doxepin (Silenor)

• Citalopram (Celexa)

• Escitalopram (Lexapro)

• Nefazodone

• Quetiapine (Seroquel)

• Haloperidol (Haldol)

• Risperidone (Risperdal)

• Thioridazine

• Ziprasidone (Geodon)

• Alprazolam (Xanax)

• Diazepam (Valium)

The severity of these interactions varies by medication. So, if you take any of these medications, let your prescriber know before starting Blujepa. Also, be sure to track any new or worsening side effects — such as dizziness or irregular heartbeat — and report them promptly. Your care team may switch your antibiotic or monitor you more closely.

3. Other medications that affect your heart rhythm

Blujepa can affect the electrical activity of your heart, better known as QT prolongation. When combined with other QT-prolonging medications, the risk of dangerous arrhythmias goes up. Some of the top medications to keep in mind are those that treat certain heart conditions, namely:

• Amiodarone (Pacerone)

• Sotalol (Betapace)

• Dofetilide (Tikosyn)

• Quinidine

• Flecainide

Medications that don’t treat heart conditions can also contribute to QT prolongation. In addition to some of the medications mentioned above, top examples include:

• Macrolide antibiotics, such as azithromycin (Zithromax) or clarithromycin (Biaxin XL)

• Fluoroquinolone antibiotics, such as levofloxacin or moxifloxacin (Avelox)

• Methadone (Methadose)

• Ondansetron

• Sumatriptan (Imitrex)

Remind your prescriber if you take any of these medications. They may order an ECG before or during your treatment with Blujepa. Listen to your body, too. Report any palpitations, fainting, or sudden dizziness to your healthcare team right away.

4. Statins, such as Lipitor

Some statins for high cholesterol rely on the same liver enzymes as Blujepa. When combined, their levels may rise, potentially increasing the risk of muscle pain, weakness, or even a rare but serious condition called rhabdomyolysis (muscle breakdown that can harm the kidneys).

The main concerns are with simvastatin (Zocor, FloLipid) and atorvastatin (Lipitor, Atorvaliq). Other statins — such as pravastatin, rosuvastatin (Crestor), and fluvastatin (Lescol XL) — are less of an issue.

Tell your prescriber if you’re taking a statin, especially simvastatin or atorvastatin. They can tell you if you should skip the Blujepa prescription or if the combination would be OK. If you do combine Blujepa with a statin, keep an eye out for issues such as unexplained muscle aches, tenderness, or dark urine.

5. Certain blood thinners, such as Eliquis

Blujepa may change how certain blood thinners work. It may enhance their effects, which could raise your risk of bleeding or contribute to other side effects. Apixaban (Eliquis) and rivaroxaban (Xarelto) are the two main ones to keep in mind.

Let your prescriber know if you take a blood thinner. They may want to monitor you extra closely while you’re taking Blujepa. Report unusual bruising, nosebleeds, or dark stools right away.

6. Cyclosporine, tacrolimus, and sirolimus

Cyclosporine (Gengraf, Neoral) is sometimes prescribed after organ transplants or for autoimmune conditions. Blujepa can raise cyclosporine levels in the body, which increases the risk of cyclosporine-related side effects, such as kidney problems, high blood pressure, or infections. Blujepa can interact with tacrolimus (Prograf) and sirolimus (Rapamune) in a similar way.

If you take medication after an organ transplant, let your care team know before starting any new antibiotic. In this case, your prescriber will likely choose a different option than Blujepa.

7. Antiseizure medications, such as Dilantin

Some seizure medications speed up liver enzymes, which can clear Blujepa from the body too quickly. This may lower your antibiotic’s levels and lead to an undertreated infection. It’s ideal to avoid the combination if you can. Examples include:

• Carbamazepine (Tegretol)

• Phenytoin (Dilantin)

• Phenobarbital

• Primidone (Mysoline)

If you take any antiseizure medications, share this information with your prescriber before starting Blujepa. Treating epilepsy is very personalized, so they may recommend another antibiotic and/or closely monitor your seizure control.

8. St. John’s wort

St. John’s wort, a popular herbal supplement that’s marketed for depression, can also speed up certain liver enzymes. It, too, can reduce Blujepa’s effectiveness, raising the risk that your infection won’t clear. Try to avoid it while taking Blujepa.

That doesn’t mean you should deprioritize your mental health, though. If you’re interested in taking medication for depression, make sure to loop in a healthcare professional. They can talk to you about your symptoms, what you’re going through, and connect you to a safer prescription antidepressant that can help.

9. Anticholinergic medications, such as Benadryl

Blujepa may interfere with how anticholinergic medications work, which may make them less effective. These medications block acetylcholine, a brain chemical involved in movement, memory, and muscle control.

Many everyday prescriptions and OTC products fall into this group, including:

• Overactive bladder medications, such as oxybutynin (Oxytrol) and tolterodine (Detrol)

• Allergy medications, such as diphenhydramine (Benadryl) and hydroxyzine (Vistaril)

• Parkinson’s disease medications, such as benztropine and trihexyphenidyl

• Irritable bowel syndrome medications, such as dicyclomine

• Several mental health medications

You likely won’t need to avoid these combinations altogether. But if you notice that your anticholinergic medication isn’t working as well while you’re taking Blujepa, let your prescriber know. They may suggest a different antibiotic or adjust your treatment plan.

10. Cholinergic medications, such as donepezil

Cholinergic medications do the opposite of anticholinergic medications. They boost acetylcholine levels. Since Blujepa can also affect acetylcholine, taking both together may cause stronger side effects, such as diarrhea, sweating, or excessive saliva.

Medications that treat Alzheimer’s disease are some of the main examples. Donepezil (Aricept, Adlarity), rivastigmine (Exelon), and benzgalantamine (Zunveyl) are all cases in point. Oral pilocarpine (Salagen) for dry mouth and pyridostigmine (Mestinon) for myasthenia gravis (an autoimmune condition) are additional examples.

Again, you likely won’t need to avoid these combinations altogether. But if you notice new or worsening side effects while taking these drugs, let your healthcare team know. They may adjust your dose or suggest supportive treatments to manage the symptoms that you’re experiencing.

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Written by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Jennifer Gershman, PharmD, CPh, PACS

Jennifer Gershman, PharmD, is a licensed pharmacist in Florida. She has worked in the pharmacy industry for more than 15 years and is currently a medical writer.

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