7 Journavx Interactions: Antivirals, St. John’s Wort, and More

When you’re in pain, it’s often the only thing you can think about. Unmanaged pain can affect your mood, relationships, and ability to move throughout the day. Acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids are typical options for pain relief. But each of them has its own pros and cons. One of the biggest concerns with opioids is the risk of misuse and dependence.

Journavx (suzetrigine) is a newer nonopioid pain medication that treats short-term, moderate-to-severe pain. Because it works differently than other pain medication options, the hope is that it will help you avoid some of the troublesome side effects linked to opioids and NSAIDs.

That said, Journavx is most effective and safe when it reaches the right level in your body. Certain medications and foods have the potential to interact, resulting in too high or too low of a level in your body. This can result in Journavx not working as well (too little) or increase the risk of side effects (too much).

Journavx interactions at a glance

Journavx is mostly broken down in the liver. CYP3A4 enzymes are the main proteins responsible for doing this. Several other medications and foods can affect these enzymes, though, which can speed up or slow down the breakdown of Journavx.

Common medications and foods that interact with Journavx include but are not limited to:

• Antibiotics such as clarithromycin, ciprofloxacin (Cipro), and rifampin

• Medications that contain ritonavir, such as nirmatrelvir / ritonavir (Paxlovid)

• Antifungals such as ketoconazole, voriconazole (Vfend), and fluconazole (Diflucan)

• Efavirenz

• Cancer medications such as tucatinib (Tukysa), imatinib (Gleevec), and enzalutamide (Xtandi)

• Heart medications such as diltiazem (Cardizem), verapamil (Verelan), and dronedarone (Multaq)

• Anti-seizure medications such as carbamazepine (Tegretol), phenobarbital, and phenytoin (Dilantin)

• St. John’s wort

• Grapefruit products

• Several hormonal birth control medications

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Let’s take a closer look at seven medications and supplements that can cause Journavx interactions.

1. Several antibiotics, antivirals, and antifungals

Medications used to treat infections are the most common products that interact with Journavx. Several antibiotics, antivirals, and antifungals can affect how your body breaks down Journavx.

Medications that are considered “strong” inhibitors intensely block the metabolism of Journavx, which leads to higher amounts in your body. You should avoid combining these medications with Journavx when possible.

Other medications — known as “moderate” inhibitors — block the metabolism of Journavx to a lesser degree. In this case, it’s OK to take Journavx along with these medications, but you’ll likely need to take Journavx less often as a result. 

Here are some common examples of inhibitors to keep in mind.

Some antibiotics and antivirals have the opposite effect. They can speed up the breakdown of Journavx and make it less effective. These are known as CYP3A4 inducers.

EXPERT PICKS: WHAT TO READ NEXT

• Want to know exactly how to take Journavx (suzetrigine)? Explore Journavx dosage recommendations based on interactions, liver and kidney health, and more. 

• Other medication options: Read about other nonopioid options beyond Journavx to help lessen your pain.

• Journavx’s effectiveness: Take a deeper dive into the studies that talk about Journavx’s effectiveness for moderate-to-severe pain.

One of the most common inducers is an antibiotic called rifampin. It’s known as a strong CYP3A4 inducer. Efavirenz — an antiviral used for HIV — is a moderate inducer, so it speeds up enzyme activity to a lesser degree than rifampin. You should avoid taking Journavx with most inducers like these.

2. Several oral oncolytics

Oncolytics are medications that treat cancer. Several oral oncolytics can slow down enzyme activity and increase Journavx levels in your body. 

If your cancer is treatable with one of the strong inhibitors below, your oncologist may prescribe another pain medication in place of Journavx. If your oral oncolytic is a moderate inhibitor, Journavx may still be OK for you to take, but you’ll need to take it less often.

Certain cancer medications can also speed up the breakdown of Journavx. This, again, decreases Journavx levels in your body and makes it less effective. If you need one of these medications, Journavx probably isn’t your best choice as a pain medication:

• Apalutamide (Erleada)

• Enzalutamide (Xtandi)

• Lorlatinib (Lorbrena)

• Dabrafenib (Tafinlar)

• Sotorasib (Lumakras)

• Ivosidenib (Tibsovo)

3. Certain heart medications

Antiarrhythmics are medications that help manage your heart rate when your heart beats abnormally. These often include:

• Diltiazem (Cardizem)

• Verapamil (Verelan)

• Dronedarone (Multaq)

These medications are all moderate inhibitors. It may be OK to take them while you’re taking Journavx, but you’ll likely need to lower your Journavx dose by taking it less often.

4. Anti-seizure medications

There are several anti-seizure medications that can speed up the breakdown of Journavx, such as:

• Carbamazepine (Tegretol, Equetro)

• Phenobarbital

• Phenytoin (Dilantin)

• Cenobamate (Xcopri)

• Primidone (Mysoline)

If you have a seizure disorder and are taking one of these medications, you’ll want to avoid Journavx and take an alternative pain medication.

Keep in mind: It can take up to 2 weeks for your body to get back to normal after stopping a medication that speeds up the breakdown of Journavx. That’s because these medications cause the enzyme activity to remain high even after stopping a medication that speeds up its metabolism. During this period, Journavx may not work as well while the enzyme levels return to normal.

5. St. John’s wort

St. John’s wort is an herbal supplement that’s marketed for many health conditions, including depression and obsessive-compulsive disorder, among others. St. John’s wort is a strong CYP3A4 inducer, which can decrease Journavx’s effectiveness. It’s best to avoid pairing the two.

If you’re thinking about taking St. John’s wort, talk with a healthcare professional first. They can point you toward treatments with more proven effectiveness that don’t interact with Journavx. 

Since St. John’s wort isn’t the only supplement with potential for medication interactions, this is a good reminder to let your prescriber or pharmacist know about all the over-the-counter medications and supplements you take — they can check for any interactions with your medications.

6. Grapefruit products

Food can slow down how quickly Journavx is absorbed. You should take your first dose of Journavx on an empty stomach; this helps it work quickly and fight your pain faster. If you need something other than water with your first dose, clear liquids such as apple juice, vegetable broth, or tea are fine. After your first dose, you can take Journavx with or without food. 

The exception to this rule is food and drinks that contain grapefruit. Grapefruit is a CYP3A4 inhibitor, which can increase Journavx levels in your body and raise your risk for side effects such as itching, rashes, and muscle spasms. It’s best to avoid grapefruit-containing products while taking Journavx — especially in large quantities.

7. Hormonal birth control

Journavx can make certain hormonal birth control medications less effective.

If you’re taking a hormonal birth control that contains levonorgestrel or norethindrone, you’re in the clear. 

However, if you’re taking hormonal birth control that doesn’t contain one of these medications, Journavx could make them less effective. Examples of common birth control options that don’t contain these specific hormones include: 

• Combination pills such as ethinyl estradiol / desogestrel (Kariva, Viorele) and estradiol valerate / dienogest (Natazia)

• Progestin-only pills such as norgestrel (Opill) or drospirenone (Slynd)

• Implants (Nexplanon) or vaginal rings (Nuvaring) that contain etonogestrel 

• Injections that contain medroxyprogesterone (Depo-Provera)

If you decide to stick with a hormonal birth control that doesn’t contain levonorgestrel or norethindrone like those listed above, you should use an additional form of nonhormonal birth control — such as condoms — for the time you’re taking Journavx and for 28 days after you stop it. 

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Written by:

Rachel Feaster, PharmD, BCOP, BCPS

Rachel Feaster has over 10 years of professional experience in ambulatory, inpatient, pharmacogenomics, and oncology care. She is board certified in oncology and pharmacotherapy.

Edited 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:

Bailey E. Eason, PharmD, MS, BCPS

Bailey Eason, PharmD, MS, BCPS, is the program director of drug diversion at Northwestern Medicine. Eason has experience as an operating room pharmacy manager and a pharmacy manager of clinical operations.

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