Medical Oncologist
Medicines
Medicines, foods and supplements to avoid on pertuzumab
Pertuzumab itself interacts with very few medicines or foods, but the chemotherapy given alongside it can, and some products add to loose motions or heart strain. This page explains, in general terms, which medicines, supplements, vaccines and herbal products need checking during treatment, and how to keep every doctor informed.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
On this page
- What should you avoid while on pertuzumab?
- Four kinds of interaction to know about
- Common products, in general terms
- Interaction terms, in plain language
- Honest realities about interactions
- Keeping every doctor informed
- How to check a new product
- What people assume about interactions
- Common questions about pertuzumab interactions
The short answer
What should you avoid while on pertuzumab?
Pertuzumab is an antibody medicine. Unlike many tablets, it is not broken down by the liver enzymes that cause most drug interactions, so very few medicines or foods change how pertuzumab itself works. That does not mean anything goes. Pertuzumab is almost always given with trastuzumab, and at the start usually with chemotherapy such as docetaxel or paclitaxel, and those medicines do have interactions. Some antifungal tablets, certain antibiotics, and herbal products such as St John's wort can change the levels of these chemotherapy medicines and make side effects stronger or treatment weaker. The second concern is side effects that add up. Pertuzumab often causes loose motions, so laxatives, magnesium-containing antacids and some supplements can make diarrhoea worse. Medicines that affect the heart, including anthracycline chemotherapy such as doxorubicin, need careful timing because pertuzumab and trastuzumab can also affect heart pumping strength. During chemotherapy, live vaccines should be avoided, while inactivated vaccines such as the flu jab are generally recommended. There are no special food rules for pertuzumab, but food safety matters while white cell counts are low, and alcohol can worsen loose motions and tiredness. The safest habit is to tell every doctor, dentist and pharmacist that you are on HER2-targeted treatment and chemotherapy, and to check before starting anything new, including ayurvedic, homeopathic and over-the-counter products.
Few direct interactions
Pertuzumab itself interacts with very few medicines or foods.
Chemotherapy partners matter more
Docetaxel and paclitaxel have more interactions, especially with some antifungals and herbal products.
Watch for added side effects
Products that loosen motions or strain the heart need extra care.
This page gives general information only. Always check with your oncology team or pharmacist before starting anything new.The main concerns
Four kinds of interaction to know about
Most problems fall into one of these groups.
Changes to chemotherapy levels
Some antifungals, antibiotics, seizure medicines and St John's wort can raise or lower levels of docetaxel or paclitaxel.
More diarrhoea
Laxatives, stool softeners, magnesium antacids and high-dose vitamin C or magnesium supplements can make loose motions worse.
Check before using any digestive remedy.Heart strain
Anthracycline chemotherapy and some other heart-affecting medicines add to the effect of HER2 antibodies on the heart.
Infection and bleeding risks
During chemotherapy, some products carry extra risk.
Ask before using
- Live vaccines
- Blood thinners and high-dose fish oil
- Unregulated herbal mixtures
Everyday products
Common products, in general terms
Product
General guidance
Paracetamol
Usually suitable, but check first, as it can hide a fever during chemotherapy
Anti-inflammatory painkillers
Ask first, especially if platelets are low or you have stomach or kidney problems
Flu and other inactivated vaccines
Generally recommended, with timing advised by your team
Herbal, ayurvedic or homeopathic products
Check each one, as content and strength vary widely
Alcohol
Keep to small amounts or avoid, as it can worsen loose motions and tiredness
Words you will hear
Interaction terms, in plain language
- Drug interaction
- When one medicine or product changes how another works or adds to its side effects.
- Monoclonal antibody
- A laboratory-made protein that attaches to a specific target, such as HER2.
- Liver enzymes
- Proteins in the liver that break down many tablets, the usual source of interactions.
- Live vaccine
- A vaccine containing weakened living germs, usually avoided during chemotherapy.
- Inactivated vaccine
- A vaccine with no living germs, generally safe during cancer treatment.
- Over-the-counter medicine
- A medicine bought without a prescription.
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Being straight with you
Honest realities about interactions
Interaction advice is a guide, not a complete rulebook, and it changes with your treatment phase.
No list is complete
New medicines and supplements appear constantly, and many have never been tested with cancer treatments.
Your treatment phase matters
More care is needed during chemotherapy than during the antibody-only months, when interactions become much less of a concern.
Traditional remedies vary
The same named product can differ in content between makers, and some contain unlisted ingredients or metals.
What this page cannot tell you
It cannot check your own medicine list. Bring every tablet, powder and tonic to your pharmacist or oncology team for review.
Staying safe
Keeping every doctor informed
Interactions most often happen when a doctor outside your cancer team does not know about your treatment.
Carry a treatment card
Keep a card or phone note listing pertuzumab, trastuzumab, your chemotherapy, and your cancer unit's contact number.
Tell dentists and surgeons
Dental work and minor procedures may need timing around blood counts during chemotherapy.
Be careful with infection treatment
If a local doctor prescribes antifungals or antibiotics, ask them to check with your oncology team, especially while you are having docetaxel.
Keep one up-to-date list
Write down every prescription, tablet bought at a chemist, vitamin, powder and tonic you take, with the strength and how often. Update it whenever something changes, and bring it to every clinic visit so your team can check it against your current treatment phase.
Heart medicines
Tell your cardiologist or family doctor about HER2 treatment before changing blood pressure or heart medicines.
A simple routine
How to check a new product
A quick check before starting anything new avoids most problems.
Show the pack, not just the name
Brand names can hide several ingredients. A photo of the label helps your pharmacist identify each one.
Ask three questions
Does it affect my chemotherapy? Could it worsen diarrhoea or bleeding? Is there a safer option?
Report changes early
If new symptoms start after beginning a product, stop and tell your team.
Commonly believed
What people assume about interactions
Natural products cannot interact with cancer treatment.
Some herbal products change chemotherapy levels or add to side effects.
Pertuzumab has a long list of forbidden foods.
There are no special food restrictions for pertuzumab itself.
All vaccines are unsafe during treatment.
Inactivated vaccines such as the flu jab are generally recommended.
Once chemotherapy ends, interactions no longer matter.
They matter less, but heart and bowel effects still need thought.
Questions we are asked
Common questions about pertuzumab interactions
Can I take painkillers on pertuzumab?
Paracetamol is usually suitable, but during chemotherapy check your temperature before taking it, because it can hide a fever that needs urgent attention. Anti-inflammatory painkillers such as ibuprofen may not suit you if platelets are low or you have stomach or kidney problems, so ask your team first.
Is grapefruit a problem?
Grapefruit does not affect pertuzumab or trastuzumab. It can, however, affect how the body handles docetaxel and some other medicines, so many teams advise avoiding grapefruit and its juice while chemotherapy is part of your plan. Ask your pharmacist about your own medicines.
Are ayurvedic or homeopathic medicines safe?
Some may be harmless, but content varies, and a few products contain ingredients that affect the liver, blood clotting or chemotherapy levels. Show the exact product to your team before taking it. Stopping a remedy is usually safer than guessing, particularly during chemotherapy.
Can I have the flu or COVID vaccine?
Inactivated vaccines, including the flu jab, are generally recommended for people on cancer treatment. Your team may suggest the best timing around chemotherapy cycles. Live vaccines are usually avoided during chemotherapy, and family members' vaccines are rarely a concern, but ask if unsure.
Can I take my blood pressure and diabetes medicines?
Usually yes, and keeping these conditions well controlled helps protect your heart. Steroids given with chemotherapy can raise blood sugar, so diabetes medicines may need adjusting. Tell your team about every regular medicine at the start of treatment.
What about antacids and acidity tablets?
Most acidity tablets are fine, but antacids containing magnesium can loosen motions, which may add to pertuzumab-related diarrhoea. If you often need acidity treatment, ask your team which product suits you best during treatment.
Can I use protein powders or multivitamins?
A standard multivitamin at normal strength is generally acceptable, but check first. High-dose antioxidants, large amounts of vitamin C or magnesium, and some protein powders with added herbs may cause problems. Getting nutrition from regular food is usually the best approach.
Does pertuzumab affect my other medicines?
Pertuzumab is not known to change the levels of most other medicines. The main effects to consider are loose motions, which can reduce absorption of some tablets, and heart effects. If a regular medicine stops working as expected, tell your team.
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Sources
- European Medicines Agency — Perjeta: product information
- Macmillan Cancer Support — Pertuzumab
- Cancer Research UK — Docetaxel (Taxotere)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.