hypericum
20 interactions related to hypericum
adderall + st. john's wort
Adderall (amphetamine/dextroamphetamine) raises synaptic norepinephrine, dopamine, and serotonin. St. John's Wort inhibits serotonin, dopamine, and norepinephrine reuptake. Combined, the serotonergic load can produce serotonin syndrome and a hypertensive response, while St. John's Wort's CYP3A4 induction may also alter amphetamine metabolism.
methylphenidate + st. john's wort
Methylphenidate inhibits dopamine and norepinephrine reuptake and modestly affects serotonin signaling. St. John's Wort adds reuptake inhibition of serotonin, dopamine, and norepinephrine, plus weak MAO inhibition. Combination risks serotonin syndrome and a published case series suggests reduced methylphenidate efficacy for ADHD.
carvedilol + st. john's wort
Carvedilol is metabolized by CYP2D6, CYP2C9, CYP3A4, and CYP1A2, and is also a P-glycoprotein substrate. St. John's Wort potently induces several of these enzymes and P-gp, accelerating carvedilol clearance and reducing plasma levels, which can blunt its heart failure and antihypertensive effects.
sertraline + st. john's wort
Sertraline is an SSRI that blocks serotonin reuptake, and St. John's wort independently inhibits serotonin reuptake and contains constituents (hyperforin, hypericin) that elevate central serotonin. Combining them can trigger serotonin syndrome, a potentially life-threatening syndrome of altered mental status, autonomic instability, and neuromuscular hyperactivity. St. John's wort also induces CYP3A4 and CYP2C19, which can lower sertraline plasma levels and undermine treatment.
duloxetine + st. john's wort
Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI), and St. John's wort independently raises central serotonin through reuptake inhibition. Combined use can precipitate serotonin syndrome, and St. John's wort induction of CYP3A4 and P-glycoprotein may also alter duloxetine exposure.
cyclosporine + st. john's wort
St. John's wort is a potent inducer of CYP3A4 and P-glycoprotein, which dramatically accelerates cyclosporine metabolism and efflux. Co-administration reduces cyclosporine blood AUC by roughly 40-50%, producing subtherapeutic levels that have caused documented acute organ rejection in heart, kidney, and liver transplant recipients.
phenytoin + st. john's wort
St. John's Wort is a potent inducer of CYP3A4, CYP2C9, CYP2C19, and P-glycoprotein via activation of the pregnane X receptor. Because phenytoin is heavily metabolized by CYP2C9 and CYP2C19, concurrent St. John's Wort can lower phenytoin plasma concentrations into the subtherapeutic range, increasing the risk of breakthrough seizures.
oral contraceptives + st. john's wort
St. John's Wort induces CYP3A4 and P-glycoprotein, which accelerates the metabolism of ethinyl estradiol and progestins in combined oral contraceptives. Clinical trials have documented breakthrough bleeding and reduced contraceptive hormone exposure when the two are combined, raising the risk of ovulation and unintended pregnancy.
ketoconazole + st. john's wort
St. John's Wort is a potent inducer of CYP3A4 and P-glycoprotein via PXR activation, which can accelerate the metabolism of ketoconazole and reduce its antifungal blood concentrations and clinical effectiveness.
maoi + st. john's wort
St. John's Wort inhibits serotonin, dopamine, and norepinephrine reuptake and has weak MAOI activity in vitro. Combined with a prescription MAOI, monoamine clearance is blocked at multiple levels, producing serotonin syndrome and/or hypertensive crisis.
simvastatin + st. john's wort
St. John's wort induces intestinal and hepatic CYP3A4 and P-glycoprotein, sharply increasing simvastatin's first-pass metabolism. In a crossover study of healthy adults, the AUC of active simvastatin hydroxy acid was cut roughly in half (to about 48% of placebo).
propranolol + st. john's wort
St. John's Wort potently induces CYP1A2 and CYP2C19 along with CYP3A4 and P-glycoprotein, accelerating the metabolism of propranolol and reducing its plasma levels. Documented cases include loss of intraocular pressure control in glaucoma patients on topical beta-blockers, and the mechanism predicts similar loss of antihypertensive and antiarrhythmic effect with systemic propranolol.
paroxetine + st. john's wort
Paroxetine is an SSRI with potent serotonin reuptake inhibition; St. John's wort independently inhibits serotonin reuptake and induces CYP3A4 and P-glycoprotein. The combination can precipitate serotonin syndrome and is among the most frequently reported SSRI plus St. John's wort interactions in published case series.
venlafaxine + st. john's wort
Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI). St. John's wort independently inhibits serotonin (and to a lesser extent norepinephrine and dopamine) reuptake. Combining them can drive a sharp rise in synaptic serotonin and trigger serotonin syndrome, and St. John's wort can also alter venlafaxine pharmacokinetics through CYP3A4 induction.
fluoxetine + st. john's wort
Fluoxetine is an SSRI with a very long half-life (its active metabolite norfluoxetine persists for weeks), and St. John's wort independently raises serotonin via reuptake inhibition. Combined use can precipitate serotonin syndrome and, because of fluoxetine's slow elimination, the risk window extends well beyond the day of last dose.
omeprazole + st. john's wort
St. John's wort potently induces CYP3A4 and CYP2C19, the enzymes responsible for omeprazole metabolism. Co-administration significantly lowers omeprazole plasma concentrations, reducing its acid-suppressing efficacy and potentially compromising treatment of GERD, ulcers, or H. pylori eradication.
atorvastatin + st. john's wort
St. John's wort potently induces hepatic and intestinal CYP3A4, accelerating atorvastatin's first-pass metabolism. A controlled study showed roughly a 12% drop in atorvastatin AUC and meaningful increases in LDL and total cholesterol over 4 weeks of co-administration.
escitalopram + st. john's wort
Escitalopram is a highly selective SSRI metabolized largely by CYP2C19 and CYP3A4. St. John's wort independently inhibits serotonin reuptake and strongly induces these same enzymes plus P-glycoprotein. Combined use risks serotonin syndrome and can also lower escitalopram plasma levels, blunting its antidepressant effect.
carbamazepine + st. john's wort
Both carbamazepine and St. John's Wort are strong inducers of CYP3A4, the enzyme that primarily metabolizes carbamazepine. Although healthy-volunteer studies have shown limited additional effect on chronic carbamazepine kinetics (because carbamazepine already maximally autoinduces its own metabolism), starting or stopping St. John's Wort can destabilize carbamazepine levels, and the herb can lower exposure to single carbamazepine doses by up to 21% before autoinduction is established.
tacrolimus + st. john's wort
St. John's wort induces CYP3A4 and P-glycoprotein, slashing tacrolimus blood concentrations and risking acute graft rejection. Conversely, abrupt discontinuation of the herb can unmask tacrolimus nephrotoxicity as levels rebound.