hypericum
20 interactions related to hypericum
adderall + st. john's wort
Adderall (mixed amphetamine salts) raises synaptic norepinephrine, dopamine, and to a lesser extent serotonin. St. John's Wort inhibits reuptake of those same monoamines. Together they can push the serotonergic system far enough to risk serotonin syndrome and can add cardiovascular strain. Separately, St. John's Wort strongly induces the CYP3A4 enzyme and P-glycoprotein, which can blunt the effect of many co-taken medicines.
methylphenidate + st. john's wort
Methylphenidate treats ADHD by inhibiting reuptake of dopamine and norepinephrine. St. John's Wort adds its own monoamine reuptake activity and is a strong inducer of the CYP3A4 drug-metabolising enzyme. A small published observation suggests St. John's Wort can blunt methylphenidate's effect on ADHD symptoms. There is also a theoretical, additive serotonergic risk, mainly relevant if other serotonergic drugs are present, but no confirmed serotonin syndrome cases have been reported for this specific pair.
carvedilol + st. john's wort
Carvedilol is partly broken down by liver enzymes (including CYP2C9 and CYP3A4) and is also a P-glycoprotein substrate. St. John's Wort induces several of these enzymes and P-glycoprotein, which can speed carvedilol clearance and lower its blood levels, potentially weakening its blood-pressure and heart-failure effects. The interaction is mechanism-based and extrapolated from St. John's Wort's effect on similar drugs; no direct human study of this specific pair has been published.
sertraline + st. john's wort
Sertraline is an SSRI that blocks serotonin reuptake, and St. John's wort independently raises central serotonin through constituents such as hyperforin and hypericin. Combining them can trigger serotonin syndrome, a potentially life-threatening reaction marked by altered mental status, autonomic instability, and neuromuscular hyperactivity. St. John's wort also induces CYP3A4 and CYP2C19, which can lower sertraline levels and undermine treatment.
duloxetine + st. john's wort
Duloxetine and St. John's wort both increase serotonergic activity, and combining them can raise serotonin to levels associated with serotonin syndrome.
cyclosporine + st. john's wort
St. John's wort is a potent inducer of CYP3A4 and P-glycoprotein, the enzyme and transporter that clear cyclosporine. Taking the two together markedly lowers cyclosporine blood levels, which can render the drug subtherapeutic. This has caused documented acute organ rejection in transplant recipients, making the combination a contraindication.
fluoxetine + st. john's wort
Fluoxetine and St. John's wort both increase serotonin activity, and combining them can add to the same effect and contribute to serotonin syndrome.
phenytoin + st. john's wort
St. John's Wort activates the pregnane X receptor and induces drug-metabolizing enzymes (CYP3A4, CYP2C9, CYP2C19) and P-glycoprotein. Because phenytoin is cleared mainly by CYP2C9 and CYP2C19, taking St. John's Wort alongside it could speed phenytoin's breakdown and lower its blood levels, raising the theoretical risk of breakthrough seizures. Direct human data for phenytoin specifically are limited, so regulators treat this as a mechanism-based precaution rather than a documented loss of control.
oral contraceptives + st. john's wort
St. John's Wort induces CYP3A4 and P-glycoprotein, increasing the clearance of contraceptive hormones and reducing the effectiveness of hormonal contraceptives.
ketoconazole + st. john's wort
St. John's Wort induces CYP3A4 and P-glycoprotein through PXR activation. Because oral ketoconazole is cleared by CYP3A4, regular St. John's Wort use can speed its breakdown, lower antifungal blood levels, and risk reduced effectiveness. The effect is established by mechanism and by analogy with other azole antifungals; topical ketoconazole is not a practical concern.
maoi + st. john's wort
St. John's Wort raises brain serotonin, norepinephrine, and dopamine through reuptake inhibition and shows weak monoamine oxidase inhibition. Layered on a prescription MAOI, which blocks the breakdown of those same monoamines, the combination can push monoamine signaling to dangerous levels and is contraindicated because of the risk of serotonin syndrome and hypertensive crisis.
atorvastatin + st. john's wort
St. John's wort induces CYP3A4, the enzyme that metabolizes atorvastatin, lowering statin exposure and weakening cholesterol-lowering efficacy over time.
simvastatin + st. john's wort
St. John's wort induces the CYP3A4 enzyme and the P-glycoprotein transporter that simvastatin depends on, sharply increasing the drug's first-pass breakdown. In a controlled crossover study of healthy volunteers, two weeks of St. John's wort substantially lowered the amount of active simvastatin reaching the bloodstream, weakening its cholesterol-lowering effect.
propranolol + st. john's wort
St. John's Wort induces several liver drug-metabolizing enzymes, including CYP1A2 and CYP3A4, plus the transporter P-glycoprotein. Propranolol is cleared mainly through CYP1A2 and CYP2D6, so regular St. John's Wort use can plausibly speed up its breakdown and weaken its effect. Direct studies of this specific pair are lacking; the concern is based on St. John's Wort's confirmed enzyme-inducing action, its documented lowering of theophylline (which shares propranolol's CYP1A2 pathway), and a case report of lost intraocular-pressure control in a glaucoma patient on a topical beta-blocker.
paroxetine + st. john's wort
Paroxetine is an SSRI that raises serotonin by blocking its reuptake. St. John's wort independently raises serotonin and also induces drug-metabolizing enzymes and P-glycoprotein. Taken together, the additive serotonin effect can precipitate serotonin syndrome, and paroxetine is among the most frequently implicated SSRIs in published St. John's wort case reports.
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 synaptic serotonin higher and trigger serotonin syndrome, and St. John's wort can also reduce venlafaxine exposure by inducing drug-metabolizing enzymes such as CYP3A4.
omeprazole + st. john's wort
St. John's wort induces the liver enzymes CYP3A4 and CYP2C19 that break down omeprazole. Taking the two together speeds up omeprazole clearance, lowers its blood levels, and can weaken its acid-suppressing effect — potentially undermining treatment of GERD, ulcers, or H. pylori eradication.
escitalopram + st. john's wort
Escitalopram is a selective SSRI cleared mainly by CYP2C19 and CYP3A4. St. John's wort independently raises serotonin tone and is a strong inducer of those same enzymes and P-glycoprotein. Taken together, the combination can add to serotonergic effects and, through enzyme induction, lower escitalopram levels and blunt its antidepressant effect. Documented serotonin syndrome cases with St. John's wort involve other SSRIs rather than escitalopram specifically, so the combination is best avoided rather than treated as a guaranteed emergency.
carbamazepine + st. john's wort
Both carbamazepine and St. John's Wort induce CYP3A4, the liver enzyme that primarily breaks carbamazepine down. The combined effect is hard to predict: carbamazepine already induces its own metabolism, so adding the herb may lower exposure most before that self-induction is fully established. The bigger danger comes at transitions — especially stopping St. John's Wort while still on carbamazepine, when the loss of enzyme induction can let carbamazepine levels climb toward toxicity.
tacrolimus + st. john's wort
St. John's wort induces the CYP3A4 enzyme and the P-glycoprotein transporter, which speeds up clearance of tacrolimus and lowers its blood levels, raising the risk of transplant rejection. Stopping the herb after the body has adjusted can let tacrolimus levels rebound, which has been linked to kidney toxicity.