snri
8 interactions related to snri
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.
tramadol + st. john's wort
Tramadol inhibits serotonin and norepinephrine reuptake, and St. John's Wort increases central serotonergic activity, so combining them can add together and raise the risk of serotonin syndrome. St. John's Wort also induces CYP3A4 and CYP2B6, enzymes involved in tramadol metabolism, which may lower levels of tramadol's active M1 metabolite and weaken pain relief.
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.
saffron + antidepressants
Saffron's active constituents (crocin and safranal) show antidepressant-like activity in laboratory and animal studies, partly through monoamine reuptake and monoamine-oxidase inhibition. This overlaps with how SSRIs, SNRIs, and MAOIs work, raising a theoretical concern about additive serotonergic effects. In practice, human trials combining standardized saffron with fluoxetine or sertraline reported no serotonin syndrome and no serious adverse events, and there are no documented human cases from this combination.
alcohol + venlafaxine
Venlafaxine (Effexor) is an SNRI antidepressant, and alcohol is a central nervous system depressant. The FDA-approved label advises avoiding alcohol because the combination can add to drowsiness and dizziness and can worsen the mood or anxiety disorder being treated. The concern is about additive sedation, blood pressure, and undermined treatment rather than a dramatic pharmacokinetic clash, which is why it is rated moderate.
alcohol + duloxetine
Duloxetine (Cymbalta) can occasionally cause liver injury, and its FDA label advises against prescribing it to people with substantial or chronic alcohol use or existing liver disease, because both substances stress the liver. Documented cases have generally been reversible after stopping the drug, with no clear pattern of alcohol-linked liver failure in the published case series.
tramadol + 5-htp
Tramadol blocks the reuptake of serotonin, and 5-HTP is a direct precursor that raises serotonin production in the brain. Stacking the two can push serotonin activity too high and trigger serotonin syndrome, a potentially life-threatening reaction.
coffee + antidepressants
Some antidepressants slow how fast the body clears caffeine by inhibiting the liver enzyme CYP1A2 — fluvoxamine does this most strongly, while fluoxetine, sertraline, paroxetine, and duloxetine have milder effects. At the same time, caffeine independently worsens anxiety, insomnia, tremor, and a racing heart, the very symptoms antidepressants are often prescribed to relieve. With MAOIs, very high caffeine intake has been linked in case reports to blood pressure spikes.