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St. John'S Wort

146 interactions on record

St. John'S Wort has 146 known drug interactions based on U.S. FDA drug labeling data. Of these, 16 are contraindicated combinations that should be avoided entirely. 71 are classified as major interactions requiring close medical supervision. Notable interactions include combinations with Apixaban, Artemether And Lumefantrine, Clozapine. Patients taking St. John'S Wort should inform their healthcare provider of all current medications — including over-the-counter drugs and supplements — to avoid potentially harmful combinations. Data sourced from OpenFDA and the NIH National Library of Medicine.

Total: 146
Contraindicated: 16
Major: 71
Moderate: 59

Contraindicated (16)

St. John'S Wort + Apixaban— Combined P-gp and strong CYP3A4 inducer that decreases apixaban exposure and increases risk of stroke and thromboembolic…
St. John'S Wort + Artemether And Lumefantrine— Strong CYP3A4 inducer contraindicated with artemether and lumefantrine due to potential loss of antimalarial efficacy.
St. John'S Wort + Clozapine— Strong CYP3A4 inducer that decreases clozapine plasma concentration. Concomitant use is not recommended due to decreased…
St. John'S Wort + Doravirine— Co-administration decreases doravirine plasma concentrations. At least a 4-week cessation period is recommended prior to…
St. John'S Wort + Doravirine, Lamivudine, And Tenofovir Disoproxil Fumarate— Co-administration decreases doravirine plasma concentrations and is contraindicated. At least a 4-week cessation period …
St. John'S Wort + Elexacaftor, Tezacaftor, And Ivacaftor— Strong CYP3A inducer (Hypericum perforatum) expected to decrease TRIKAFTA component exposures and reduce efficacy.
St. John'S Wort + Estradiol Valerate And Estradiol Valerate/Dienogest— Strong CYP3A4 inducer. Should not use Estradiol Valerate/Dienogest while taking or for 28 days after discontinuation due…
St. John'S Wort + Irinotecan Hydrochloride— Strong CYP3A4 inducer substantially reduces exposure to irinotecan and SN-38. Do not administer unless no therapeutic al…
St. John'S Wort + Istradefylline— Strong CYP3A4 inducer. Avoid concomitant use with istradefylline.
St. John'S Wort + Ixazomib— Strong CYP3A inducer. Avoid concomitant use with NINLARO (ixazomib).
St. John'S Wort + Lemborexant— Strong CYP3A inducer that decreases lemborexant exposure, which may reduce DAYVIGO efficacy. Concomitant use should be a…
St. John'S Wort + Lurasidone Hydrochloride— Strong CYP3A4 inducer that decreases lurasidone exposure; concomitant use is contraindicated.
St. John'S Wort + Ranolazine— CYP3A inducer. Do not use with ranolazine extended-release tablets.
St. John'S Wort + Rivaroxaban— Combined P-gp and strong CYP3A inducer that decreases rivaroxaban exposure and may increase thromboembolic risk. Avoid c…
St. John'S Wort + Safinamide Mesylate— Serotonergic drug; concomitant use is contraindicated due to risk of serotonin syndrome.
St. John'S Wort + Voriconazole— CYP450 and P-glycoprotein inducer significantly reduces voriconazole plasma exposure.

Major (71)

St. John'S Wort + Aminolevulinic Acid Hydrochloride— Phototoxic agent that may cause severe phototoxic skin reaction (severe sunburn). Avoid for 24 hours before and after AL…
St. John'S Wort + Amiodarone Hydrochloride— CYP450 inducer that reduces amiodarone serum levels.
St. John'S Wort + Amphetamine Sulfate— Serotonergic drug that increases risk of serotonin syndrome when used concomitantly with amphetamine sulfate.
St. John'S Wort + Axitinib— Strong CYP3A4/5 inducer reduces axitinib plasma exposure. Co-administration should be avoided.
St. John'S Wort + Citalopram— Concomitant use increases risk of serotonin syndrome.
St. John'S Wort + Citalopram Hydrobromide— Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and…
St. John'S Wort + Cobimetinib— Strong CYP3A inducer may decrease cobimetinib exposure by >80% and reduce efficacy. Avoid concurrent use.
St. John'S Wort + Desvenlafaxine Succinate— Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and consider discontinuation if serotonin syn…
St. John'S Wort + Dextroamphetamine— Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and discontinue if serotonin syndrome occurs.
St. John'S Wort + Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate— Serotonergic drug that increases risk of serotonin syndrome when combined with amphetamines. Initiate with lower doses a…
St. John'S Wort + Dextroamphetamine Sulfate— Serotonergic drug increasing risk of serotonin syndrome with dextroamphetamine sulfate.
St. John'S Wort + Doxorubicin Hydrochloride— CYP3A4 inducer that may decrease doxorubicin concentration and clinical effect.
St. John'S Wort + Erlotinib— CYP3A4 inducer decreases erlotinib exposure. Increase erlotinib dosage if co-administration is unavoidable.
St. John'S Wort + Erlotinib Hydrochloride— CYP3A4 inducer decreases erlotinib exposure. Increase erlotinib dosage if co-administration is unavoidable.
St. John'S Wort + Escitalopram— Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and…
St. John'S Wort + Escitalopram Oxalate— Serotonergic agent that increases risk of serotonin syndrome when combined with escitalopram oxalate.
St. John'S Wort + Exemestane— Strong CYP 3A4 inducer that significantly decreases exemestane exposure. Dose increase to 50 mg recommended.
St. John'S Wort + Fluoxetine— Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during treatment init…
St. John'S Wort + Fluoxetine Hydrochloride— Concomitant use increases risk of serotonin syndrome; monitor for symptoms.
St. John'S Wort + Fostemsavir Tromethamine— Herbal product that significantly decreases temsavir plasma concentrations, which may lead to loss of virologic response…
St. John'S Wort + Glecaprevir And Pibrentasvir— May significantly decrease plasma concentrations of glecaprevir and pibrentasvir, leading to reduced therapeutic effect.…
St. John'S Wort + Isotretinoin— Possible interaction with hormonal contraceptives; reports of breakthrough bleeding and pregnancies in users of combined…
St. John'S Wort + Ivabradine— CYP3A4 inducer that decreases ivabradine plasma concentrations; avoid concomitant use.
St. John'S Wort + Ivacaftor— Strong CYP3A inducer. Co-administration not recommended.
St. John'S Wort + Larotrectinib— Strong CYP3A4 inducer; coadministration may decrease larotrectinib plasma concentrations and decrease efficacy. Avoid co…
St. John'S Wort + Ledipasvir And Sofosbuvir— P-gp inducer that may decrease ledipasvir and sofosbuvir plasma concentrations, leading to reduced therapeutic effect. U…
St. John'S Wort + Levonorgestrel/Ethinyl Estradiol And Ethinyl Estradiol— Induces hepatic enzymes and p-glycoprotein transporter, reducing contraceptive effectiveness and potentially resulting i…
St. John'S Wort + Lumacaftor And Ivacaftor— Strong CYP3A inducer significantly reduces ivacaftor exposure and ORKAMBI therapeutic effectiveness. Co-administration n…
St. John'S Wort + Macimorelin Acetate— Strong CYP3A4 inducer may reduce plasma macimorelin concentrations and lead to false positive test results. Discontinue …
St. John'S Wort + Maraviroc— Coadministration is not recommended; expected to substantially decrease maraviroc concentrations, leading to suboptimal …
St. John'S Wort + Medroxyprogesterone Acetate— CYP3A4 inducer may decrease medroxyprogesterone acetate concentrations and reduce contraceptive efficacy. Effect varies …
St. John'S Wort + Methadone Hydrochloride— CYP3A4, CYP2B6, CYP2C19, and CYP2C9 inducer decreases methadone plasma concentration, resulting in decreased efficacy or…
St. John'S Wort + Milnacipran Hydrochloride— Concomitant use can result in serotonin syndrome. Careful monitoring advised.
St. John'S Wort + Mirtazapine— Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and…
St. John'S Wort + Naldemedine— Strong CYP3A inducer causing significant decrease in plasma naldemedine concentrations, which may reduce efficacy.
St. John'S Wort + Naloxegol Oxalate— Strong CYP3A4 inducer that significantly decreases plasma naloxegol concentrations and may decrease efficacy; use is not…
St. John'S Wort + Nifedipine— Strong CYP3A inducer reduces the bioavailability and efficacy of nifedipine; careful consideration needed if co-administ…
St. John'S Wort + Nintedanib— P-gp and CYP3A4 inducer that may decrease nintedanib exposure. Should be avoided due to risk of reduced efficacy.
St. John'S Wort + Norethindrone— May reduce contraceptive effectiveness and cause breakthrough bleeding by inducing hepatic enzymes and p-glycoprotein tr…
St. John'S Wort + Norethindrone Acetate/Ethinyl Estradiol— St. John's Wort may induce hepatic enzymes and p-glycoprotein transporter, reducing contraceptive effectiveness and incr…
St. John'S Wort + Norgestimate And Ethinyl Estradiol— May decrease plasma concentrations of COCs and potentially diminish effectiveness or increase breakthrough bleeding.
St. John'S Wort + Omeprazole Magnesium, Amoxicillin And Rifabutin— Strong CYP2C19/CYP3A4 inducer causing decreased exposure of omeprazole. Concomitant use should be avoided.
St. John'S Wort + Palbociclib— Strong CYP3A inducer. Avoid concomitant use with palbociclib.
St. John'S Wort + Paliperidone Palmitate— Strong CYP3A4/P-gp inducer that may decrease paliperidone exposure. Avoid during 3-month dosing interval if possible; co…
St. John'S Wort + Paroxetine— Concomitant use increases risk of serotonin syndrome.
St. John'S Wort + Pexidartinib Hydrochloride— Strong CYP3A inducer that decreases pexidartinib concentrations, which may decrease the efficacy of TURALIO. Avoid conco…
St. John'S Wort + Quetiapine— Potent CYP3A4 inducer increases quetiapine clearance; increase quetiapine dose up to 5-fold during chronic use and reduc…
St. John'S Wort + Quetiapine Fumarate— Strong CYP3A4 inducer that decreases quetiapine exposure; quetiapine dose may need to be increased up to 5 fold.
St. John'S Wort + Regorafenib— Strong CYP3A4 inducer that decreases regorafenib plasma concentrations and may lead to decreased efficacy.
St. John'S Wort + Riociguat— Strong CYP3A inducer may significantly reduce riociguat exposure. Data are not available to guide dosing.
St. John'S Wort + Rydapt— Strong CYP3A4 inducer that decreases midostaurin concentrations and may reduce efficacy. Avoid coadministration. Inducti…
St. John'S Wort + Sertraline— Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms, particularly during initi…
St. John'S Wort + Sertraline Hydrochloride— Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms, particularly during treat…
St. John'S Wort + Sofosbuvir, Velpatasvir, And Voxilaprevir— P-gp inducer and moderate to strong CYP inducer that may significantly decrease plasma concentrations of sofosbuvir, vel…
St. John'S Wort + Tacrolimus— May decrease tacrolimus whole blood trough concentrations and increase risk of rejection. Increase tacrolimus dose and m…
St. John'S Wort + Tacrolimus Extended-Release Capsules— Strong CYP3A inducer may decrease tacrolimus concentrations and increase risk of rejection. Increase tacrolimus dose and…
St. John'S Wort + Tezacaftor And Ivacaftor— Strong CYP3A inducer (Hypericum perforatum). Co-administration not recommended due to reduced SYMDEKO efficacy.
St. John'S Wort + Toremifene Citrate— Strong CYP3A4 inducer that decreases toremifene steady-state concentration and should be avoided.
St. John'S Wort + Trabectedin— Strong CYP3A inducer. Avoid concomitant use with trabectedin.
St. John'S Wort + Trazodone Hydrochloride— Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms during trazodone initiatio…
St. John'S Wort + Ubrogepant— Strong CYP3A4 inducer expected to cause loss of ubrogepant efficacy. Concomitant use should be avoided.
St. John'S Wort + Vandetanib— Can decrease vandetanib exposure unpredictably. Avoid concomitant use during CAPRELSA therapy.
St. John'S Wort + Velpatasvir And Sofosbuvir— P-gp and moderate to strong CYP inducer that may decrease concentrations of sofosbuvir and/or velpatasvir, leading to re…
St. John'S Wort + Venlafaxine— Potential for serotonin syndrome with serotonergic drug St. John's Wort. Careful patient observation advised.
St. John'S Wort + Venlafaxine Hcl Er— Potential for serotonin syndrome when used with serotonergic drugs. Careful patient observation advised.
St. John'S Wort + Venlafaxine Hydrochloride— Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and consider discontinuation if serotonin syn…
St. John'S Wort + Vincristine Sulfate— Strong CYP3A inducer that should be avoided during concurrent use with vincristine sulfate.
St. John'S Wort + Ziprasidone— Risk of serotonin syndrome with concomitant therapy with St. John's Wort.
St. John'S Wort + Ziprasidone Hcl— Risk of serotonin syndrome with concomitant serotonergic therapy including St. John's Wort.
St. John'S Wort + Ziprasidone Mesylate— Risk of serotonin syndrome with concomitant serotonergic therapy including St. John's Wort.
St. John'S Wort + Zolpidem Tartrate— CYP3A4 inducer that may decrease effect and efficacy of zolpidem.

Moderate (59)

St. John'S Wort + Afatinib— P-glycoprotein inducer that decreases afatinib exposure. Increase GILOTRIF dose by 10 mg per day as tolerated.
St. John'S Wort + Amlodipine And Benazepril Hydrochloride— CYP3A4 inducer may decrease amlodipine exposure. Blood pressure should be monitored when co-administered.
St. John'S Wort + Amlodipine And Valsartan— CYP3A inducer that may reduce amlodipine effectiveness. Blood pressure should be closely monitored when coadministered.
St. John'S Wort + Cabozantinib— St. John's wort may decrease exposure of cabozantinib, reducing efficacy. Avoid coadministration or increase CABOMETYX d…
St. John'S Wort + Carisoprodol— CYP2C19 inducer that could result in decreased carisoprodol exposure and increased meprobamate exposure; full pharmacolo…
St. John'S Wort + Conjugated Estrogens And Medroxyprogesterone Acetate— CYP3A4 inducer may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and/or altering ut…
St. John'S Wort + Conjugated Estrogens/Bazedoxifene— CYP3A4 inducer may reduce plasma concentrations of estrogens, decreasing therapeutic effects and altering uterine bleedi…
St. John'S Wort + Dapsone— May increase formation of dapsone hydroxylamine, a metabolite associated with hemolysis. Monitor for hemolytic reactions…
St. John'S Wort + Dapsone Gel, 5%— May increase formation of dapsone hydroxylamine, a metabolite associated with hemolysis.
St. John'S Wort + Desogestrel And Ethinyl Estradiol And Ethinyl Estradiol— Induces CYP3A4 and may decrease plasma concentrations of desogestrel and ethinyl estradiol, potentially diminishing cont…
St. John'S Wort + Desvenlafaxine— Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and consider discontinuation if serotonin syn…
St. John'S Wort + Desvenlafaxine Er— Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and consider discontinuation if serotonin syn…
St. John'S Wort + Digoxin— Decreases digoxin concentrations. Requires monitoring and dose adjustment.
St. John'S Wort + Drospirenone— May decrease systemic concentrations of hormonal contraceptives and diminish effectiveness or increase breakthrough blee…
St. John'S Wort + Drospirenone And Ethinyl Estradiol— Induces CYP3A4 enzyme, may decrease effectiveness of COCs or increase breakthrough bleeding.
St. John'S Wort + Drospirenone, Ethinyl Estradiol And Levomefolate Calcium And Levomefolate Calcium— May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induct…
St. John'S Wort + Drospirenone/Ethinyl Estradiol/Levomefolate Calcium And Levomefolate Calcium— Herbal product that may decrease effectiveness of COCs or increase breakthrough bleeding. Use back-up contraception.
St. John'S Wort + Duloxetine— Concomitant use increases risk of serotonin syndrome. Monitor for symptoms during treatment initiation and dose increase…
St. John'S Wort + Emtricitabine And Tenofovir Alafenamide— May decrease TAF concentration through P-gp and BCRP induction.
St. John'S Wort + Estradiol— CYP3A4 inducer that may reduce plasma concentrations of estradiol, possibly decreasing therapeutic effects and altering …
St. John'S Wort + Estradiol Acetate— CYP3A4 inducer may decrease estradiol acetate plasma concentration, resulting in decreased therapeutic effects and/or ch…
St. John'S Wort + Estradiol And Levonorgestrel— CYP3A4 inducer that may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and/or alteri…
St. John'S Wort + Estradiol And Norethindrone Acetate— CYP3A4 inducer that may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and/or alteri…
St. John'S Wort + Estradiol And Progesterone— CYP3A4 inducer may reduce plasma concentrations of estrogens and progestins, possibly decreasing therapeutic effects and…
St. John'S Wort + Estradiol Gel 0.1%— CYP3A4 inducer that may reduce estradiol plasma concentrations, possibly decreasing therapeutic effects and altering ute…
St. John'S Wort + Estradiol Transdermal— CYP3A4 inducer that may reduce estradiol plasma concentrations, possibly decreasing therapeutic effects and/or altering …
St. John'S Wort + Estradiol Valerate— CYP3A4 inducer that may reduce plasma concentrations of estradiol valerate, possibly decreasing therapeutic effects and …
St. John'S Wort + Estradiol/Norethindrone Acetate Transdermal System— CYP3A4 inducer that may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and altering …
St. John'S Wort + Estrogens, Conjugated— CYP3A4 inducer may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and altering uteri…
St. John'S Wort + Etonogestrel— May decrease plasma concentrations of etonogestrel and diminish contraceptive effectiveness or increase breakthrough ble…
St. John'S Wort + Etonogestrel And Ethinyl Estradiol— Herbal product that induces CYP3A4 enzyme and may decrease plasma concentrations of etonogestrel and ethinyl estradiol, …
St. John'S Wort + Etonogestrel And Ethinyl Estradiol Vaginal Ring— Herbal product that induces CYP3A4, may decrease plasma concentrations of CHCs and potentially diminish effectiveness or…
St. John'S Wort + Flibanserin— CYP3A4 inducer; concomitant use may decrease flibanserin exposure and therapeutic effect.
St. John'S Wort + Fosphenytoin Sodium— May decrease phenytoin serum levels; dose adjustment may be required. Induction potency may vary widely based on prepara…
St. John'S Wort + Ifosfamide— CYP3A4 inducer may increase metabolism of ifosfamide to active metabolites and increase formation of neurotoxic/nephroto…
St. John'S Wort + Imatinib— CYP3A4 inducer that reduces imatinib AUC by 30%; consider alternative therapeutic agents.
St. John'S Wort + Lasmiditan— Increased risk of serotonin syndrome when combined with lasmiditan; use with caution.
St. John'S Wort + Levomilnacipran Hydrochloride— Serotonergic drug that increases risk of serotonin syndrome. Monitor for symptoms and discontinue if serotonin syndrome …
St. John'S Wort + Levonorgestrel And Ethinyl Estradiol And Ethinyl Estradiol Tablets— St. John's wort induces CYP3A4 and may decrease plasma concentrations of COCs, potentially diminishing contraceptive eff…
St. John'S Wort + Levonorgestrel And Ethinyl Estradiol And Ferrous Fumarate— St. John's wort induces CYP3A4 enzymes, potentially decreasing contraceptive effectiveness and increasing breakthrough b…
St. John'S Wort + Mifepristone— CYP3A4 inducer that may lower mifepristone serum concentrations and reduce efficacy. Verify treatment success through fo…
St. John'S Wort + Nateglinide— CYP inducer that may reduce blood-glucose-lowering effect of nateglinide and increase susceptibility to hyperglycemia.
St. John'S Wort + Nexterone (Amiodarone Hci)— May induce CYP450 enzymes, potentially decreasing amiodarone exposure.
St. John'S Wort + Norelgestromin And Ethinyl Estradiol— Herbal product that induces CYP3A4 and may decrease plasma concentrations of CHCs and diminish effectiveness or increase…
St. John'S Wort + Norethindrone Acetate, Ethinyl Estradiol And Ferrous Fumarate— CYP3A4 inducer that may decrease the effectiveness of COCs or increase breakthrough bleeding.
St. John'S Wort + Norethindrone And Ethinyl Estradiol— Herbal product that induces CYP3A4 and may decrease plasma concentrations of norethindrone and ethinyl estradiol, potent…
St. John'S Wort + Norgestrel And Ethinyl Estradiol— Herbal product may decrease plasma concentrations and efficacy of contraceptive; may increase breakthrough bleeding.
St. John'S Wort + Paroxetine Hydrochloride— Concomitant use of serotonergic drugs with paroxetine increases the risk of serotonin syndrome. Monitor for symptoms.
St. John'S Wort + Paroxetine Hydrochloride Hemihydrate— Caution advised due to potential for serotonin syndrome when coadministered with paroxetine.
St. John'S Wort + Phenytoin— May decrease phenytoin serum levels; induction potency may vary based on preparation.
St. John'S Wort + Phenytoin Sodium— May decrease phenytoin serum levels; induction potency varies widely based on preparation.
St. John'S Wort + Rapamycin— Weak/moderate CYP3A4/P-gp inducer that may decrease sirolimus concentrations. Monitor and adjust dosage as needed.
St. John'S Wort + Segesterone Acetate And Ethinyl Estradiol— Metabolic enzyme inducer with variable induction potency that may decrease systemic concentrations of estrogen and/or pr…
St. John'S Wort + Sofosbuvir— P-gp inducer that may decrease sofosbuvir plasma concentration, leading to reduced therapeutic effect. Concomitant use n…
St. John'S Wort + Tramadol Hydrochloride— CYP3A4 inducer that may alter tramadol metabolism and exposure.
St. John'S Wort + Ulipristal Acetate— Herbal CYP3A4 inducer decreases plasma concentrations of ulipristal acetate and may decrease its effectiveness as emerge…
St. John'S Wort + Valsartan And Hydrochlorothiazide— CYP3A inducer that may decrease amlodipine efficacy. Blood pressure should be closely monitored when amlodipine is coadm…
St. John'S Wort + Vilazodone Hydrochloride— Serotonergic drug that increases risk of serotonin syndrome; monitor patients for signs and symptoms during initiation.
St. John'S Wort + Vortioxetine— Serotonergic drug that increases risk of serotonin syndrome when used with TRINTELLIX. Monitor for serotonin syndrome sy…

St. John'S Wort + Apixaban⛔Contraindicated

Combined P-gp and strong CYP3A4 inducer that decreases apixaban exposure and increases risk of stroke and thromboembolic events. Avoid concomitant use.

St. John'S Wort + Artemether And Lumefantrine⛔Contraindicated

Strong CYP3A4 inducer contraindicated with artemether and lumefantrine due to potential loss of antimalarial efficacy.

St. John'S Wort + Clozapine⛔Contraindicated

Strong CYP3A4 inducer that decreases clozapine plasma concentration. Concomitant use is not recommended due to decreased clozapine effectiveness.

St. John'S Wort + Doravirine⛔Contraindicated

Co-administration decreases doravirine plasma concentrations. At least a 4-week cessation period is recommended prior to initiation of PIFELTRO.

St. John'S Wort + Doravirine, Lamivudine, And Tenofovir Disoproxil Fumarate⛔Contraindicated

Co-administration decreases doravirine plasma concentrations and is contraindicated. At least a 4-week cessation period is recommended prior to initiation of DELSTRIGO.

St. John'S Wort + Elexacaftor, Tezacaftor, And Ivacaftor⛔Contraindicated

Strong CYP3A inducer (Hypericum perforatum) expected to decrease TRIKAFTA component exposures and reduce efficacy.

St. John'S Wort + Estradiol Valerate And Estradiol Valerate/Dienogest⛔Contraindicated

Strong CYP3A4 inducer. Should not use Estradiol Valerate/Dienogest while taking or for 28 days after discontinuation due to risk of decreased contraceptive efficacy.

St. John'S Wort + Irinotecan Hydrochloride⛔Contraindicated

Strong CYP3A4 inducer substantially reduces exposure to irinotecan and SN-38. Do not administer unless no therapeutic alternatives exist.

St. John'S Wort + Istradefylline⛔Contraindicated

Strong CYP3A4 inducer. Avoid concomitant use with istradefylline.

St. John'S Wort + Ixazomib⛔Contraindicated

Strong CYP3A inducer. Avoid concomitant use with NINLARO (ixazomib).

St. John'S Wort + Lemborexant⛔Contraindicated

Strong CYP3A inducer that decreases lemborexant exposure, which may reduce DAYVIGO efficacy. Concomitant use should be avoided.

St. John'S Wort + Lurasidone Hydrochloride⛔Contraindicated

Strong CYP3A4 inducer that decreases lurasidone exposure; concomitant use is contraindicated.

St. John'S Wort + Ranolazine⛔Contraindicated

CYP3A inducer. Do not use with ranolazine extended-release tablets.

St. John'S Wort + Rivaroxaban⛔Contraindicated

Combined P-gp and strong CYP3A inducer that decreases rivaroxaban exposure and may increase thromboembolic risk. Avoid concomitant use.

St. John'S Wort + Safinamide Mesylate⛔Contraindicated

Serotonergic drug; concomitant use is contraindicated due to risk of serotonin syndrome.

St. John'S Wort + Voriconazole⛔Contraindicated

CYP450 and P-glycoprotein inducer significantly reduces voriconazole plasma exposure.

St. John'S Wort + Aminolevulinic Acid Hydrochloride⚠️Major

Phototoxic agent that may cause severe phototoxic skin reaction (severe sunburn). Avoid for 24 hours before and after ALA administration.

St. John'S Wort + Amiodarone Hydrochloride⚠️Major

CYP450 inducer that reduces amiodarone serum levels.

St. John'S Wort + Amphetamine Sulfate⚠️Major

Serotonergic drug that increases risk of serotonin syndrome when used concomitantly with amphetamine sulfate.

St. John'S Wort + Axitinib⚠️Major

Strong CYP3A4/5 inducer reduces axitinib plasma exposure. Co-administration should be avoided.

St. John'S Wort + Citalopram⚠️Major

Concomitant use increases risk of serotonin syndrome.

St. John'S Wort + Citalopram Hydrobromide⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dosage increases.

St. John'S Wort + Cobimetinib⚠️Major

Strong CYP3A inducer may decrease cobimetinib exposure by >80% and reduce efficacy. Avoid concurrent use.

St. John'S Wort + Desvenlafaxine Succinate⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and consider discontinuation if serotonin syndrome occurs.

St. John'S Wort + Dextroamphetamine⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and discontinue if serotonin syndrome occurs.

St. John'S Wort + Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate⚠️Major

Serotonergic drug that increases risk of serotonin syndrome when combined with amphetamines. Initiate with lower doses and monitor for serotonin syndrome signs.

St. John'S Wort + Dextroamphetamine Sulfate⚠️Major

Serotonergic drug increasing risk of serotonin syndrome with dextroamphetamine sulfate.

St. John'S Wort + Doxorubicin Hydrochloride⚠️Major

CYP3A4 inducer that may decrease doxorubicin concentration and clinical effect.

St. John'S Wort + Erlotinib⚠️Major

CYP3A4 inducer decreases erlotinib exposure. Increase erlotinib dosage if co-administration is unavoidable.

St. John'S Wort + Erlotinib Hydrochloride⚠️Major

CYP3A4 inducer decreases erlotinib exposure. Increase erlotinib dosage if co-administration is unavoidable.

St. John'S Wort + Escitalopram⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dosage increases.

St. John'S Wort + Escitalopram Oxalate⚠️Major

Serotonergic agent that increases risk of serotonin syndrome when combined with escitalopram oxalate.

St. John'S Wort + Exemestane⚠️Major

Strong CYP 3A4 inducer that significantly decreases exemestane exposure. Dose increase to 50 mg recommended.

St. John'S Wort + Fluoxetine⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during treatment initiation and dosage increases.

St. John'S Wort + Fluoxetine Hydrochloride⚠️Major

Concomitant use increases risk of serotonin syndrome; monitor for symptoms.

St. John'S Wort + Fostemsavir Tromethamine⚠️Major

Herbal product that significantly decreases temsavir plasma concentrations, which may lead to loss of virologic response.

St. John'S Wort + Glecaprevir And Pibrentasvir⚠️Major

May significantly decrease plasma concentrations of glecaprevir and pibrentasvir, leading to reduced therapeutic effect. Coadministration is not recommended.

St. John'S Wort + Isotretinoin⚠️Major

Possible interaction with hormonal contraceptives; reports of breakthrough bleeding and pregnancies in users of combined hormonal contraceptives who also used St. John's Wort.

St. John'S Wort + Ivabradine⚠️Major

CYP3A4 inducer that decreases ivabradine plasma concentrations; avoid concomitant use.

St. John'S Wort + Ivacaftor⚠️Major

Strong CYP3A inducer. Co-administration not recommended.

St. John'S Wort + Larotrectinib⚠️Major

Strong CYP3A4 inducer; coadministration may decrease larotrectinib plasma concentrations and decrease efficacy. Avoid coadministration.

St. John'S Wort + Ledipasvir And Sofosbuvir⚠️Major

P-gp inducer that may decrease ledipasvir and sofosbuvir plasma concentrations, leading to reduced therapeutic effect. Use is not recommended.

St. John'S Wort + Levonorgestrel/Ethinyl Estradiol And Ethinyl Estradiol⚠️Major

Induces hepatic enzymes and p-glycoprotein transporter, reducing contraceptive effectiveness and potentially resulting in unscheduled bleeding.

St. John'S Wort + Lumacaftor And Ivacaftor⚠️Major

Strong CYP3A inducer significantly reduces ivacaftor exposure and ORKAMBI therapeutic effectiveness. Co-administration not recommended.

St. John'S Wort + Macimorelin Acetate⚠️Major

Strong CYP3A4 inducer may reduce plasma macimorelin concentrations and lead to false positive test results. Discontinue prior to use.

St. John'S Wort + Maraviroc⚠️Major

Coadministration is not recommended; expected to substantially decrease maraviroc concentrations, leading to suboptimal levels, loss of virologic response, and possible resistance.

St. John'S Wort + Medroxyprogesterone Acetate⚠️Major

CYP3A4 inducer may decrease medroxyprogesterone acetate concentrations and reduce contraceptive efficacy. Effect varies by preparation. Avoid concomitant use or use backup contraception.

St. John'S Wort + Methadone Hydrochloride⚠️Major

CYP3A4, CYP2B6, CYP2C19, and CYP2C9 inducer decreases methadone plasma concentration, resulting in decreased efficacy or withdrawal symptoms.

St. John'S Wort + Milnacipran Hydrochloride⚠️Major

Concomitant use can result in serotonin syndrome. Careful monitoring advised.

St. John'S Wort + Mirtazapine⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dose increases.

St. John'S Wort + Naldemedine⚠️Major

Strong CYP3A inducer causing significant decrease in plasma naldemedine concentrations, which may reduce efficacy.

St. John'S Wort + Naloxegol Oxalate⚠️Major

Strong CYP3A4 inducer that significantly decreases plasma naloxegol concentrations and may decrease efficacy; use is not recommended.

St. John'S Wort + Nifedipine⚠️Major

Strong CYP3A inducer reduces the bioavailability and efficacy of nifedipine; careful consideration needed if co-administered.

St. John'S Wort + Nintedanib⚠️Major

P-gp and CYP3A4 inducer that may decrease nintedanib exposure. Should be avoided due to risk of reduced efficacy.

St. John'S Wort + Norethindrone⚠️Major

May reduce contraceptive effectiveness and cause breakthrough bleeding by inducing hepatic enzymes and p-glycoprotein transporter.

St. John'S Wort + Norethindrone Acetate/Ethinyl Estradiol⚠️Major

St. John's Wort may induce hepatic enzymes and p-glycoprotein transporter, reducing contraceptive effectiveness and increasing breakthrough bleeding.

St. John'S Wort + Norgestimate And Ethinyl Estradiol⚠️Major

May decrease plasma concentrations of COCs and potentially diminish effectiveness or increase breakthrough bleeding.

St. John'S Wort + Omeprazole Magnesium, Amoxicillin And Rifabutin⚠️Major

Strong CYP2C19/CYP3A4 inducer causing decreased exposure of omeprazole. Concomitant use should be avoided.

St. John'S Wort + Palbociclib⚠️Major

Strong CYP3A inducer. Avoid concomitant use with palbociclib.

St. John'S Wort + Paliperidone Palmitate⚠️Major

Strong CYP3A4/P-gp inducer that may decrease paliperidone exposure. Avoid during 3-month dosing interval if possible; consider paliperidone extended-release tablets if necessary.

St. John'S Wort + Paroxetine⚠️Major

Concomitant use increases risk of serotonin syndrome.

St. John'S Wort + Pexidartinib Hydrochloride⚠️Major

Strong CYP3A inducer that decreases pexidartinib concentrations, which may decrease the efficacy of TURALIO. Avoid concomitant use.

St. John'S Wort + Quetiapine⚠️Major

Potent CYP3A4 inducer increases quetiapine clearance; increase quetiapine dose up to 5-fold during chronic use and reduce by 5-fold within 7-14 days of discontinuation.

St. John'S Wort + Quetiapine Fumarate⚠️Major

Strong CYP3A4 inducer that decreases quetiapine exposure; quetiapine dose may need to be increased up to 5 fold.

St. John'S Wort + Regorafenib⚠️Major

Strong CYP3A4 inducer that decreases regorafenib plasma concentrations and may lead to decreased efficacy.

St. John'S Wort + Riociguat⚠️Major

Strong CYP3A inducer may significantly reduce riociguat exposure. Data are not available to guide dosing.

St. John'S Wort + Rydapt⚠️Major

Strong CYP3A4 inducer that decreases midostaurin concentrations and may reduce efficacy. Avoid coadministration. Induction potency varies by preparation.

St. John'S Wort + Sertraline⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms, particularly during initiation and dosage increases.

St. John'S Wort + Sertraline Hydrochloride⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms, particularly during treatment initiation and dosage increases.

St. John'S Wort + Sofosbuvir, Velpatasvir, And Voxilaprevir⚠️Major

P-gp inducer and moderate to strong CYP inducer that may significantly decrease plasma concentrations of sofosbuvir, velpatasvir, and/or voxilaprevir, leading to reduced therapeutic effect.

St. John'S Wort + Tacrolimus⚠️Major

May decrease tacrolimus whole blood trough concentrations and increase risk of rejection. Increase tacrolimus dose and monitor concentrations.

St. John'S Wort + Tacrolimus Extended-Release Capsules⚠️Major

Strong CYP3A inducer may decrease tacrolimus concentrations and increase risk of rejection. Increase tacrolimus dose and monitor concentrations.

St. John'S Wort + Tezacaftor And Ivacaftor⚠️Major

Strong CYP3A inducer (Hypericum perforatum). Co-administration not recommended due to reduced SYMDEKO efficacy.

St. John'S Wort + Toremifene Citrate⚠️Major

Strong CYP3A4 inducer that decreases toremifene steady-state concentration and should be avoided.

St. John'S Wort + Trabectedin⚠️Major

Strong CYP3A inducer. Avoid concomitant use with trabectedin.

St. John'S Wort + Trazodone Hydrochloride⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms during trazodone initiation.

St. John'S Wort + Ubrogepant⚠️Major

Strong CYP3A4 inducer expected to cause loss of ubrogepant efficacy. Concomitant use should be avoided.

St. John'S Wort + Vandetanib⚠️Major

Can decrease vandetanib exposure unpredictably. Avoid concomitant use during CAPRELSA therapy.

St. John'S Wort + Velpatasvir And Sofosbuvir⚠️Major

P-gp and moderate to strong CYP inducer that may decrease concentrations of sofosbuvir and/or velpatasvir, leading to reduced therapeutic effect. Use not recommended.

St. John'S Wort + Venlafaxine⚠️Major

Potential for serotonin syndrome with serotonergic drug St. John's Wort. Careful patient observation advised.

St. John'S Wort + Venlafaxine Hcl Er⚠️Major

Potential for serotonin syndrome when used with serotonergic drugs. Careful patient observation advised.

St. John'S Wort + Venlafaxine Hydrochloride⚠️Major

Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and consider discontinuation if serotonin syndrome occurs.

St. John'S Wort + Vincristine Sulfate⚠️Major

Strong CYP3A inducer that should be avoided during concurrent use with vincristine sulfate.

St. John'S Wort + Ziprasidone⚠️Major

Risk of serotonin syndrome with concomitant therapy with St. John's Wort.

St. John'S Wort + Ziprasidone Hcl⚠️Major

Risk of serotonin syndrome with concomitant serotonergic therapy including St. John's Wort.

St. John'S Wort + Ziprasidone Mesylate⚠️Major

Risk of serotonin syndrome with concomitant serotonergic therapy including St. John's Wort.

St. John'S Wort + Zolpidem Tartrate⚠️Major

CYP3A4 inducer that may decrease effect and efficacy of zolpidem.

St. John'S Wort + Afatinib🟡Moderate

P-glycoprotein inducer that decreases afatinib exposure. Increase GILOTRIF dose by 10 mg per day as tolerated.

St. John'S Wort + Amlodipine And Benazepril Hydrochloride🟡Moderate

CYP3A4 inducer may decrease amlodipine exposure. Blood pressure should be monitored when co-administered.

St. John'S Wort + Amlodipine And Valsartan🟡Moderate

CYP3A inducer that may reduce amlodipine effectiveness. Blood pressure should be closely monitored when coadministered.

St. John'S Wort + Cabozantinib🟡Moderate

St. John's wort may decrease exposure of cabozantinib, reducing efficacy. Avoid coadministration or increase CABOMETYX dosage if unavoidable.

St. John'S Wort + Carisoprodol🟡Moderate

CYP2C19 inducer that could result in decreased carisoprodol exposure and increased meprobamate exposure; full pharmacological impact unknown.

St. John'S Wort + Conjugated Estrogens And Medroxyprogesterone Acetate🟡Moderate

CYP3A4 inducer may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and/or altering uterine bleeding profile.

St. John'S Wort + Conjugated Estrogens/Bazedoxifene🟡Moderate

CYP3A4 inducer may reduce plasma concentrations of estrogens, decreasing therapeutic effects and altering uterine bleeding profile.

St. John'S Wort + Dapsone🟡Moderate

May increase formation of dapsone hydroxylamine, a metabolite associated with hemolysis. Monitor for hemolytic reactions.

St. John'S Wort + Dapsone Gel, 5%🟡Moderate

May increase formation of dapsone hydroxylamine, a metabolite associated with hemolysis.

St. John'S Wort + Desogestrel And Ethinyl Estradiol And Ethinyl Estradiol🟡Moderate

Induces CYP3A4 and may decrease plasma concentrations of desogestrel and ethinyl estradiol, potentially diminishing contraceptive effectiveness and increasing breakthrough bleeding.

St. John'S Wort + Desvenlafaxine🟡Moderate

Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and consider discontinuation if serotonin syndrome occurs.

St. John'S Wort + Desvenlafaxine Er🟡Moderate

Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and consider discontinuation if serotonin syndrome occurs.

St. John'S Wort + Digoxin🟡Moderate

Decreases digoxin concentrations. Requires monitoring and dose adjustment.

St. John'S Wort + Drospirenone🟡Moderate

May decrease systemic concentrations of hormonal contraceptives and diminish effectiveness or increase breakthrough bleeding.

St. John'S Wort + Drospirenone And Ethinyl Estradiol🟡Moderate

Induces CYP3A4 enzyme, may decrease effectiveness of COCs or increase breakthrough bleeding.

St. John'S Wort + Drospirenone, Ethinyl Estradiol And Levomefolate Calcium And Levomefolate Calcium🟡Moderate

May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induction.

St. John'S Wort + Drospirenone/Ethinyl Estradiol/Levomefolate Calcium And Levomefolate Calcium🟡Moderate

Herbal product that may decrease effectiveness of COCs or increase breakthrough bleeding. Use back-up contraception.

St. John'S Wort + Duloxetine🟡Moderate

Concomitant use increases risk of serotonin syndrome. Monitor for symptoms during treatment initiation and dose increases.

St. John'S Wort + Emtricitabine And Tenofovir Alafenamide🟡Moderate

May decrease TAF concentration through P-gp and BCRP induction.

St. John'S Wort + Estradiol🟡Moderate

CYP3A4 inducer that may reduce plasma concentrations of estradiol, possibly decreasing therapeutic effects and altering uterine bleeding profile.

St. John'S Wort + Estradiol Acetate🟡Moderate

CYP3A4 inducer may decrease estradiol acetate plasma concentration, resulting in decreased therapeutic effects and/or changes in uterine bleeding profile.

St. John'S Wort + Estradiol And Levonorgestrel🟡Moderate

CYP3A4 inducer that may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and/or altering uterine bleeding profile.

St. John'S Wort + Estradiol And Norethindrone Acetate🟡Moderate

CYP3A4 inducer that may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and/or altering uterine bleeding profile.

St. John'S Wort + Estradiol And Progesterone🟡Moderate

CYP3A4 inducer may reduce plasma concentrations of estrogens and progestins, possibly decreasing therapeutic effects and altering uterine bleeding profile.

St. John'S Wort + Estradiol Gel 0.1%🟡Moderate

CYP3A4 inducer that may reduce estradiol plasma concentrations, possibly decreasing therapeutic effects and altering uterine bleeding profile.

St. John'S Wort + Estradiol Transdermal🟡Moderate

CYP3A4 inducer that may reduce estradiol plasma concentrations, possibly decreasing therapeutic effects and/or altering uterine bleeding profile.

St. John'S Wort + Estradiol Valerate🟡Moderate

CYP3A4 inducer that may reduce plasma concentrations of estradiol valerate, possibly decreasing therapeutic effects and altering uterine bleeding profile.

St. John'S Wort + Estradiol/Norethindrone Acetate Transdermal System🟡Moderate

CYP3A4 inducer that may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and altering uterine bleeding profile.

St. John'S Wort + Estrogens, Conjugated🟡Moderate

CYP3A4 inducer may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and altering uterine bleeding profile.

St. John'S Wort + Etonogestrel🟡Moderate

May decrease plasma concentrations of etonogestrel and diminish contraceptive effectiveness or increase breakthrough bleeding.

St. John'S Wort + Etonogestrel And Ethinyl Estradiol🟡Moderate

Herbal product that induces CYP3A4 enzyme and may decrease plasma concentrations of etonogestrel and ethinyl estradiol, potentially diminishing contraceptive effectiveness or increasing breakthrough bleeding.

St. John'S Wort + Etonogestrel And Ethinyl Estradiol Vaginal Ring🟡Moderate

Herbal product that induces CYP3A4, may decrease plasma concentrations of CHCs and potentially diminish effectiveness or increase breakthrough bleeding.

St. John'S Wort + Flibanserin🟡Moderate

CYP3A4 inducer; concomitant use may decrease flibanserin exposure and therapeutic effect.

St. John'S Wort + Fosphenytoin Sodium🟡Moderate

May decrease phenytoin serum levels; dose adjustment may be required. Induction potency may vary widely based on preparation.

St. John'S Wort + Ifosfamide🟡Moderate

CYP3A4 inducer may increase metabolism of ifosfamide to active metabolites and increase formation of neurotoxic/nephrotoxic chloroacetaldehyde. Monitor for toxicities and consider dose adjustment.

St. John'S Wort + Imatinib🟡Moderate

CYP3A4 inducer that reduces imatinib AUC by 30%; consider alternative therapeutic agents.

St. John'S Wort + Lasmiditan🟡Moderate

Increased risk of serotonin syndrome when combined with lasmiditan; use with caution.

St. John'S Wort + Levomilnacipran Hydrochloride🟡Moderate

Serotonergic drug that increases risk of serotonin syndrome. Monitor for symptoms and discontinue if serotonin syndrome occurs.

St. John'S Wort + Levonorgestrel And Ethinyl Estradiol And Ethinyl Estradiol Tablets🟡Moderate

St. John's wort induces CYP3A4 and may decrease plasma concentrations of COCs, potentially diminishing contraceptive effectiveness or increasing breakthrough bleeding.

St. John'S Wort + Levonorgestrel And Ethinyl Estradiol And Ferrous Fumarate🟡Moderate

St. John's wort induces CYP3A4 enzymes, potentially decreasing contraceptive effectiveness and increasing breakthrough bleeding.

St. John'S Wort + Mifepristone🟡Moderate

CYP3A4 inducer that may lower mifepristone serum concentrations and reduce efficacy. Verify treatment success through follow-up assessment.

St. John'S Wort + Nateglinide🟡Moderate

CYP inducer that may reduce blood-glucose-lowering effect of nateglinide and increase susceptibility to hyperglycemia.

St. John'S Wort + Nexterone (Amiodarone Hci)🟡Moderate

May induce CYP450 enzymes, potentially decreasing amiodarone exposure.

St. John'S Wort + Norelgestromin And Ethinyl Estradiol🟡Moderate

Herbal product that induces CYP3A4 and may decrease plasma concentrations of CHCs and diminish effectiveness or increase breakthrough bleeding.

St. John'S Wort + Norethindrone Acetate, Ethinyl Estradiol And Ferrous Fumarate🟡Moderate

CYP3A4 inducer that may decrease the effectiveness of COCs or increase breakthrough bleeding.

St. John'S Wort + Norethindrone And Ethinyl Estradiol🟡Moderate

Herbal product that induces CYP3A4 and may decrease plasma concentrations of norethindrone and ethinyl estradiol, potentially diminishing contraceptive effectiveness.

St. John'S Wort + Norgestrel And Ethinyl Estradiol🟡Moderate

Herbal product may decrease plasma concentrations and efficacy of contraceptive; may increase breakthrough bleeding.

St. John'S Wort + Paroxetine Hydrochloride🟡Moderate

Concomitant use of serotonergic drugs with paroxetine increases the risk of serotonin syndrome. Monitor for symptoms.

St. John'S Wort + Paroxetine Hydrochloride Hemihydrate🟡Moderate

Caution advised due to potential for serotonin syndrome when coadministered with paroxetine.

St. John'S Wort + Phenytoin🟡Moderate

May decrease phenytoin serum levels; induction potency may vary based on preparation.

St. John'S Wort + Phenytoin Sodium🟡Moderate

May decrease phenytoin serum levels; induction potency varies widely based on preparation.

St. John'S Wort + Rapamycin🟡Moderate

Weak/moderate CYP3A4/P-gp inducer that may decrease sirolimus concentrations. Monitor and adjust dosage as needed.

St. John'S Wort + Segesterone Acetate And Ethinyl Estradiol🟡Moderate

Metabolic enzyme inducer with variable induction potency that may decrease systemic concentrations of estrogen and/or progestin, potentially diminishing contraceptive effectiveness.

St. John'S Wort + Sofosbuvir🟡Moderate

P-gp inducer that may decrease sofosbuvir plasma concentration, leading to reduced therapeutic effect. Concomitant use not recommended.

St. John'S Wort + Tramadol Hydrochloride🟡Moderate

CYP3A4 inducer that may alter tramadol metabolism and exposure.

St. John'S Wort + Ulipristal Acetate🟡Moderate

Herbal CYP3A4 inducer decreases plasma concentrations of ulipristal acetate and may decrease its effectiveness as emergency contraception.

St. John'S Wort + Valsartan And Hydrochlorothiazide🟡Moderate

CYP3A inducer that may decrease amlodipine efficacy. Blood pressure should be closely monitored when amlodipine is coadministered with St. John's Wort.

St. John'S Wort + Vilazodone Hydrochloride🟡Moderate

Serotonergic drug that increases risk of serotonin syndrome; monitor patients for signs and symptoms during initiation.

St. John'S Wort + Vortioxetine🟡Moderate

Serotonergic drug that increases risk of serotonin syndrome when used with TRINTELLIX. Monitor for serotonin syndrome symptoms.

Data sourced from U.S. FDA drug labeling via openFDA and the NIH National Library of Medicine. For informational purposes only. Always consult your pharmacist or physician.