St. John'S Wort + ClozapineContraindicated
Strong CYP3A4 inducer that decreases clozapine plasma concentration. Concomitant use is not recommended due to decreased clozapine effectiveness.
Source: NLP:clozapine
St. John'S Wort Interactions
96 interactions on record
St. John'S Wort + DoravirineContraindicated
Co-administration decreases doravirine plasma concentrations. At least a 4-week cessation period is recommended prior to initiation of PIFELTRO.
Source: NLP:doravirine
St. John'S Wort + Elexacaftor, Tezacaftor, And IvacaftorContraindicated
Strong CYP3A inducer (Hypericum perforatum) expected to decrease TRIKAFTA component exposures and reduce efficacy.
Source: NLP:elexacaftor, tezacaftor, and ivacaftor
St. John'S Wort + Irinotecan HydrochlorideContraindicated
Strong CYP3A4 inducer substantially reduces exposure to irinotecan and SN-38. Do not administer unless no therapeutic alternatives exist.
Source: NLP:irinotecan hydrochloride
St. John'S Wort + IstradefyllineContraindicated
Strong CYP3A4 inducer. Avoid concomitant use with istradefylline.
Source: NLP:istradefylline
St. John'S Wort + Lurasidone HydrochlorideContraindicated
Strong CYP3A4 inducer that decreases lurasidone exposure; concomitant use is contraindicated.
Source: NLP:lurasidone hydrochloride
St. John'S Wort + RanolazineContraindicated
CYP3A inducer. Do not use with ranolazine extended-release tablets.
Source: NLP:ranolazine
St. John'S Wort + RivaroxabanContraindicated
Combined P-gp and strong CYP3A inducer that decreases rivaroxaban exposure and may increase thromboembolic risk. Avoid concomitant use.
Source: NLP:rivaroxaban
St. John'S Wort + Safinamide MesylateContraindicated
Serotonergic drug; concomitant use is contraindicated due to risk of serotonin syndrome.
Source: NLP:safinamide mesylate
St. John'S Wort + VoriconazoleContraindicated
CYP450 and P-glycoprotein inducer significantly reduces voriconazole plasma exposure.
Source: NLP:voriconazole
Combined P-gp and strong CYP3A4 inducer that decreases apixaban exposure and increases risk of stroke and thromboembolic events. Avoid concomitant use.
Source: NLP:apixaban
Strong CYP3A4/5 inducer reduces axitinib plasma exposure. Co-administration should be avoided.
Source: NLP:axitinib
Concomitant use increases risk of serotonin syndrome.
Source: NLP:citalopram
Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dosage increases.
Source: NLP:citalopram hydrobromide
Strong CYP3A inducer may decrease cobimetinib exposure by >80% and reduce efficacy. Avoid concurrent use.
Source: NLP:cobimetinib
Serotonergic drug that increases risk of serotonin syndrome when combined with amphetamines. Initiate with lower doses and monitor for serotonin syndrome signs.
Source: NLP:dextroamphetamine saccharate, amphetamine aspartate monohydrate, dextroamphetamine sulfate, and amphetamine sulfate
Serotonergic drug increasing risk of serotonin syndrome with dextroamphetamine sulfate.
Source: NLP:dextroamphetamine sulfate
CYP3A4 inducer that may decrease doxorubicin concentration and clinical effect.
Source: NLP:doxorubicin hydrochloride
CYP3A4 inducer decreases erlotinib exposure. Increase erlotinib dosage if co-administration is unavoidable.
Source: NLP:erlotinib
Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dosage increases.
Source: NLP:escitalopram
Serotonergic agent that increases risk of serotonin syndrome when combined with escitalopram oxalate.
Source: NLP:escitalopram oxalate
Strong CYP 3A4 inducer that significantly decreases exemestane exposure. Dose increase to 50 mg recommended.
Source: NLP:exemestane
Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during treatment initiation and dosage increases.
Source: NLP:fluoxetine
Concomitant use increases risk of serotonin syndrome; monitor for symptoms.
Source: NLP:fluoxetine hydrochloride
Possible interaction with hormonal contraceptives; reports of breakthrough bleeding and pregnancies in users of combined hormonal contraceptives who also used St. John's Wort.
Source: NLP:isotretinoin
Strong CYP3A4 inducer may reduce plasma macimorelin concentrations and lead to false positive test results. Discontinue prior to use.
Source: NLP:macimorelin acetate
Coadministration is not recommended; expected to substantially decrease maraviroc concentrations, leading to suboptimal levels, loss of virologic response, and possible resistance.
Source: NLP:maraviroc
CYP3A4, CYP2B6, CYP2C19, and CYP2C9 inducer decreases methadone plasma concentration, resulting in decreased efficacy or withdrawal symptoms.
Source: NLP:methadone hydrochloride
Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dose increases.
Source: NLP:mirtazapine
Strong CYP3A inducer causing significant decrease in plasma naldemedine concentrations, which may reduce efficacy.
Source: NLP:naldemedine
Strong CYP3A inducer reduces the bioavailability and efficacy of nifedipine; careful consideration needed if co-administered.
Source: NLP:nifedipine
May reduce contraceptive effectiveness and cause breakthrough bleeding by inducing hepatic enzymes and p-glycoprotein transporter.
Source: NLP:norethindrone
St. John's Wort may induce hepatic enzymes and p-glycoprotein transporter, reducing contraceptive effectiveness and increasing breakthrough bleeding.
Source: NLP:norethindrone acetate and ethinyl estradiol
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.
Source: NLP:paliperidone palmitate
Concomitant use increases risk of serotonin syndrome.
Source: NLP:paroxetine
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.
Source: NLP:quetiapine
Strong CYP3A4 inducer that decreases quetiapine exposure; quetiapine dose may need to be increased up to 5 fold.
Source: NLP:quetiapine fumarate
Strong CYP3A inducer may significantly reduce riociguat exposure. Data are not available to guide dosing.
Source: NLP:riociguat
Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms, particularly during initiation and dosage increases.
Source: NLP:sertraline
Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms, particularly during treatment initiation and dosage increases.
Source: NLP:sertraline hydrochloride
May decrease tacrolimus whole blood trough concentrations and increase risk of rejection. Increase tacrolimus dose and monitor concentrations.
Source: NLP:tacrolimus
Strong CYP3A inducer (Hypericum perforatum). Co-administration not recommended due to reduced SYMDEKO efficacy.
Source: NLP:tezacaftor and ivacaftor
Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms during trazodone initiation.
Source: NLP:trazodone hydrochloride
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.
Source: NLP:velpatasvir and sofosbuvir
Potential for serotonin syndrome with serotonergic drug St. John's Wort. Careful patient observation advised.
Source: NLP:venlafaxine
Potential for serotonin syndrome when used with serotonergic drugs. Careful patient observation advised.
Source: NLP:venlafaxine hydrochloride, extended release
Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and consider discontinuation if serotonin syndrome occurs.
Source: NLP:venlafaxine hydrochloride
Strong CYP3A inducer that should be avoided during concurrent use with vincristine sulfate.
Source: NLP:vincristine sulfate
Risk of serotonin syndrome with concomitant therapy with St. John's Wort.
Source: NLP:ziprasidone
Risk of serotonin syndrome with concomitant serotonergic therapy including St. John's Wort.
Source: NLP:ziprasidone hydrochloride
Risk of serotonin syndrome with concomitant serotonergic therapy including St. John's Wort.
Source: NLP:ziprasidone mesylate
CYP3A4 inducer that may decrease effect and efficacy of zolpidem.
Source: NLP:zolpidem tartrate
Concomitant use may enhance phototoxic reaction to photodynamic therapy.
Source: NLP:aminolevulinic acid hydrochloride
CYP450 inducer. Reduces amiodarone serum levels.
Source: NLP:amiodarone hydrochloride
CYP3A4 inducer may decrease amlodipine exposure. Blood pressure should be monitored when co-administered.
Source: NLP:amlodipine besylate and benazepril hydrochloride
CYP3A inducer that may reduce amlodipine effectiveness. Blood pressure should be closely monitored when coadministered.
Source: NLP:amlodipine and valsartan
St. John'S Wort + CabozantinibModerate
St. John's wort may decrease exposure of cabozantinib, reducing efficacy. Avoid coadministration or increase CABOMETYX dosage if unavoidable.
Source: NLP:cabozantinib
CYP3A4 inducer may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and/or altering uterine bleeding profile.
Source: NLP:conjugated estrogens and medroxyprogesterone acetate
St. John'S Wort + DapsoneModerate
May increase formation of dapsone hydroxylamine, a metabolite associated with hemolysis. Monitor for hemolytic reactions.
Source: NLP:dapsone
Induces CYP3A4 and may decrease plasma concentrations of desogestrel and ethinyl estradiol, potentially diminishing contraceptive effectiveness and increasing breakthrough bleeding.
Source: NLP:desogestrel and ethinyl estradiol
St. John'S Wort + DesvenlafaxineModerate
Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and consider discontinuation if serotonin syndrome occurs.
Source: NLP:desvenlafaxine
Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and consider discontinuation if serotonin syndrome occurs.
Source: NLP:desvenlafaxine er
Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and consider discontinuation if serotonin syndrome occurs.
Source: NLP:desvenlafaxine succinate
St. John'S Wort + DigoxinModerate
Decreases digoxin concentrations. Requires monitoring and dose adjustment.
Source: NLP:digoxin
Induces CYP3A4 enzyme, may decrease effectiveness of COCs or increase breakthrough bleeding.
Source: NLP:drospirenone and ethinyl estradiol
St. John'S Wort + Drospirenone, Ethinyl Estradiol And Levomefolate Calcium And Levomefolate CalciumModerate
May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induction.
Source: NLP:drospirenone, ethinyl estradiol and levomefolate calcium and levomefolate calcium
St. John'S Wort + Drospirenone/Ethinyl Estradiol/Levomefolate Calcium And Levomefolate CalciumModerate
Herbal product that may decrease effectiveness of COCs or increase breakthrough bleeding. Use back-up contraception.
Source: NLP:drospirenone/ethinyl estradiol/levomefolate calcium and levomefolate calcium
St. John'S Wort + EstradiolModerate
CYP3A4 inducer that may reduce plasma concentrations of estradiol, possibly decreasing therapeutic effects and altering uterine bleeding profile.
Source: NLP:estradiol
CYP3A4 inducer that may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and/or altering uterine bleeding profile.
Source: NLP:estradiol and norethindrone acetate
CYP3A4 inducer may reduce plasma concentrations of estrogens and progestins, possibly decreasing therapeutic effects and altering uterine bleeding profile.
Source: NLP:estradiol and progesterone
CYP3A4 inducer may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and altering uterine bleeding profile.
Source: NLP:estrogens, conjugated
St. John'S Wort + EtonogestrelModerate
May decrease plasma concentrations of etonogestrel and diminish contraceptive effectiveness or increase breakthrough bleeding.
Source: NLP:etonogestrel
Herbal product that induces CYP3A4 enzyme and may decrease plasma concentrations of etonogestrel and ethinyl estradiol, potentially diminishing contraceptive effectiveness or increasing breakthrough bleeding.
Source: NLP:etonogestrel and ethinyl estradiol
May decrease phenytoin serum levels; dose adjustment may be required. Induction potency may vary widely based on preparation.
Source: NLP:fosphenytoin sodium
St. John'S Wort + ImatinibModerate
CYP3A4 inducer that reduces imatinib AUC by 30%; consider alternative therapeutic agents.
Source: NLP:imatinib
St. John'S Wort + IvabradineModerate
CYP3A4 inducer that decreases ivabradine plasma concentrations. Avoid concomitant use.
Source: NLP:ivabradine
St. John'S Wort + LasmiditanModerate
Increased risk of serotonin syndrome when combined with lasmiditan; use with caution.
Source: NLP:lasmiditan
Serotonergic drug that increases risk of serotonin syndrome. Monitor for symptoms and discontinue if serotonin syndrome occurs.
Source: NLP:levomilnacipran hydrochloride
St. John's wort induces CYP3A4 and may decrease plasma concentrations of COCs, potentially diminishing contraceptive effectiveness or increasing breakthrough bleeding.
Source: NLP:levonorgestrel and ethinyl estradiol and ferrous bisglycinate
St. John's wort induces CYP3A4 enzymes, potentially decreasing contraceptive effectiveness and increasing breakthrough bleeding.
Source: NLP:norethindrone and ethinyl estradiol and ferrous fumarate
Herbal enzyme inducer that may decrease plasma concentrations of contraceptive hormones and reduce effectiveness of hormonal contraceptives or increase breakthrough bleeding.
Source: NLP:levonorgestrel / ethinyl estradiol and ethinyl estradiol
May decrease effectiveness of medroxyprogesterone acetate through enzyme induction. Counsel use of back-up or alternative contraception.
Source: NLP:medroxyprogesterone acetate
St. John'S Wort + NateglinideModerate
CYP inducer that may reduce blood-glucose-lowering effect of nateglinide and increase susceptibility to hyperglycemia.
Source: NLP:nateglinide
May induce CYP450 enzymes, potentially decreasing amiodarone exposure.
Source: NLP:nexterone (amiodarone hci)
St. John'S Wort + NintedanibModerate
P-gp and CYP3A4 inducer that may decrease nintedanib exposure. Concomitant use should be avoided.
Source: NLP:nintedanib
Herbal product that induces CYP3A4 and may decrease plasma concentrations of CHCs and diminish effectiveness or increase breakthrough bleeding.
Source: NLP:norelgestromin and ethinyl estradiol
CYP3A4 inducer that may decrease the effectiveness of COCs or increase breakthrough bleeding.
Source: NLP:norethindrone acetate and ethinyl estradiol, and ferrous fumarate
Herbal product that induces CYP3A4 and may decrease plasma concentrations of norethindrone and ethinyl estradiol, potentially diminishing contraceptive effectiveness.
Source: NLP:norethindrone and ethinyl estradiol
Herbal product that induces CYP3A4 and may decrease plasma concentrations of COCs and potentially diminish contraceptive effectiveness or increase breakthrough bleeding.
Source: NLP:norgestimate and ethinyl estradiol
Concomitant use of serotonergic drugs with paroxetine increases the risk of serotonin syndrome. Monitor for symptoms.
Source: NLP:paroxetine hydrochloride
Caution advised due to potential for serotonin syndrome when coadministered with paroxetine.
Source: NLP:paroxetine hydrochloride hemihydrate
May decrease phenytoin serum levels; induction potency varies widely based on preparation.
Source: NLP:extended phenytoin sodium
St. John'S Wort + RapamycinModerate
Weak/moderate CYP3A4/P-gp inducer that may decrease sirolimus concentrations. Monitor and adjust dosage as needed.
Source: NLP:sirolimus
CYP3A inducer that may decrease amlodipine efficacy. Blood pressure should be closely monitored when amlodipine is coadministered with St. John's Wort.
Source: NLP:amlodipine besylate valsartan hydrochlorothiazide
Serotonergic drug that increases risk of serotonin syndrome; monitor patients for signs and symptoms during initiation.
Source: NLP:vilazodone hydrochloride
CYP2C19 inducer that could decrease carisoprodol exposure and increase meprobamate exposure. Full pharmacological impact is unknown.
Source: NLP:carisoprodol