Some Drug Interactions With St. John's Wort
Affected Drugs | Interaction |
|---|---|
Some antipsychotics (for example, clozapine)Some antipsychotics (for example, clozapine) | St. John's wort may reduce the effectiveness of antipsychotics.St. John's wort may reduce the effectiveness of antipsychotics. |
Benzodiazepines (for example, alprazolam, lorazepam, diazepam)Benzodiazepines (for example, alprazolam, lorazepam, diazepam) | St. John’s wort may reduce the effectiveness of these medications in reducing anxiety and may increase the risk of side effects such as drowsiness. |
ClopidogrelClopidogrel | St. John's wort may increase the levels and effects, increasing bleeding risk.St. John's wort may increase the levels and effects, increasing bleeding risk. |
Cyclosporine and tacrolimusCyclosporine and tacrolimus | St. John’s wort may reduce blood levels of cyclosporine, making it less effective, with potentially dangerous results (such as rejection of an organ transplant).St. John’s wort may reduce blood levels of cyclosporine, making it less effective, with potentially dangerous results (such as rejection of an organ transplant). |
DigoxinDigoxin | St. John’s wort may reduce blood levels of digoxin, making it less effective, with potentially dangerous results.St. John’s wort may reduce blood levels of digoxin, making it less effective, with potentially dangerous results. |
Factor Xa inhibitors (for example, rivaroxaban) used as blood thinnersFactor Xa inhibitors (for example, rivaroxaban) used as blood thinners | St. John’s wort may reduce blood levels of factor Xa inhibitors. |
Imatinib (a cancer chemotherapy agent)Imatinib (a cancer chemotherapy agent) | St. John's wort may reduce the effectiveness of imatinib.St. John's wort may reduce the effectiveness of imatinib. |
Iron | St. John’s wort may reduce iron absorption. |
KetamineKetamine | St. John's wort may decrease the effectiveness of ketamine.St. John's wort may decrease the effectiveness of ketamine. |
Monoamine oxidase inhibitors (MAOIs) | St. John’s wort may intensify the effects of MAOIs, possibly causing very high blood pressure that requires emergency treatment. |
Nonnucleoside reverse transcriptase inhibitors (for example, nevirapine or efavirenz)Nonnucleoside reverse transcriptase inhibitors (for example, nevirapine or efavirenz) | St. John’s wort increases the metabolism of these medications, reducing their effectiveness. |
Oral contraceptives | St. John’s wort increases the metabolism of oral contraceptives, reducing their effectiveness. |
OmeprazoleOmeprazole | St. John’s wort decreases blood levels of omeprazole, reducing its effectiveness.St. John’s wort decreases blood levels of omeprazole, reducing its effectiveness. |
Oxycodone, methadone, and tramadolOxycodone, methadone, and tramadol | St. John's wort may reduce the effectiveness of oxycodone, methadone, and tramadol.St. John's wort may reduce the effectiveness of oxycodone, methadone, and tramadol. |
Phenobarbitol | St. John's wort may decrease the effectiveness of phenobarbitol.St. John's wort may decrease the effectiveness of phenobarbitol. |
PhenytoinPhenytoin | St. John's wort may reduce the effectiveness of phenytoin.St. John's wort may reduce the effectiveness of phenytoin. |
Photosensitizing medications (such as amiodarone, naproxen, sulfonylureas [such as glipizide], and sulfonamide antibiotics)Photosensitizing medications (such as amiodarone, naproxen, sulfonylureas [such as glipizide], and sulfonamide antibiotics) | When taken with these medications, St. John’s wort may increase the risk of sun sensitivity. |
Protease inhibitors (such as indinavir or saquinavir), which are used to treat human immunodeficiency virus (HIV) infectionProtease inhibitors (such as indinavir or saquinavir), which are used to treat human immunodeficiency virus (HIV) infection | St. John’s wort may reduce blood levels of protease inhibitors, making them less effective. |
Selective serotonin reuptake inhibitors (SSRIs, such as fluoxetine, paroxetine, and sertraline)Selective serotonin reuptake inhibitors (SSRIs, such as fluoxetine, paroxetine, and sertraline) | St. John’s wort may intensify the effects of these medications. |
Statins (for example, atorvastatin, lovastatin, and rosuvastatin)Statins (for example, atorvastatin, lovastatin, and rosuvastatin) | St. John's wort may decrease the effectiveness of statins.St. John's wort may decrease the effectiveness of statins. |
Tricyclic antidepressants (for example, desipramine and amitriptyline)Tricyclic antidepressants (for example, desipramine and amitriptyline) | St. John’s wort may increase the effects of these medications. |
WarfarinWarfarin | St. John’s wort may reduce blood levels of warfarin, making it less effective and clot formation more likely.St. John’s wort may reduce blood levels of warfarin, making it less effective and clot formation more likely. |