This could result in serotonin syndrome. Consider therapy modification.Russo 2014, Metaxalone: Metaxalone may enhance the serotonergic effect of serotonin modulators. Avoid combination.Xarelto July 2011, Romidepsin: St. John's wort may decrease the serum concentration of romidepsin. Avoid combination.Goey 2014, Dolutegravir: St. John's wort may decrease the serum concentration of dolutegravir. Improved glucose response may occur that has been shown to result from an acute increase in insulin response, which is independent of the glucose-lowering action of metformin.Stage 2015, Methadone: St. John's wort may decrease the serum concentration of methadone. Consider therapy modification.Tradjenta May 2011, Linezolid: Linezolid may enhance the serotonergic effect of serotonin modulators. Avoid combination.Iclusig December 2012, Porfimer: Photosensitizing agents may enhance the photosensitizing effect of porfimer. St. John's wort is a perennial plant native to Europe but found throughout the United States and parts of Canada. Consider therapy modification.Supect 2014, Ranolazine: St. John's wort may decrease the serum concentration of ranolazine. Avoid combination.Dirix 2016, Lynparza January 2018, Omeprazole: St. John's wort may decrease the serum concentration of omeprazole. Scientific Name(s): Hypericum perforatum L.Common Name(s): Amber touch-and-heal, Esbericum, Goatweed, Gol-raei, Hofariqoun, Hyperforat, Hyperiforce, John's wort, Kira, Klamath weed, LI 160, Millepertuis, Neuroplant, Psychotonin, Rosin rose, Sedariston, St John's wort, St. John's wort, STEI 300, WS 5573, Ze 117. Avoid combination.Reyataz June 2014, Axitinib: St. John's wort may decrease the serum concentration of axitinib. The American Psychiatric Association practice guideline for the treatment of patients with MDD recognizes that while modest evidence supports the use of St. John's wort, data are conflicting and insufficient to make a recommendation for its use in the treatment of MDD. Potential adverse reactions include GI symptoms (eg, dry mouth, dizziness, constipation) and confusion. Medically reviewed by Drugs.com. Although it fell into disuse for a time, a renewed interest, especially in Western countries, has led to use as a component of numerous preparations for treating anxiety and depression. It grows to be 50-100 cm tall.. St. John's wort … Avoid combination.Venclexta April 2016, Verapamil: St. John's wort may decrease the serum concentration of verapamil. St John's wort may decrease the serum concentration of irinotecan products. Serious adverse effects could occur if the two drugs are taken together. Avoid combination.Harvoni November 2015, Sovaldi December 2013, Sonidegib: CYP3A4 inducers (moderate) may decrease the serum concentration of sonidegib. Specifically, meprobamate concentrations may be increased. Subsequently, AST and ALT levels were also decreased. Further quality studies are needed with larger numbers of subjects. This could result in serotonin syndrome. Research has also looked at the use of St. John’s wort for: Further evidence is needed to confirm its effectiveness. Insulin disposition indices suggest that St. John's wort reduces glucose-stimulated insulin secretion during the oral glucose tolerance test.Stage 2016, Limited information on genotoxicity exists. Hyperforin appears to be the specific receptor ligand and it is hyperforin content, not hypericin, that seems to most consistently determine the extent of the drug interaction, with 1 mg/day suggested as the critical cut-off dose for clinically significant interactions.Chrubasik-Hausmann 2018, Kummer 2016, Pereira 2013 UGT isozyme induction is also mediated by PXR, so drugs metabolized by UGT have the potential to be affected by St. John's wort. Read on to discover their benefits, how to use them, and a list of CBD balms to consider trying. Additionally, bioactivities of some compounds were dependent on light, whereas others were light independent. Here, we describe changes to the diet that…, © 2004-2021 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. Monitor therapy.Albermann 2005, Callaghan 2008, Gurley 2008, Ho 2005, Kim 2002, Kivistö 2004, Leslie 2005, Mueller 2004, Teng 2008, Pimavanserin: St. John's wort may decrease the serum concentration of pimavanserin. Avoid combination.Eurartesim September 2017, Pitolisant: St. John's wort may decrease the serum concentration of pitolisant. Avoid combination.de Jong 2015, de Zwart 2016, Imbruvica August 2017, Ibuprofen: St. John's wort may decrease the serum concentration of ibuprofen. Monitor therapy.Chopra 2004, Duggal 2005, Fisher 2002, Gambassi 2006, Karki 2003, Kaufman 2006, Kim 2007, Kohen 2007, Kontaxakis 2003, Kontaxakis 2003, Marlowe 2006, Matsumoto 2005, Stevens 2008, Verre 2008, Apixaban: St. John's wort may decrease the serum concentration of apixaban. Statins are a medical treatment for high cholesterol, while fish oil is a dietary supplement. Platelet response improved significantly when measured as P2Y12 reaction units to clopidogrel but not when measured as thrombin receptor activating peptide units to thrombin receptor activating peptide or as aspirin reaction units or arachidonic acid units to aspirin, which indicated a selective interaction of St. John's wort with the clopidogrel pathway.Trana 2013, A case of reduced hyperbilirubinemia, decreased fatigue, and improved quality of life has been reported in a patient with congenital Crigler-Najjar syndrome type II. Other possible rare adverse reactions include induction of mania and effects on male and female reproductive capabilities. The popular herbal therapy is often used to ease symptoms of depression. Inositol. Penetration of the blood-brain barrier is similarly low with only about 5% of hypericin likely to reach the brain; hypericin's half-life in the brain appears to be a few weeks.Russo 2014 Time to peak plasma levels (Cmax) ranges from 30 minutes to 3 hours for pseudohypericin, from 4.6 to 8.1 hours for hypericin, and about 2.8 to 3.6 hours for hyperforin after single doses of St. John's wort (range, 300 to 1,800 mg [approximately 0.3% of hypericins]).Hammer 2014, Russo 2014 Steady-state levels of hypericin are reached at 4 days, with a prolonged plasma half-life of about 25 hours due to hypericin's high affinity for albumin and lipoprotein. Avoid combination.Afinitor October 2010, Zortress March 2010, Exemestane: St. John's wort may decrease the serum concentration of exemestane. Monitor therapy.Alacare March 2015, Ameluz May 2016, Drucker 2011, Ladner 2001, Lankerani 2004, Levulan March 2010, Naldi 1999, Ambrisentan: St. John's wort may decrease the serum concentration of ambrisentan. Tolnaftate is a synthetic thiocarbamate used as an anti-fungal agent that may be sold without medical prescription in most jurisdictions. Avoid combination.Xalkori August 2011, Cyclosporine (systemic): St. John's wort may decrease the serum concentration of cyclosporine (systemic); cases of organ rejection have been documented. Avoid combination.Martin 2011, Vandetanib April 2011, Velpatasvir: CYP3A4 inducers (moderate) may decrease the serum concentration of velpatasvir. Summary. Avoid combination.Dooley 2012, Sirturo May 2015, Svensson 2013, Benzodiazepines (metabolized by oxidation): St. John's wort may increase the metabolism of benzodiazepines (metabolized by oxidation). Invertase. Specifically, concentrations of the active monomethyl auristatin E (MMAE) component may be decreased. St John's wort may decrease the serum concentration of quetiapine. Avoid combination.Daklinza July 2015, Dapoxetine: Dapoxetine may enhance the adverse/toxic effect of serotonin modulators. St John's wort may decrease the serum concentration of CYP3A4 substrates. It can be taken by mouth or applied as a cream to the skin or in the vagina.. Common side effects when taken by mouth include nausea and itchiness. Monitor therapy.Lilja 2004, Selectol July 2017, Ceritinib: St. John's wort may decrease the serum concentration of ceritinib. Some studies have reported insignificant pharmacokinetic drug interactions with natural products. Avoid combination.Machiels 2014, Yondelis July 2014, Tricyclic antidepressants: St. John's wort may increase the metabolism and decrease the serum concentration of tricyclic antidepressants. Antipsychotic agents may enhance the serotonergic effect of serotonin modulators. Monitor therapy.Ishii 2008, Metadate February 2017, Park 2010, Turkoglu 2015, Metoclopramide: Serotonin modulators may enhance the adverse/toxic effect of metoclopramide. Patients should be cautioned on the potential for interactions and consult their health care provider before taking St. John's wort with prescription or nonprescription drugs. However, not all research was consistently reliable. Avoid combination.Prilosec June 2011, Wang 2004, Opioid analgesics: Opioid analgesics may enhance the serotonergic effect of serotonin modulators. In addition to the overall improvement in hot flushes, hot flush severity, duration, and frequency also improved significantly (P<0.0001 each). Avoid combination.Ofev October 2014, Nisoldipine: CYP3A4 inducers (moderate) may decrease the serum concentration of nisoldipine. Depressive disorder: For the treatment of mild-to-moderate major depression, short-term studies, lasting up to 12 weeks, indicate that the herb is more effective than a placebo and as equally effective as tricyclic antidepressants TCAs in treating depression. This can lead to a hazardous increase in serotonin in the body. Monitor therapy.Bosak 2014, Martini 2015, Skelaxin March 2018, Surmaitis 2015, Metformin: St John's wort may decrease the renal clearance of metformin. Avoid combination.Ixempra May 2010, Ketamine (oral): St. John's wort may decrease the serum concentration of ketamine (oral). Avoid combination.Bosulif September 2012, Brentuximab vedotin: P-gp/ABCB1 Inducers may decrease the serum concentration of brentuximab vedotin. During phase 1, a St. John's wort 300 mg standardized extract was taken daily. Iris versicolor (Blue Flag) Iron. Data sources include IBM Watson Micromedex (updated 2 Feb 2021), Cerner Multum™ (updated 3 Feb 2021), ASHP (updated 29 Jan 2021) and others. Learn more about how it works and the safety…, Certain foods and supplements may improve or worsen symptoms of hypothyroidism, or an underactive thyroid. In a small, open-label, randomized clinical trial (N=23), known clopidogrel nonresponders were randomized 2:1 to receive St. John's wort 300 mg 3 times daily or placebo, in addition to dual antiplatelet therapy (aspirin 80 mg and clopidogrel 75 mg), for 2 weeks after PCI. Avoid combination.Rengelshausen 2005, Vfend March 2008. Hyperforin. Avoid combination.Kalydeco January 2012, Ixazomib: St John's wort may decrease the serum concentration of ixazomib. It also appears to have antibacterial properties and may act as an antiviral agent. Atopic dermatitis: A study of the effectiveness of hypericum cream has suggested that mild to moderate atopic dermatitis may respond positively to topical treatment. Avoid combination.Zepatier January 2016, Eliglustat: St. John's wort may decrease the serum concentration of eliglustat. The development of serotonin syndrome may occur. Limited data are available for several other areas of therapeutic use. Avoid combination.Samsca February 2012, Shoaf 2012, Trabectedin: St. John's wort may decrease the serum concentration of trabectedin. Avoid combination.Cometriq December 2012, Canagliflozin: St. John's wort may decrease the serum concentration of canagliflozin.Invokana May 2014, Cannabis: St. John's wort may decrease the serum concentration of cannabis.Sativex February 2014, Watanabe 2007, Cardiac glycosides: St. John's wort may decrease the serum concentration of cardiac glycosides. This could result in serotonin syndrome. Avoid combination.Movantik September 2014, Neratinib: CYP3A4 inducers (moderate) may decrease the serum concentration of neratinib. Meta-analyses of quality clinical trials support a place for St. John's wort in the treatment of depression as mono- or adjunctive therapy. Monitor therapy.Chrubasik-Hausmann 2018, Markowitz 2000, Markowitz 2003, Bictegravir: St. John's wort may decrease the serum concentration of bictegravir. Researchers cautioned, however, that the evidence was flawed by a lack of research into the use of the therapy for severe depression and poor reporting of adverse events. St. John's wort, particularly hyperforin, has been shown in vitro and in vivo to inhibit monoamine oxidase type A (MAO-A) and MAO-B as well as the reuptake of norepinephrine, dopamine, and serotonin. Clinical studies have also reported induction of CYP2E1. Origin: The yellow flower, leaves and stem of the St. John’s wort plant, is native to Europe and grows wild in the U.S. Claims: Acts as an antidepressant drug and reduces inflammation and pain. Hydrogen peroxide is a common ingredient in many at-home and commercial teeth whitening solutions. This could result in serotonin syndrome. A 2016 review of studies concluded that St. John’s wort is better than a placebo in treating mild or moderate depression. 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