MAJOR — Use With Caution
DANGEROUS — serotonin syndrome risk + reduced TCA efficacy
Evidence level: MODERATE
St. Johns Wort can cause serotonin syndrome with amitriptyline and also makes it less effective.
St. Johns Wort has serotonergic activity and induces CYP enzymes. Combined: serotonin syndrome risk + reduced TCA levels (unpredictable).
Do not combine. Stop St. Johns Wort before starting a TCA.
Take Amitriptyline as prescribed. St. Johns Wort can typically be taken with a meal at a different time. As a general rule, space botanicals 1-2 hours from prescription medications. St. John's Wort is the most interaction-prone botanical — it affects dozens of drugs via CYP enzyme induction. Always inform your prescriber about herbal supplements.
Depression, concurrent serotonergic agents
Serotonin syndrome, loss of antidepressant effect, seizure breakthrough
Inform doctor about all herbal supplements.
Discuss safer alternatives with your healthcare provider. They can recommend substitutions based on your specific health goals while minimizing interaction risks. Always bring a complete list of everything you take to your appointments.
St. Johns Wort can cause serotonin syndrome with amitriptyline and also makes it less effective.
Take Amitriptyline as prescribed. St. Johns Wort can typically be taken with a meal at a different time. As a general rule, space botanicals 1-2 hours from prescription medications. St. John's Wort is the most interaction-prone botanical — it affects dozens of drugs via CYP enzyme induction. Always inform your prescriber about herbal supplements.
Serotonin syndrome, loss of antidepressant effect, seizure breakthrough
Discuss safer alternatives with your healthcare provider. They can recommend substitutions based on your specific health goals while minimizing interaction risks. Always bring a complete list of everything you take to your appointments.
Inform doctor about all herbal supplements.
Or browse the full interaction database (121,000+ pairs).