MAJOR — Use With Caution
DANGEROUS — unpredictable additive enzyme induction
Evidence level: MODERATE
Combining two potent enzyme inducers creates unpredictable drug interactions that could affect seizure control.
Both are CYP3A4 inducers. Additive enzyme induction may cause unpredictable effects on carbamazepine and other drug metabolism.
Avoid combining. St. Johns Wort should not be used with antiepileptic drugs.
Take Carbamazepine at exact consistent times — seizure control depends on stable blood levels. St. Johns Wort can be taken at a separate meal. Some botanicals (evening primrose, borage) may lower seizure threshold. St. John's Wort can dramatically reduce antiepileptic levels via CYP enzyme induction.
Epilepsy, concurrent medications affected by CYP induction
Seizure breakthrough, unpredictable drug levels
Do not use St. Johns Wort with antiepileptics.
Antiepileptic drug levels are sensitive to enzyme inducers and inhibitors. Discuss any changes with your neurologist before adding new substances. Safer supplement options: magnesium, omega-3s, and B vitamins are generally well-tolerated alongside seizure medications.
Combining two potent enzyme inducers creates unpredictable drug interactions that could affect seizure control.
Take Carbamazepine at exact consistent times — seizure control depends on stable blood levels. St. Johns Wort can be taken at a separate meal. Some botanicals (evening primrose, borage) may lower seizure threshold. St. John's Wort can dramatically reduce antiepileptic levels via CYP enzyme induction.
Seizure breakthrough, unpredictable drug levels
Antiepileptic drug levels are sensitive to enzyme inducers and inhibitors. Discuss any changes with your neurologist before adding new substances. Safer supplement options: magnesium, omega-3s, and B vitamins are generally well-tolerated alongside seizure medications.
Do not use St. Johns Wort with antiepileptics.
Or browse the full interaction database (121,000+ pairs).