MAJOR — Use With Caution
DANGEROUS — St. Johns Wort makes digoxin less effective
Evidence level: STRONG
St. Johns Wort reduces digoxin levels by up to 35%, which can cause your heart condition to worsen.
St. Johns Wort induces P-glycoprotein (intestinal efflux transporter), reducing digoxin absorption by 25-35%. Can cause subtherapeutic digoxin levels.
Do not take St. Johns Wort while on digoxin. If stopping St. Johns Wort, digoxin levels will rise — inform your doctor.
Take Digoxin 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.
Concurrent use of other P-gp inducers, borderline digoxin levels
Worsening heart failure symptoms (edema, shortness of breath), rapid/irregular heart rate, fatigue
Always inform cardiologist about herbal supplements. Stopping SJW requires digoxin level monitoring.
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 reduces digoxin levels by up to 35%, which can cause your heart condition to worsen.
Take Digoxin 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.
Worsening heart failure symptoms (edema, shortness of breath), rapid/irregular heart rate, fatigue
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.
Always inform cardiologist about herbal supplements. Stopping SJW requires digoxin level monitoring.
Or browse the full interaction database (121,000+ pairs).