Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Some products that may interact with this product include: drugs used to prevent organ rejection (such as cyclosporine, sirolimus, tacrolimus), drugs used to treat cancer (such as cyclophosphamide, irinotecan, tamoxifen), heart medications (including digoxin, beta blockers such as metoprolol, calcium channel blockers such as diltiazem), anti-seizure drugs (such as carbamazepine, phenytoin, phenobarbital), tricyclic antidepressants (such as amitriptyline, nortriptyline), sympathomimetic drugs (such as albuterol, phenylephrine), drugs used to treat HIV infection (including cobicistat, elvitegravir, protease inhibitors such as indinavir/nelfinavir/ritonavir, certain NNRTIs such as delavirdine/nevirapine/etravirine, entry inhibitors such as maraviroc), drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, "blood thinners" such as warfarin and heparin, NSAIDs such as ibuprofen).
Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.
The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.
Aspirin can increase the risk of bleeding when used with this product. If your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81-325 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Discuss the risks and benefits with your doctor.
This product may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Discuss with your doctor or pharmacist if you should use additional reliable birth control methods while using this product. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.
The interactions listed above are not a complete listing of all possible drug interactions. St. John's wort can interact with many medications and products. It may also speed up the removal of other medications from your body, which may affect how they work.
Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.