Meta Information
ID:saint-johns-wort
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/class/cyp3a4-substrates
Target name:
Drugs Metabolized by CYP3A4
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Saint John's Wort is a potent inducer of the CYP3A4 enzyme, which metabolizes approximately 50% of all prescription drugs, leading to reduced efficacy for a vast number of medications.
Actionable advice:
Assume an interaction with any prescription medication; always consult a pharmacist or doctor before combining.
Target id:
/class/p-glycoprotein-substrates
Target name:
Drugs Transported by P-glycoprotein
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Saint John's Wort induces the P-glycoprotein (P-gp) drug efflux pump, increasing the clearance of many drugs and reducing their absorption and effectiveness.
Actionable advice:
Consult a pharmacist to check if your medications are affected by P-glycoprotein induction.
Target id:
/class/serotonergic-agents
Target name:
Serotonergic Medications (SSRIs, SNRIs, TCAs, Triptans)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Combining Saint John's Wort with other serotonergic drugs can lead to an excessive accumulation of serotonin, causing a potentially life-threatening condition called serotonin syndrome.
Actionable advice:
Avoid taking with any other serotonergic medication unless under strict medical supervision.
Target id:
/class/immunosuppressants
Target name:
Immunosuppressants (e.g., Cyclosporine, Tacrolimus)
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Saint John's Wort strongly induces enzymes (CYP3A4) and transporters (P-gp) that break down these drugs, leading to dangerously low levels and risk of organ transplant rejection.
Actionable advice:
Avoid completely; this combination can lead to life-threatening treatment failure.
Target id:
/class/antiretrovirals
Target name:
Antiretroviral Medications (for HIV)
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Saint John's Wort induces CYP3A4, rapidly clearing HIV medications from the body, which can cause treatment failure and viral resistance.
Actionable advice:
Avoid completely; this can render HIV treatment ineffective.
Target id:
/class/estrogens
Target name:
Hormonal Contraceptives (Oral, Patch, Ring)
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
By inducing liver enzymes, Saint John's Wort accelerates the breakdown of contraceptive hormones, significantly increasing the risk of unintended pregnancy.
Actionable advice:
Avoid completely; use a reliable alternative form of contraception.
Target id:
/class/anticoagulants-antiplatelets
Target name:
Anticoagulants (e.g., Warfarin, Rivaroxaban, Apixaban)
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Saint John's Wort induces enzymes (CYP2C9, CYP3A4) and transporters (P-gp) that metabolize anticoagulants, lowering their concentration and increasing the risk of blood clots.
Actionable advice:
Avoid this combination completely due to the high risk of thrombosis.
Target id:
/class/maois
Target name:
Monoamine Oxidase Inhibitors (MAOIs)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
This combination poses a very high risk of severe serotonin syndrome and hypertensive crisis due to additive monoamine oxidase inhibition.
Actionable advice:
This combination is absolutely contraindicated and potentially fatal.
Target id:
/intervention/digoxin
Target name:
Digoxin
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Saint John's Wort induces the P-glycoprotein (P-gp) transporter, which pumps digoxin out of the body, leading to subtherapeutic levels and worsening of heart failure or arrhythmia.
Actionable advice:
Avoid this combination completely as it can lead to loss of cardiac control.
Target id:
/class/chemotherapy-radiation
Target name:
Certain Chemotherapy Agents (e.g., Imatinib, Irinotecan)
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Saint John's Wort induces enzymes that metabolize many chemotherapy drugs, drastically reducing their effectiveness and compromising cancer treatment outcomes.
Actionable advice:
Avoid completely during cancer treatment.
Target id:
/procedure/surgery-anesthesia
Target name:
Surgery with General Anesthesia
Severity:
major
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
120
Hours after target:
null
Description:
Saint John's Wort's widespread effects on drug metabolism and neurotransmitters can interfere with anesthetic agents and blood pressure control during surgery.
Actionable advice:
Discontinue use at least 5 days before any scheduled surgery.
Target id:
/condition/bipolar-disorder
Target name:
Bipolar Disorder
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
The antidepressant effects of Saint John's Wort can trigger a switch from depression to mania or hypomania in individuals with bipolar disorder.
Actionable advice:
Avoid completely if you have a diagnosis of bipolar disorder.
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
The safety of Saint John's Wort during pregnancy has not been established, and its effects on uterine tone are a theoretical concern.
Actionable advice:
Avoid use during pregnancy due to unknown risks to the fetus.
Target id:
/class/photosensitizing-agents
Target name:
Photosensitizing Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Saint John's Wort causes photosensitivity, and taking it with other drugs that do the same (e.g., tetracyclines, thiazides) greatly increases the risk of severe sunburn.
Actionable advice:
Avoid this combination or use extreme caution with sun exposure, including high-SPF sunscreen and protective clothing.
Target id:
/procedure/sun-exposure
Target name:
Direct Sun Exposure / UV Light
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
The compound hypericin in Saint John's Wort makes the skin more sensitive to UV light, increasing the risk of sunburn, sometimes severely.
Actionable advice:
Minimize sun exposure and use broad-spectrum sunscreen and protective clothing while taking this supplement.
Target id:
/class/statins
Target name:
Statins (especially Simvastatin, Atorvastatin)
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Saint John's Wort increases the metabolism of many statins via CYP3A4 induction, which can reduce their cholesterol-lowering effects.
Actionable advice:
Avoid this combination or discuss using a statin less affected by CYP3A4 (e.g., pravastatin, rosuvastatin) with your doctor.
Target id:
/class/benzodiazepines
Target name:
Benzodiazepines (e.g., Alprazolam, Midazolam)
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
The induction of CYP3A4 by Saint John's Wort can speed up the breakdown of certain benzodiazepines, reducing their sedative and anti-anxiety effects.
Actionable advice:
Avoid this combination as it may lead to reduced efficacy of the benzodiazepine.
Target id:
/class/calcium-channel-blockers
Target name:
Calcium Channel Blockers (e.g., Nifedipine, Verapamil)
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Saint John's Wort can decrease the effectiveness of these blood pressure and heart medications by accelerating their metabolism through CYP3A4 induction.
Actionable advice:
Avoid this combination to ensure proper control of blood pressure or heart conditions.
Target id:
/intervention/tramadol
Target name:
Tramadol
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Both substances have serotonergic properties, and their combination increases the risk of serotonin syndrome. SJW may also reduce tramadol's analgesic effect.
Actionable advice:
Avoid this combination due to the increased risk of serotonin syndrome.
Target id:
/intervention/dextromethorphan
Target name:
Dextromethorphan (Cough Suppressant)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
This combination can increase the risk of serotonin syndrome due to the additive serotonergic effects of both substances.
Actionable advice:
Avoid using dextromethorphan-containing cough and cold products while taking Saint John's Wort.
Target id:
/intervention/sam-e
Target name:
SAM-e (S-adenosylmethionine)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Both supplements have serotonergic properties, and combining them may increase the risk of developing serotonin syndrome.
Actionable advice:
Avoid combining these two supplements unless directed by a healthcare professional.
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Components of Saint John's Wort can pass into breast milk and may cause adverse effects like drowsiness or colic in the nursing infant.
Actionable advice:
Avoid use while breastfeeding due to potential risks to the infant.
Target id:
/class/tyramine-rich-foods
Target name:
Tyramine-Rich Foods
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Due to its weak MAO-inhibiting properties, there is a theoretical risk of a hypertensive reaction when consuming large amounts of tyramine-rich foods (e.g., aged cheeses, cured meats).
Actionable advice:
Be mindful of consuming large quantities of aged, fermented, or cured foods, although the clinical risk is low.