Drug interactions
Clomipramine + St john's wort
Severity: Major
Clomipramine and St john's wort: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
St John's wort has serotonergic activity, and combining it with clomipramine increases the risk of serotonin syndrome. It also induces metabolic enzymes and transporters, which may lower clomipramine concentrations and make its effect unpredictable.
What this interaction means in plain words
Clomipramine and St john's wort can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Additive serotonin reuptake inhibition, plus induction of CYP enzymes and P-glycoprotein by hyperforin.
What to do
Avoid the combination and ask patients about herbal use. Stop St John's wort and monitor for serotonin toxicity and for changes in clomipramine response.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Clomipramine
- Arsenic trioxide + Clomipramine Contraindicated
- Clomipramine + Dofetilide Contraindicated
- Clomipramine + Droperidol Contraindicated
- Clomipramine + Isocarboxazid Contraindicated
- Clomipramine + Methylene blue Contraindicated
- Clomipramine + Pentamidine Contraindicated
Frequently asked questions
Can I take Clomipramine with St john's wort?
MediHelp rates the interaction as major. Clomipramine and St john's wort can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. St John's wort has serotonergic activity, and combining it with clomipramine increases the risk of serotonin syndrome. It also induces metabolic enzymes and transporters, which may lower clomipramine concentrations and make its effect unpredictable.
How serious is the interaction between Clomipramine and St john's wort?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination and ask patients about herbal use. Stop St John's wort and monitor for serotonin toxicity and for changes in clomipramine response.
What other medicines interact with Clomipramine?
MediHelp also lists interactions of Clomipramine with, for example, Arsenic trioxide, Dofetilide, Droperidol. The full list is on the Clomipramine page.
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