Drug interactions
Escitalopram + St john's wort
Severity: Major
Escitalopram 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 an SSRI can produce serotonin syndrome. Its induction of CYP enzymes may also change escitalopram concentrations and make the response unpredictable. Symptoms include agitation, tremor, sweating, diarrhea, and hyperthermia.
What this interaction means in plain words
Escitalopram 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, with possible CYP3A4/2C19 induction by St John's wort altering escitalopram exposure.
What to do
Avoid concurrent use and advise patients to stop the herbal product. Monitor for serotonin toxicity symptoms and for loss of antidepressant effect after changes.
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 Escitalopram
- Cisapride + Escitalopram Contraindicated
- Citalopram + Escitalopram Contraindicated
- Escitalopram + Isocarboxazid Contraindicated
- Escitalopram + Methylene blue Contraindicated
- Escitalopram + Phenelzine Contraindicated
- Escitalopram + Pimozide Contraindicated
Frequently asked questions
Can I take Escitalopram with St john's wort?
MediHelp rates the interaction as major. Escitalopram 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 an SSRI can produce serotonin syndrome. Its induction of CYP enzymes may also change escitalopram concentrations and make the response unpredictable. Symptoms include agitation, tremor, sweating, diarrhea, and hyperthermia.
How serious is the interaction between Escitalopram 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 concurrent use and advise patients to stop the herbal product. Monitor for serotonin toxicity symptoms and for loss of antidepressant effect after changes.
What other medicines interact with Escitalopram?
MediHelp also lists interactions of Escitalopram with, for example, Cisapride, Citalopram, Isocarboxazid. The full list is on the Escitalopram page.
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