Drug interactions
Hydrocodone + St john's wort
Severity: Moderate
Hydrocodone and St john's wort: moderate interaction.
Last updated
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 induces CYP3A4 and can lower hydrocodone levels, reducing analgesia, and levels may rebound when it is stopped, risking toxicity. It also has serotonergic activity, giving a theoretical risk of serotonin syndrome.
What this interaction means in plain words
Hydrocodone and St john's wort can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
CYP3A4 induction lowers hydrocodone exposure, with additive serotonergic effects.
What to do
Avoid the combination if possible; if used, monitor pain control and serotonin toxicity, and reduce the opioid dose after discontinuing St John's wort.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Hydrocodone
- Alvimopan + Hydrocodone Contraindicated
- Bupropion-naltrexone + Hydrocodone Contraindicated
- Hydrocodone + Isocarboxazid Contraindicated
- Hydrocodone + Olanzapine / samidorphan Contraindicated
- Hydrocodone + Phenelzine Contraindicated
- Alfentanil + Hydrocodone Major
Frequently asked questions
Can I take Hydrocodone with St john's wort?
MediHelp rates the interaction as moderate. Hydrocodone and St john's wort can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. St John's wort induces CYP3A4 and can lower hydrocodone levels, reducing analgesia, and levels may rebound when it is stopped, risking toxicity. It also has serotonergic activity, giving a theoretical risk of serotonin syndrome.
How serious is the interaction between Hydrocodone and St john's wort?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination if possible; if used, monitor pain control and serotonin toxicity, and reduce the opioid dose after discontinuing St John's wort.
What other medicines interact with Hydrocodone?
MediHelp also lists interactions of Hydrocodone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydrocodone page.
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