Drug interactions
Maprotiline + St john's wort
Severity: Major
Maprotiline and St john's wort: major 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 has serotonergic activity, and combining it with maprotiline may increase the risk of serotonin syndrome. It also induces CYP enzymes and P-glycoprotein, which may reduce maprotiline levels and efficacy.
What this interaction means in plain words
Maprotiline 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 serotonergic and monoamine reuptake effects, plus enzyme induction by St John's wort.
What to do
Avoid concurrent use and advise patients to stop the herbal product. Monitor for serotonin toxicity and for loss of antidepressant effect.
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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Other interactions of Maprotiline
- Arsenic trioxide + Maprotiline Contraindicated
- Disopyramide + Maprotiline Contraindicated
- Dofetilide + Maprotiline Contraindicated
- Ibutilide + Maprotiline Contraindicated
- Isocarboxazid + Maprotiline Contraindicated
- Maprotiline + Methylene blue Contraindicated
Frequently asked questions
Can I take Maprotiline with St john's wort?
MediHelp rates the interaction as major. Maprotiline 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 maprotiline may increase the risk of serotonin syndrome. It also induces CYP enzymes and P-glycoprotein, which may reduce maprotiline levels and efficacy.
How serious is the interaction between Maprotiline 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 and for loss of antidepressant effect.
What other medicines interact with Maprotiline?
MediHelp also lists interactions of Maprotiline with, for example, Arsenic trioxide, Disopyramide, Dofetilide. The full list is on the Maprotiline page.
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