Drug interactions
Ramelteon + St john's wort
Severity: Moderate
Ramelteon 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 can lower ramelteon concentrations and may reduce its effectiveness. The effect is inferred from enzyme induction rather than direct clinical studies.
What this interaction means in plain words
Ramelteon 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
St John's wort induces CYP3A4 (and possibly other CYP enzymes), accelerating ramelteon metabolism.
What to do
Monitor for loss of hypnotic effect. Consider stopping the herb or choosing an alternative if insomnia control worsens.
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 Ramelteon
- Calcium / magnesium / potassium / sodium oxybates + Ramelteon Contraindicated
- Fluvoxamine + Ramelteon Contraindicated
- Ramelteon + Sodium oxybate Contraindicated
- Alfentanil + Ramelteon Moderate
- Amitriptyline + Ramelteon Moderate
- Amobarbital + Ramelteon Moderate
Frequently asked questions
Can I take Ramelteon with St john's wort?
MediHelp rates the interaction as moderate. Ramelteon 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 can lower ramelteon concentrations and may reduce its effectiveness. The effect is inferred from enzyme induction rather than direct clinical studies.
How serious is the interaction between Ramelteon 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: Monitor for loss of hypnotic effect. Consider stopping the herb or choosing an alternative if insomnia control worsens.
What other medicines interact with Ramelteon?
MediHelp also lists interactions of Ramelteon with, for example, Calcium / magnesium / potassium / sodium oxybates, Fluvoxamine, Sodium oxybate. The full list is on the Ramelteon page.
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