Drug interactions
Sertraline + St john's wort
Severity: Major
Sertraline 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 an SSRI has been reported to cause serotonin syndrome. It also induces CYP3A4 and other enzymes, which can alter exposure to sertraline.
What this interaction means in plain words
Sertraline 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 effects from reuptake inhibition by both agents, plus enzyme induction by St John's wort.
What to do
Avoid concurrent use and advise patients to stop St John's wort before starting sertraline. Monitor for agitation, tremor, hyperthermia and diarrhea if they overlap.
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 Sertraline
- Isocarboxazid + Sertraline Contraindicated
- Methylene blue + Sertraline Contraindicated
- Phenelzine + Sertraline Contraindicated
- Pimozide + Sertraline Contraindicated
- Selegiline transdermal + Sertraline Contraindicated
- Selegiline + Sertraline Contraindicated
Frequently asked questions
Can I take Sertraline with St john's wort?
MediHelp rates the interaction as major. Sertraline 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 has been reported to cause serotonin syndrome. It also induces CYP3A4 and other enzymes, which can alter exposure to sertraline.
How serious is the interaction between Sertraline 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 St John's wort before starting sertraline. Monitor for agitation, tremor, hyperthermia and diarrhea if they overlap.
What other medicines interact with Sertraline?
MediHelp also lists interactions of Sertraline with, for example, Isocarboxazid, Methylene blue, Phenelzine. The full list is on the Sertraline page.
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