Drug interactions
St john's wort + Tramadol
Severity: Major
St john's wort and Tramadol: 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 with tramadol it may raise the risk of serotonin syndrome. It also induces CYP3A4, which may lower tramadol exposure and shift metabolism, adding unpredictability.
What this interaction means in plain words
St john's wort and Tramadol 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, plus CYP3A4 and P-glycoprotein induction by St John's wort.
What to do
Advise patients to avoid St John's wort while taking tramadol. If it is used, monitor for serotonin toxicity and for loss of analgesic 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 Tramadol
- Isocarboxazid + Tramadol Contraindicated
- Olanzapine / samidorphan + Tramadol Contraindicated
- Phenelzine + Tramadol Contraindicated
- Procarbazine + Tramadol Contraindicated
- Rasagiline + Tramadol Contraindicated
- Safinamide + Tramadol Contraindicated
Frequently asked questions
Can I take St john's wort with Tramadol?
MediHelp rates the interaction as major. St john's wort and Tramadol 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 with tramadol it may raise the risk of serotonin syndrome. It also induces CYP3A4, which may lower tramadol exposure and shift metabolism, adding unpredictability.
How serious is the interaction between St john's wort and Tramadol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Advise patients to avoid St John's wort while taking tramadol. If it is used, monitor for serotonin toxicity and for loss of analgesic effect.
What other medicines interact with Tramadol?
MediHelp also lists interactions of Tramadol with, for example, Isocarboxazid, Olanzapine / samidorphan, Phenelzine. The full list is on the Tramadol page.
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