Meta Information
ID:saint-johns-wort
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/class/cyp3a4-substrates
Target name:
Drugs Metabolized by CYP3A4
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Saint John's Wort is a potent inducer of the CYP3A4 enzyme, which metabolizes approximately 50% of all prescription drugs, leading to reduced efficacy for a vast number of medications.
Actionable advice:
St. John's Wort strongly induces CYP3A4 and can make many drugs fail (contraceptives, immunosuppressants, some HIV and cancer drugs). Do not combine; if you take a prescription medication, stop the St. John's Wort and tell your prescriber.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Preparations of SJW are potent activators of PXR and hence inducers of cytochrome P450 enzymes (most importantly CYP3A4) and P-glycoprotein.
Label source:
PubMed: Clinical relevance of St. John's wort drug interactions revisited. (PMID 31742659)
Action type:
avoid
Target id:
/class/p-glycoprotein-substrates
Target name:
Drugs Transported by P-glycoprotein
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Saint John's Wort induces the P-glycoprotein (P-gp) drug efflux pump, increasing the clearance of many drugs and reducing their absorption and effectiveness.
Actionable advice:
St. John's Wort induces P-glycoprotein and can lower levels of P-gp drugs such as digoxin. Avoid the combination; if you've been taking both, have your prescriber check the affected drug's level.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
SJW increased expression and enhanced the drug efflux function of the multi drug transporter P-glycoprotein in PBMCs of healthy volunteers.
Label source:
PubMed: St Johns wort increases expression of P-glycoprotein: implications for drug interactions. (PMID 11849198)
Action type:
avoid
Target id:
/class/serotonergic-agents
Target name:
Serotonergic Medications (SSRIs, SNRIs, TCAs, Triptans)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Combining Saint John's Wort with other serotonergic drugs can lead to an excessive accumulation of serotonin, causing a potentially life-threatening condition called serotonin syndrome.
Actionable advice:
This should not be taken with any other serotonergic medication unless under strict medical supervision.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
its predisposition to causing fatal serotonin syndrome, when used in conjunction with other serotonergic agents and drug interactions noted with CYP 450 drugs, raises a question in the safety profile.
Label source:
PubMed: Cureus (2022)
Source url:
Exact phrase from label:
When combined with serotonin reuptake inhibitor, antidepressants (e.g. sertaline, paroxetine, nefazodone) or buspirone, SJW can cause serotonergic syndrome.
Label source:
PubMed: International journal of clinical pharmacology and therapeutics (2004)
Source url:
Exact phrase from label:
Serotonin syndrome may occur when St. John's wort is combined with sympathomimetics, antidepressants, or triptans.
Label source:
PubMed: Journal of the Society for Integrative Oncology (2006)
Action type:
avoid
Target id:
/class/immunosuppressants
Target name:
Immunosuppressants (e.g., Cyclosporine, Tacrolimus)
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Saint John's Wort strongly induces enzymes (CYP3A4) and transporters (P-gp) that break down these drugs, leading to dangerously low levels and risk of organ transplant rejection.
Actionable advice:
This combination should be avoided completely, as it can lead to life-threatening treatment failure.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Tacrolimus is metabolized by cytochrome P450 3A (CYP3A) and is susceptible to interactions with the CYP3A and P-glycoprotein inducer St. John's Wort (SJW).
Label source:
PubMed: Effect of Tacrolimus Formulation (Prolonged-Release vs Immediate-Release) on Its Susceptibility to Drug-Drug Interactions with St. John's Wort. (PMID 38176912)
Action type:
avoid
Target id:
/class/antiretrovirals
Target name:
Antiretroviral Medications (for HIV)
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Saint John's Wort induces CYP3A4, rapidly clearing HIV medications from the body, which can cause treatment failure and viral resistance.
Actionable advice:
It should be avoided completely, as this can render HIV treatment ineffective.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Clinical trials indicate that St John's wort (Hypericum perforatum), via cytochrome P450 (CYP) and/or P-glycoprotein induction, reduces the plasma concentrations (and/or increases the clearance) of alprazolam, amitriptyline, atorvastatin, chlorzoxazone, ciclosporin, debrisoquine, digoxin, erythromycin, fexofenadine, gliclazide, imatinib, indinavir, irinotecan, ivabradine, mephenytoin, methadone, midazolam, nifedipine, omeprazole, oral contraceptives, quazepam, simvastatin, tacrolimus, talinolol, verapamil, voriconazole and warfarin.
Label source:
PubMed: Interactions between herbal medicines and prescribed drugs: an updated systematic review. (PMID 19719333)
Action type:
avoid
Target id:
/class/estrogens
Target name:
Hormonal Contraceptives (Oral, Patch, Ring)
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
By inducing liver enzymes, Saint John's Wort accelerates the breakdown of contraceptive hormones, significantly increasing the risk of unintended pregnancy.
Actionable advice:
It should be avoided completely, and a reliable alternative form of contraception should be used.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
BACKGROUND: St. John's wort (SJW), a commonly used herbal remedy, has been shown to compromise the efficacy of drugs, including oral contraceptive pills (OCPs), by inducing cytochrome P-450.
Label source:
PubMed: Does St. John's wort interfere with the antiandrogenic effect of oral contraceptive pills? (PMID 16904419)
Action type:
avoid
Target id:
/class/anticoagulants-antiplatelets
Target name:
Anticoagulants (e.g., Warfarin, Rivaroxaban, Apixaban)
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Saint John's Wort induces enzymes (CYP2C9, CYP3A4) and transporters (P-gp) that metabolize anticoagulants, lowering their concentration and increasing the risk of blood clots.
Actionable advice:
This combination should be strictly avoided due to the high risk of thrombosis.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Clinical trials indicate that St John's wort (Hypericum perforatum), via cytochrome P450 (CYP) and/or P-glycoprotein induction, reduces the plasma concentrations (and/or increases the clearance) of alprazolam, amitriptyline, atorvastatin, chlorzoxazone, ciclosporin, debrisoquine, digoxin, erythromycin, fexofenadine, gliclazide, imatinib, indinavir, irinotecan, ivabradine, mephenytoin, methadone, midazolam, nifedipine, omeprazole, oral contraceptives, quazepam, simvastatin, tacrolimus, talinolol, verapamil, voriconazole and warfarin.
Label source:
PubMed: Interactions between herbal medicines and prescribed drugs: an updated systematic review. (PMID 19719333)
Action type:
avoid
Target id:
/class/maois
Target name:
Monoamine Oxidase Inhibitors (MAOIs)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
This combination poses a very high risk of severe serotonin syndrome and hypertensive crisis due to additive monoamine oxidase inhibition.
Actionable advice:
This combination is absolutely contraindicated and potentially fatal.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
moreover, the inhibition of monoaminoxidase enzyme activity has been involved. In any case, the increase of monoamine concentrations in the synaptic cleft resembles several actions exerted by clinically effective antidepressants.
Label source:
PubMed: Phytomedicine : international journal of phytotherapy and phytopharmacology (2003)
Source url:
Exact phrase from label:
An inhibition of MAO could be shown in the following concentrations (extract correlated to a mean molecular value of 500): hypericin to 10(-3) mol/L, hypericum total extract to 10(-4) mol/L, one extract fraction up to 10(-5).
Label source:
PubMed: Journal of geriatric psychiatry and neurology (1994)
Source url:
Exact phrase from label:
its predisposition to causing fatal serotonin syndrome, when used in conjunction with other serotonergic agents and drug interactions noted with CYP 450 drugs, raises a question in the safety profile.
Label source:
PubMed: Cureus (2022)
Action type:
avoid
Target id:
/intervention/digoxin
Target name:
Digoxin
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Saint John's Wort induces the P-glycoprotein (P-gp) transporter, which pumps digoxin out of the body, leading to subtherapeutic levels and worsening of heart failure or arrhythmia.
Actionable advice:
This combination should be strictly avoided, as it can lead to loss of cardiac control.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Clinical trials indicate that St John's wort (Hypericum perforatum), via cytochrome P450 (CYP) and/or P-glycoprotein induction, reduces the plasma concentrations (and/or increases the clearance) of alprazolam, amitriptyline, atorvastatin, chlorzoxazone, ciclosporin, debrisoquine, digoxin, erythromycin, fexofenadine, gliclazide, imatinib, indinavir, irinotecan, ivabradine, mephenytoin, methadone, midazolam, nifedipine, omeprazole, oral contraceptives, quazepam, simvastatin, tacrolimus, talinolol, verapamil, voriconazole and warfarin.
Label source:
PubMed: Interactions between herbal medicines and prescribed drugs: an updated systematic review. (PMID 19719333)
Action type:
avoid
Target id:
/class/chemotherapy-radiation
Target name:
Certain Chemotherapy Agents (e.g., Imatinib, Irinotecan)
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Saint John's Wort induces enzymes that metabolize many chemotherapy drugs, drastically reducing their effectiveness and compromising cancer treatment outcomes.
Actionable advice:
This should be strictly avoided during cancer treatment.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
St John's wort administration increased imatinib clearance by 43% ( P < .001), from 12.5 +/- 3.6 L/h to 17.9 +/- 5.6 L/h; imatinib area under the concentration versus time curve (AUC) extrapolated to infinity was decreased by 30%, from 34.5 +/- 9.5 microg . h/mL to 24.2 +/- 7.0 microg . h/mL ( P < .001).
Label source:
PubMed: Clinical pharmacology and therapeutics (2004)
Source url:
Exact phrase from label:
The plasma levels of the active metabolite SN-38 decreased by 42% (95% confidence interval [CI] = 14% to 70%) following SJW cotreatment with 1.0 micro M x h (95% CI = 0.34 micro M x h to 1.7 micro M x h) versus 1.7 micro M x h (95% CI = 0.83 micro M x h to 2.6 micro M x h) (P =.033, two-sided paired Student's t test).
Label source:
PubMed: Journal of the National Cancer Institute (2002)
Source url:
Exact phrase from label:
Drugs most prominently affected and contraindicated for concomitant use with St John's wort are metabolised via both CYP3A4 and P-glycoprotein pathways, including HIV protease inhibitors, HIV non-nucleoside reverse transcriptase inhibitors (only CYP3A4), the immunosuppressants ciclosporin and tacrolimus, and the antineoplastic agents irinotecan and imatinib mesylate.
Label source:
PubMed: Drug safety (2004)
Action type:
avoid
Target id:
/procedure/surgery-anesthesia
Target name:
Surgery with General Anesthesia
Severity:
major
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
120
Hours after target:
null
Description:
Saint John's Wort's widespread effects on drug metabolism and neurotransmitters can interfere with anesthetic agents and blood pressure control during surgery.
Actionable advice:
Use should be discontinued at least 5 days before any scheduled surgery.
Validation status:
validated_via_clinical_guidance
Evidence tier:
tier_b
Evidence basis:
clinical_guidance_verbatim
Evidence anchors:
Exact phrase from label:
St. John's Wort — Used to ease anxiety and help with sleep problems, but it may prolong the effects of anesthesia
Label source:
Clinical guidance: ASA (American Society of Anesthesiologists) — Herbal and Dietary Supplements and Anesthesia
Action type:
avoid
Target id:
/condition/bipolar-disorder
Target name:
Bipolar Disorder
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The antidepressant effects of Saint John's Wort can trigger a switch from depression to mania or hypomania in individuals with bipolar disorder.
Actionable advice:
This should be strictly avoided with a diagnosis of bipolar disorder.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
She experienced hypomania after adding St John's wort and Ginkgo biloba to her regimen of fluoxetine and buspirone, which remitted after discontinuation of the herbal medicines.
Label source:
PubMed: Hypomania induced by herbal and pharmaceutical psychotropic medicines following mild traumatic brain injury. (PMID 11953006)
Action type:
avoid
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The safety of Saint John's Wort during pregnancy has not been established, and its effects on uterine tone are a theoretical concern.
Actionable advice:
Use should be avoided during pregnancy due to unknown risks to the fetus.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
St. John’s wort has not been well-studied with use in pregnancy.
Label source:
Anecdotal: MotherToBaby
Action type:
avoid
Target id:
/class/photosensitizing-agents
Target name:
Photosensitizing Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Saint John's Wort causes photosensitivity, and taking it with other drugs that do the same (e.g., tetracyclines, thiazides) greatly increases the risk of severe sunburn.
Actionable advice:
This combination is best avoided, or approached with extreme caution regarding sun exposure, including high-SPF sunscreen and protective clothing.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
St. John's Wort (SJW), an over-the-counter antidepressant, contains hypericin, which absorbs light in the UV and visible ranges and is phototoxic to skin
Label source:
Primary literature: https://pubmed.ncbi.nlm.nih.gov/15623347/
Action type:
avoid
Target id:
/lifestyle/sun-exposure
Target name:
Direct Sun Exposure / UV Light
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The compound hypericin in Saint John's Wort makes the skin more sensitive to UV light, increasing the risk of sunburn, sometimes severely.
Actionable advice:
Minimize sun exposure and use broad-spectrum sunscreen and protective clothing while taking this supplement.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Investigations in volunteers have shown that the threshold dose for an increased risk of photosensitisation is about 2-4 g/day of a usual commercial extract (equivalent to approximately 5-10 mg of the hypericin that causes the phenomenon).
Label source:
PubMed: Incidence and clinical relevance of the interactions and side effects of Hypericum preparations. (PMID 11315759)
Action type:
informational_none
Target id:
/class/statins
Target name:
Statins (especially Simvastatin, Atorvastatin)
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Saint John's Wort increases the metabolism of many statins via CYP3A4 induction, which can reduce their cholesterol-lowering effects.
Actionable advice:
This combination is best avoided, or using a statin less affected by CYP3A4 (e.g., pravastatin, rosuvastatin) is worth discussing with a doctor.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
OBJECTIVE: St John's Wort, a widely used herbal product, is an inducer of CYP3A4 and it decreases blood concentrations of CYP3A4 substrates.
Label source:
PubMed: Different effects of St John's wort on the pharmacokinetics of simvastatin and pravastatin. (PMID 11753267)
Action type:
avoid
Target id:
/class/benzodiazepines
Target name:
Benzodiazepines (e.g., Alprazolam, Midazolam)
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The induction of CYP3A4 by Saint John's Wort can speed up the breakdown of certain benzodiazepines, reducing their sedative and anti-anxiety effects.
Actionable advice:
This combination is best avoided, as it may lead to reduced efficacy of the benzodiazepine.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Clinical trials indicate that St John's wort (Hypericum perforatum), via cytochrome P450 (CYP) and/or P-glycoprotein induction, reduces the plasma concentrations (and/or increases the clearance) of alprazolam, amitriptyline, atorvastatin, chlorzoxazone, ciclosporin, debrisoquine, digoxin, erythromycin, fexofenadine, gliclazide, imatinib, indinavir, irinotecan, ivabradine, mephenytoin, methadone, midazolam, nifedipine, omeprazole, oral contraceptives, quazepam, simvastatin, tacrolimus, talinolol, verapamil, voriconazole and warfarin.
Label source:
PubMed: Interactions between herbal medicines and prescribed drugs: an updated systematic review. (PMID 19719333)
Action type:
avoid
Target id:
/class/calcium-channel-blockers
Target name:
Calcium Channel Blockers (e.g., Nifedipine, Verapamil)
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Saint John's Wort can decrease the effectiveness of these blood pressure and heart medications by accelerating their metabolism through CYP3A4 induction.
Actionable advice:
This combination is best avoided, to ensure proper control of blood pressure or heart conditions.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Blood pressure should be closely
monitored when Amlodipine is co-administered with CYP3A4 inducers.
Label source:
Action type:
avoid
Target id:
/intervention/tramadol
Target name:
Tramadol
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Both substances have serotonergic properties, and their combination increases the risk of serotonin syndrome. SJW may also reduce tramadol's analgesic effect.
Actionable advice:
This combination is best avoided due to the increased risk of serotonin syndrome.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Preclinical animal studies demonstrated the ability of low doses of SJW dry extracts (0.3% hypericins; 3-5% hyperforins) to induce antinociception, to relieve from acute and chronic hyperalgesic states and to augment opioid analgesia.
Label source:
PubMed: Journal of ethnopharmacology (2017)
Source url:
Exact phrase from label:
Circumstances in which opioid is comedicated as an object drug include rifampin-opioids (morphine, tramadol, oxycodone, methadone), quinidine-opioids (morphine, fentanyl, oxycodone, codeine, dihydrocodeine, methadone), antimycotics-opioids (buprenorphine, fentanyl, morphine, oxycodone, methadone, tilidine, tramadol), protease inhibitors-opioids (ritonavir, ritonavir/lopinavir-oxycodone, ritonavir-fentanyl, ritonavir-tilidine), grapefruit juice-opioids (oxycodone, fentanyl, methadone), antidepressants-opioids (paroxetine-tramadol, paroxetine-hydrocodone, paroxetine-oxycodone, escitalopram-tramadol), metoclopramide-morphine, amantadine-morphine, sumatriptan-butorphanol nasal sprays, ticlopidine-tramadol, St John's wort-oxycodone, macrolides/ketolides-oxycodone, and levomepromazine-codeine.
Label source:
PubMed: Journal of pain research (2017)
Source url:
Exact phrase from label:
St John's wort greatly reduced the plasma concentrations of oral oxycodone. The self-reported drug effect of oxycodone decreased significantly.
Label source:
PubMed: European journal of pain (London, England) (2010)
Action type:
avoid
Target id:
/intervention/dextromethorphan
Target name:
Dextromethorphan (Cough Suppressant)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
This combination can increase the risk of serotonin syndrome due to the additive serotonergic effects of both substances.
Actionable advice:
Dextromethorphan-containing cough and cold products are best avoided while taking Saint John's Wort.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Dextromethorphan may cause serotonin syndrome, and this risk is increased by
overdose, particularly if taken with other serotonergic agents, SSRIs or tricyclic antidepressants.
Label source:
Action type:
avoid
Target id:
/intervention/sam-e
Target name:
SAM-e (S-adenosylmethionine)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Both supplements have serotonergic properties, and combining them may increase the risk of developing serotonin syndrome.
Actionable advice:
These two supplements are best not combined unless directed by a healthcare professional.
Validation status:
validated_via_clinical_guidance
Evidence tier:
tier_b
Evidence basis:
clinical_guidance_verbatim
Evidence anchors:
Exact phrase from label:
St. John's wort. Be cautious when taking this supplement with SAMe. The combination could cause serotonin syndrome.
Label source:
Clinical guidance: Mayo Clinic — SAMe drug interactions
Action type:
avoid
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Components of Saint John's Wort can pass into breast milk and may cause adverse effects like drowsiness or colic in the nursing infant.
Actionable advice:
Use is best avoided while breastfeeding due to potential risks to the infant.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
One study found a slightly increased frequency of colic, drowsiness and lethargy among breastfed infants whose mothers were taking St. John's wort, but none of the effects were severe or required treatment.
Label source:
Anecdotal: LactMed
Action type:
avoid
Target id:
/class/tyramine-rich-foods
Target name:
Tyramine-Rich Foods
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Due to its weak MAO-inhibiting properties, there is a theoretical risk of a hypertensive reaction when consuming large amounts of tyramine-rich foods (e.g., aged cheeses, cured meats).
Actionable advice:
Consuming large quantities of aged, fermented, or cured foods is worth keeping in mind, although the clinical risk is low.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The paper also discusses the toxic effects of tyramine, present in inter alia blue cheese, resulting from interactions with MAO-metabolised drugs.
Label source:
PubMed: International journal of molecular sciences (2025)
Action type:
informational_none