Is St. John's Wort Safe with Fluoxetine?
Free · No account · based on published sources including NIH ODS, FDA drug labels, and peer-reviewed literature
Do not use together. Discontinue St. John's Wort and consult your prescriber before making any changes. Watch for warning signs: confusion, restlessness, sweating, tremor, or rapid heartbeat and seek emergency care immediately if present.
Why this interaction occurs
Fluoxetine is a potent SSRI and CYP2D6 inhibitor. St. John's Wort also inhibits serotonin reuptake and is a CYP inducer. Together they cause both pharmacodynamic serotonergic excess and complex pharmacokinetic interactions, creating a high-risk scenario for serotonin syndrome.
Evidence
Evidence level: strong.
Data source
PubMed: PMID 36299970
Reported safety data
The FDA’s adverse event reporting system (FAERS) has received 87,365 reports mentioning Fluoxetine. This reflects reported cases involving the medication in general — not confirmed causation, and not specific to the Fluoxetine + supplement combination on this page.
FAERS reports are voluntary and cannot prove that a drug caused an event. Do not use report counts to assess the safety of this specific drug-supplement pair.
Frequently asked questions
Related interactions
All St. John's Wort interactions → · All Fluoxetine interactions →
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Educational only — not medical advice.
Always confirm with your doctor or pharmacist.