Is St. John's Wort Safe with SAM-e?
Free · No account · based on published sources including NIH ODS, FDA drug labels, and peer-reviewed literature
Avoid concurrent use. This combination is not recommended outside of clinical supervision. Report any symptoms of agitation, tremor, sweating, or rapid heartbeat to your provider immediately.
Why this interaction occurs
St. John's Wort inhibits reuptake of serotonin, dopamine, and norepinephrine. SAM-e independently increases monoamine neurotransmitter activity. Together, they significantly elevate the risk of serotonin syndrome through complementary but additive serotonergic mechanisms.
Evidence
Evidence level: moderate.
Data source
PubMed: PMID 27486153
Reported safety data
The FDA’s adverse event reporting system (FAERS) has received 47,167 reports mentioning SAM-e. This reflects reported cases involving the medication in general — not confirmed causation, and not specific to the SAM-e + 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 SAM-e interactions →
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Educational only — not medical advice.
Always confirm with your doctor or pharmacist.