Check my stack

Is St. John's Wort Safe with Tricyclic Antidepressants (Amitriptyline, Nortriptyline, Doxepin, Imipramine, Desipramine, Amoxapine)?

⛔ CRITICAL SEVERITY
CHECK MY STACK
Tricyclic Antidepressants (Amitriptyline, Nortriptyline, Doxepin, Imipramine, Desipramine, Amoxapine) St. John's Wort
Check these in my full stack →

Free · No account · based on published sources including NIH ODS, FDA drug labels, and peer-reviewed literature

WHAT YOU NEED TO KNOW

Do not take St. John's Wort if you are prescribed any tricyclic antidepressant. Inform your doctor or pharmacist immediately if you are using both. Seek emergency care if you experience agitation, rapid heart rate, high fever, muscle twitching, or confusion.

Why this interaction occurs

Combined serotonergic activity from tricyclic antidepressants and St. John's Wort significantly increases the risk of serotonin syndrome, a potentially life-threatening condition. All major tertiary drug resources (Lexicomp, Micromedex, Medscape) consistently flag this interaction as significant.

Evidence

Evidence level: strong.

Data source

PubMed - PMID 37051281

Reported safety data

The FDA’s adverse event reporting system (FAERS) has received 158,901 reports mentioning Tricyclic Antidepressants (Amitriptyline, Nortriptyline, Doxepin, Imipramine, Desipramine, Amoxapine). This reflects reported cases involving the medication in general — not confirmed causation, and not specific to the Tricyclic Antidepressants (Amitriptyline, Nortriptyline, Doxepin, Imipramine, Desipramine, Amoxapine) + 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

Can I take St. John's Wort with Tricyclic Antidepressants (Amitriptyline, Nortriptyline, Doxepin, Imipramine, Desipramine, Amoxapine)?
Avoid unless your doctor or pharmacist directs otherwise. Do not take St. John's Wort if you are prescribed any tricyclic antidepressant. Inform your doctor or pharmacist immediately if you are using both. Seek emergency care if you experience agitation, rapid heart rate, high fever, muscle twitching, or confusion.

Related interactions

St. John's Wort and cyclosporine St. John's Wort and warfarin St. John's Wort and indinavir St. John's Wort and oral contraceptives St. John's Wort and Direct-Acting Oral Anticoagulants (DOACs) — excluding Dabigatran St. John's Wort and Serotonergic Antidepressants (SSRIs, SNRIs) St. John's Wort and CYP450-metabolized drugs (general) St. John's Wort and Sertraline

All St. John's Wort interactions →  ·  All Tricyclic Antidepressants (Amitriptyline, Nortriptyline, Doxepin, Imipramine, Desipramine, Amoxapine) interactions →

Already checked this one — check your whole list

Check My Full Stack → Generate Visit Packet →
Powered by Elthio Health · elthio.health
Educational only — not medical advice.
Always confirm with your doctor or pharmacist.