St Johns Wort × Methadone Interaction — Severity, Mechanism & Management

⚠️ Mechanism

St. John's wort induces CYP3A4 and P-gp, significantly increasing methadone metabolism.

📋 Effect

Severe methadone withdrawal symptoms; subtherapeutic levels

💊 Management

Avoid combination. Can precipitate acute withdrawal.

Plain Language Summary

This combination is dangerous. St. John's Wort causes your body to break down methadone much faster than usual, which can lead to dangerously low levels of the medication and severe withdrawal symptoms.

Source

Eich-Höchli D et al. Pharmacopsychiatry 2003

Supporting Research

The effect of Hypericum perforatum on postmenopausal symptoms and depression: A randomized controlled trial PMID:31331546 DOI:10.1016/j.ctim.2019.05.028 2019

Hypericum extract LI 160 and fluoxetine in mild to moderate depression: a randomized, placebo-controlled multi-center study in outpatients PMID:15538592 2005

[Hypericum perforatum extract in treatment of mild to moderate depression. Clinical and pharmacological aspects] PMID:12212522 2002

Hypericum perforatum versus fluoxetine in the treatment of mild to moderate depression PMID:12008860 2002

Efficacy of continuation treatment with hypericum perforatum in depression PMID:12019675 2002

Predicting stable treatment response in patients with major depression treated with hypericum extract WS 5570/5572 PMID:16189745 2005

Adverse Event Profile: St Johns Wort 0

Medical Disclaimer: This interaction record is for informational and educational purposes only and does not constitute medical advice. Drug-supplement interactions can be dangerous. Always consult your healthcare provider or pharmacist before combining any supplement with prescription medications. Do not stop or change any medication without professional guidance.