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Hypericum perforatum
St. John's Wort is a flowering plant that has been used medicinally since ancient Greece. It is best known for its use in treating mild to moderate depression, where clinical evidence supports its efficacy comparable to some conventional antidepressants. It is named for its traditional harvest on St. John's Day.
| Drug | Severity | Description |
|---|---|---|
| Fluoxetine (Prozac) | contraindicated | Combining St. John's Wort with SSRIs can cause serotonin syndrome, a potentially life-threatening condition characterized by agitation, confusion, rapid heart rate, high blood pressure, and hyperthermia. |
| Sertraline (Zoloft) | contraindicated | Concurrent use with sertraline significantly increases the risk of serotonin syndrome. Multiple case reports document this dangerous interaction. |
| Paroxetine (Paxil) | contraindicated | St. John's Wort combined with paroxetine can cause serotonin syndrome. This combination should be strictly avoided. |
| Oral Contraceptives | severe | St. John's Wort significantly reduces the effectiveness of birth control pills, leading to breakthrough bleeding and unintended pregnancies. Multiple case reports of contraceptive failure exist. |
| Warfarin (Coumadin) | severe | St. John's Wort decreases warfarin effectiveness by increasing its metabolism, potentially leading to subtherapeutic INR levels and increased risk of blood clots. |