I have read that St Johns Wort can interact with prozac (& potentially with ecstasy). Can you supply more info on this combination? I believe with the herbal industry taking off this might be a problem. I
have friends who take St Johns Wort for periods after ecstasy use to regulate emotional stability. It is believed that because it is a herbal remedy it is entirely safe.

Dr ChalZ replied:

St Johns Wort is a relatively safe herbal preparation which has mild to moderate antidepressant activities, with fairly minor side effects. It appears to have mixed effects on the serotonin system (still being studied but probably some MAOI effects), & may thus interact with other substances that effect the same system. Just because it is herbal does not mean it is innocuous. There are documented accounts of problems arising in mixing St John's Wort with an SSRI (eg in one case described as very groggy, slow-moving, incoherent, lethargic), & although I have not seen documented cases where St John's Wort combined with ecstasy, there is a definite theoretical risk of similar toxicity.

Physicians-on-line gives the following information:

"Warnings: Unexpected toxicity may occur when St John's Wort & Serotonin Reuptake Blockers are co-administered. Due to possible additive effects on serotonin concentrations, it is advisable to avoid combinations of St John's Wort, Hypericum perforatum with fluoxetine. Since serotonin is deaminated by monoamine oxidase type A, administration of drugs that can inhibit this enzyne concurrently with St John's Wort can lead to a reaction known as 'serotonin syndrome'. This reaction may include confusion, severe nausea, sweating, agitation, & can include severe symptoms like hypertension & unresponsiveness."

Regards, ChalZ

Added 1st July 2000

 

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