ModerateCardiac glycosides (digitalis)×Antidepressants. Other antidepressants of herbal origin
Updated · Methodology
Mechanism
St. John's wort is a potent inducer of the CYP3A4 enzyme (and of CYP2C9 and P-glycoprotein). After 1–2 weeks it speeds up the breakdown of Digoxin and lowers its blood level, weakening its effect.
Symptoms
Lower digoxin levels through P-glycoprotein induction, weaker rhythm control and control of heart failure symptoms.
Management
Avoid the combination. If needed, monitor digoxin levels and clinical response.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
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Sources
- British Journal of Pharmacology: Clinical relevance of St. John's wort drug interactions revisited (2020)– Nicolussi S, et al. Br J Pharmacol. 2020;177(6):1212-1226.