Major
Hypericum perforatum × Sertraline
Antidepressants. Other antidepressants of herbal origin×Selective serotonin reuptake inhibitors (SSRIs)
Mechanism
St John's wort contains hypericin and hyperforin – serotonergic activators and strong inducers of CYP3A4 and P-glycoprotein. On sertraline (SSRI), serotonergic activity adds up; serotonin syndrome risk arises.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia. Autonomic features: sweating, tachycardia, hypertension, fever above 38.5 °C.
Management
The combination is not prescribed. Warn the patient that St John's wort is not a neutral herbal supplement but an active serotonergic with dozens of drug interactions. CYP3A4 induction persists for 1–2 weeks after stopping the herb.
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.