Escitalopram and St Johns Wort

Supplement–drug interaction evidence from the TruthStack database.

SeverityCRITICAL
Evidence TierLimited
Interaction TypeSEROTONERGIC RISK
MechanismPHARMACODYNAMIC
Last Reviewed2026-02-15

Summary

Monitor closely. 11 serious adverse events reported with this combination in FDA FAERS. Pharmacovigilance signal, not proof of causation. Discuss with prescriber.

CYP Enzyme Pathway Overlap

Escitalopram and St Johns Wort share activity on the following CYP enzymes:

EnzymeEscitalopramSt Johns Wort
CYP2C19SUBSTRATE (STRONG)INDUCER (MODERATE)
CYP3A4SUBSTRATE (MODERATE)INDUCER (STRONG)

Shared Pharmacodynamic Endpoints

Both compounds influence the same physiological endpoints in the same direction:

EndpointDirectionEscitalopramSt Johns Wort
SEROTONININCREASESTRONGSTRONG

Cumulative effect on shared endpoints may exceed individual compound profiles. This is relevant to discussion with a prescribing clinician.

What We Don't Know

This interaction has limited evidence. Key gaps may include: direct clinical trial data for this specific combination, dose-response relationships, and long-term outcome data. Absence of evidence is not evidence of absence.

API Reference

GET https://api.truthstack.co/v1/check?c1=escitalopram&c2=st_johns_wort

Open, unauthenticated. Returns JSON. Developer documentation

Related Interactions

Methylene Blue + St. John'S Wort Clozapine + St Johns Wort Ethinyl Estradiol + St Johns Wort Phenytoin + St Johns Wort St Johns Wort + Theophylline Amitriptyline + St Johns Wort Citalopram + St Johns Wort Fluoxetine + St Johns Wort
What this page is and is not. TruthStack is an informational reference database that describes published pharmacological findings. It does not provide medical advice, diagnosis, or treatment recommendations. The information on this page reflects flags in our database and should not replace consultation with a qualified healthcare provider. Always discuss supplement-drug combinations with your prescriber or pharmacist.