Taking St. John's Wort With "Tripan" Migraine Medications

In our latest question and answer, the pharmacist discusses the drug interaction between St. John's Wort and "Triptan" medications.

Question

Hi, I am suffering from mild depression and I am considering starting to take st johns wort. I currently take topiramate daily for migraine prevention and triptans when I do get a migraine. I also have asthma and use a symbicort inhaler. Please can you advise me of any interactions with St John's wort? Thanks, Emily

Asked by tealcheese On May 08, 2018

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On May 08, 2018

St. Johns Wort On TableSt. John's Wort is one of the most studied herbal supplements in the world. As such, we have extensive data on its mechanism of action, adverse effects and potential drug interactions, much more so than other natural remedies.


The antidepressant effects of St. John's Wort are thought to be mostly due to two of the plants constituents, hyperforin and adhyperforin, as they likely inhibit the re-uptake of several neurotransmitters including serotonin, norepinephrine and dopamine. The effects on serotonin are thought to be primarily responsible for its antidepressant activity.


As St. John's Wort can increase serotonin levels, it is generally not recommended to use with other medications that increase serotonin due to the risk of serotonin syndrome. Although rare, serotonin syndrome is extremely serious and requires immediate medical attention if it occurs. Side effects include:

  • Mental status changes (e.g. confusion, agitation)
  • Sweating
  • Muscle tremor
  • Fever


Taking St. John's Wort With "Triptans"

Any medication that increases serotonin levels is considered to have a potentially major interaction with St. John's Wort. This includes the "Triptan" migraine medications, which work by agonizing (i.e. stimulating) serotonin receptors. Triptan medications include:

  • Imitrex (Sumatriptan)
  • Axert (Almotriptan)
  • Relpax (Eletriptan)
  • Frova (Frovatriptan)
  • Amerge (Naratriptan)
  • Maxalt (Rizatriptan)
  • Zomig (Zolmitriptan)


Due to the potential interaction between St. John's Wort and "Triptan" medications, combined use isn't recommended. If you are looking to use St. John's Wort to treat depressive symptoms, be sure to discuss with your doctor your options.

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Brian.Staiger@PharmacistAnswers.com Office: 716-389-3076

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