The short answer
St. John’s wort needs a medication review before use with butorphanol. The specific claim that it increases sedation is not established; serotonin-related effects and possible changes in drug handling are separate concerns.
What this answer covers
Hypericum perforatum oral products; constituent strength differs among preparations.
- Supplement or preparation
- Hypericum perforatum
- Medication ingredient
- butorphanol
The sedation claim is not established
The inspected sources do not document increased sedation from this exact combination. General opioid warnings cannot prove that every herb adds the same CNS-depressant effect.
A different interaction concern remains
St. John’s wort can interact with medicines that affect serotonin. Butorphanol labels warn about serotonin syndrome with serotonergic drugs, supporting a precaution without establishing an exact-pair case or incidence.
Formulation and metabolism matter
The nasal spray label also discusses CYP3A4 inhibitors and inducers. Changing a metabolically active herbal product can complicate treatment, but the sources do not quantify this pair or establish the same pharmacokinetic effect for injection.
Do not rely on separating doses
Have the prescriber review starting or stopping the herb. A short interval has not been shown to prevent systemic interactions. Agitation with fever, tremor, muscle stiffness or confusion needs urgent medical assessment.
Evidence and practical considerations
Side effects & toxicity
Current claim specifically asserts increased sedation; no exact-pair sedation evidence. Separate serotonergic or metabolic concerns do not validate that endpoint.
- Exact scope
- Hypericum perforatum oral products; constituent strength differs among preparations. with Butorphanol1841 IN; human nasal tartrate or IV/IM tartrate, with route-specific label distinctions.
- Medication form and route
- intranasal medication; intravenous medication; intramuscular medication; oral supplement
What remains uncertain
- No unmeasured pair incidence, blanket class transfer or arbitrary spacing interval.
Factors that may matter: Preparation; Dose; Other medicines; Organ function.
Read the supporting source summaries
Source 1: current product label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: People prescribed butorphanol
Mixed opioid agonist-antagonist with sedation and respiratory-depression warnings; general serotonergic-drug and CYP3A4 interaction precautions.
How this applies: Exact butorphanol RxCUI 1841 IN, with stated salt/formulation/route bridge.
Nasal formulation-specific pharmacokinetic warnings; not an oral drug or veterinary preparation.
Source 2: current product label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: People prescribed butorphanol
Warns about CNS-depressant combinations and serotonin syndrome with serotonergic drugs.
How this applies: Exact butorphanol RxCUI 1841 IN, with stated salt/formulation/route bridge.
No exact supplement-pair event rate; nasal CYP3A wording is not assumed identical for injection.
Source 3: federal supplement safety guidance
nccih.nih.gov · Source check Sep 10, 2026
Population: Users of the named oral supplement
Possible serious serotonin-related effects with other serotonin-active drugs.
How this applies: Original source interpreted for butorphanol only within the stated preparation and endpoint limits.
Not a direct butorphanol combination trial; original preparation, dose and endpoint limits apply. No exact-pair adverse-event rate or protective spacing established.
Research assessment: · Open full citations ↗
Timing & monitoring
Conditional medication-review/avoid-unsupervised-co-use precaution from serotonergic guidance and exact label; no universal prohibition or protective short spacing established.
- Exact scope
- Hypericum perforatum oral products; constituent strength differs among preparations. with Butorphanol1841 IN; human nasal tartrate or IV/IM tartrate, with route-specific label distinctions.
- Medication form and route
- intranasal medication; intravenous medication; intramuscular medication; oral supplement
What remains uncertain
- No unmeasured pair incidence, blanket class transfer or arbitrary spacing interval.
Factors that may matter: Preparation; Dose; Other medicines; Organ function.
Read the supporting source summaries
Source 1: current product label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: People prescribed butorphanol
Mixed opioid agonist-antagonist with sedation and respiratory-depression warnings; general serotonergic-drug and CYP3A4 interaction precautions.
How this applies: Exact butorphanol RxCUI 1841 IN, with stated salt/formulation/route bridge.
Nasal formulation-specific pharmacokinetic warnings; not an oral drug or veterinary preparation.
Source 2: current product label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: People prescribed butorphanol
Warns about CNS-depressant combinations and serotonin syndrome with serotonergic drugs.
How this applies: Exact butorphanol RxCUI 1841 IN, with stated salt/formulation/route bridge.
No exact supplement-pair event rate; nasal CYP3A wording is not assumed identical for injection.
Source 3: federal supplement safety guidance
nccih.nih.gov · Source check Sep 10, 2026
Population: Users of the named oral supplement
Possible serious serotonin-related effects with other serotonin-active drugs.
How this applies: Original source interpreted for butorphanol only within the stated preparation and endpoint limits.
Not a direct butorphanol combination trial; original preparation, dose and endpoint limits apply. No exact-pair adverse-event rate or protective spacing established.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Prepared exact butorphanol article with formulation-specific evidence and uncertainty. | |
| Research summary published |
Article revision: 8424e2e377f6780e
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.