The short answer
Do not add St John’s wort to desipramine without prescriber review. The desipramine label specifically names it in the serotonin-syndrome warning.
What this answer covers
Oral Hypericum perforatum; different extracts and hyperforin content do not establish a universally safe product.
- Supplement or preparation
- Hypericum perforatum
- Medication ingredient
- desipramine
The warning is in this medicine’s label
Desipramine’s prescribing information names St John’s wort among serotonergic products that can increase serotonin-syndrome risk. This supports review even though exact-pair frequency is unknown.
Laboratory findings answer a different question
Mixing desipramine with Hypericum preparations produced different particle and binding patterns depending on the extract. That does not establish clinical serotonin toxicity or reduced absorption.
A dosing gap is not an established solution
Tell the prescriber about the exact extract, amount and recent changes. The label does not offer a supplement timing gap that removes this risk.
Recognize concerning symptoms
Seek urgent medical care for a combination of agitation or confusion, fever or heavy sweating, tremor, muscle rigidity or repeated twitching. These can be signs of serotonin syndrome; a single nonspecific symptom does not establish the diagnosis.
Evidence and practical considerations
Side effects & toxicity
Exact label supports a conditional serotonin precaution, not a measured event rate or a protective timing rule.
- Exact scope
- Oral Hypericum perforatum; different extracts and hyperforin content do not establish a universally safe product. with Exact oral desipramine hydrochloride tablets. RxNorm IN 3247/PIN 203174 hydrochloride. Mainly norepinephrine reuptake activity does not erase the exact label’s serotonin warning. CYP2D6 inhibition can affect concentrations; not assumed identical to CYP3A substrates.
- Medication form and route
- oral
- Timing or duration
- Source-specific single-dose, repeated-dose and observational exposures distinguished.
What remains uncertain
- No exact human adverse-event series identified. Laboratory binding differs by preparation and does not measure serotonin toxicity.
Factors that may matter: preparation and plant part; clinical indication; dose; other medicines; baseline alertness.
Read the supporting source summaries
Source 1: current product label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: People prescribed oral desipramine.
Exact label warns about serotonin syndrome with tryptophan and St John’s wort, CYP2D6 inhibition, impaired alertness and cardiovascular/anticholinergic effects.
How this applies: RxNorm IN 3247/PIN 203174 hydrochloride. Mainly norepinephrine reuptake activity does not erase the exact label’s serotonin warning. CYP2D6 inhibition can affect concentrations; not assumed identical to CYP3A substrates.
No universal supplement interval, event rate or preparation equivalence established. Original label distinguishes warnings from measured pair-specific results.
Source 2: original in vitro study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Laboratory mixtures.
Particle formation and binding differed by extract preparation.
How this applies: Only the named drug, preparation, route and measured endpoints apply.
No patient serotonin syndrome, absorption measurement or protective timing test.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Current exact available claims adjudicated using original captures and explicit identity and comparator limits. | |
| Research summary published |
Article revision: e2b4c62177c693c9
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.