The short answer
Ask for a product-specific review before adding St John’s wort to estazolam. A change in treatment effect is possible, but the size of this exact interaction is not established.
What this answer covers
Oral Hypericum perforatum extracts; hyperforin content and the exact medication metabolism matter.
- Supplement or preparation
- Hypericum perforatum
- Medication ingredient
- estazolam
Why the exact medicine matters
The estazolam label identifies CYP3A metabolism and predicts lower levels with strong enzyme inducers, while stating that direct in vivo inducer studies were not performed.
The best measured interaction used another drug
A fourteen-day St John’s wort study substantially lowered alprazolam exposure. It measured a different medicine and did not demonstrate this medicine’s clinical failure or reduced intestinal absorption.
A different extract gave a different result
A low-hyperforin preparation had little effect on alprazolam exposure. Bring the exact St John’s wort product for review; no protective timing gap has been established.
Plan treatment changes together
Do not increase estazolam to offset a supplement or abruptly stop regular treatment. Bring the full ingredient list to the prescriber so changes can be planned around the reason you take the medicine.
Evidence and practical considerations
Absorption & effectiveness
Other-drug induction results support careful review, but do not establish exact-pair loss of effectiveness, reduced absorption or a validated interval.
- Exact scope
- Oral Hypericum perforatum extracts; hyperforin content and the exact medication metabolism matter. with Exact oral estazolam tablets. Human liver microsomes identify CYP3A metabolism; label predicts effects of strong inhibitors/inducers but explicitly lacks in vivo studies with those CYP3A classes. Parent drug contributes most hypnotic effect; limited metabolites are not assumed equivalent.
- Medication form and route
- oral
- Timing or duration
- Source-specific single-dose, repeated-dose and observational exposures distinguished.
What remains uncertain
- No exact human co-use study identified; preparations differ and alprazolam effect size is not transferable.
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: Patients prescribed oral estazolam.
Can impair alertness and coordination; other CNS depressants can increase impairment. Opioid combinations have a specific respiratory-depression warning. Dependence and withdrawal require supervised changes. Human liver microsomes identify CYP3A metabolism; label predicts effects of strong inhibitors/inducers but explicitly lacks in vivo studies with those CYP3A classes. Parent drug contributes most hypnotic effect; limited metabolites are not assumed equivalent.
How this applies: Exact IN and labeled oral formulation; route, salt and metabolite distinctions retained.
No quantified risk for every herb or universal protective spacing interval. Opioid-specific evidence does not prove equal botanical respiratory risk.
Source 2: original human study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Twelve healthy volunteers in an open-label fixed-order crossover.
Alprazolam exposure fell about one-half and clearance increased; elimination half-life shortened.
How this applies: Original named medication and preparation only; indirect evidence for estazolam. Comparator arms are not coadministration.
Single extract and short exposure, healthy volunteers; no anxiety-treatment failure endpoint. Does not imply reduced gut absorption or transfer to predominantly conjugated benzodiazepines.
Source 3: original human study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Healthy participants in randomized placebo-controlled studies.
Changes in probe exposures were small and judged clinically irrelevant; hyperforin levels were below quantification.
How this applies: Original named medication and preparation only; indirect evidence for estazolam. Comparator arms are not coadministration.
Preparation-specific result, not permission to assume all retail products are low-hyperforin or all doses safe.
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: f6adfe34b34e35fe
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.