The short answer
Trimipramine specifically warns about St John’s wort and serotonin syndrome. Discuss any use with the prescriber; reduced trimipramine absorption and a protective timing gap are not established.
What this answer covers
Oral Hypericum perforatum with trimipramine maleate capsules.
- Supplement or preparation
- Hypericum perforatum
- Medication ingredient
- trimipramine
The label names the herb
Trimipramine explicitly includes St John’s wort among serotonergic agents of concern. Its mechanism need not be assumed identical to other antidepressants to apply its own warning.
Metabolism evidence uses other medicines
One St John’s wort extract lowered alprazolam exposure, while a low-hyperforin product had no relevant effect in probe studies. These do not establish the magnitude or direction of a trimipramine interaction.
Avoid an invented timing solution
Do not increase trimipramine to compensate for assumed reduced absorption. Bring the herb’s extract and amount to the prescriber; a gap has not been shown to resolve serotonin concerns.
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
Conditional exact-label serotonergic precaution; reduced absorption/effectiveness remains insufficiently established.
- Exact scope
- Oral Hypericum perforatum with trimipramine maleate capsules. with Exact oral trimipramine maleate capsules. RxNorm IN10834 / PIN71532 maleate; mesylate PIN236189 is distinct. Oral maleate capsules only.
- Medication form and route
- oral
- Timing or duration
- Source-specific single-dose, repeated-dose and observational exposures distinguished.
What remains uncertain
- No exact trimipramine co-use PK study identified; other-drug probe results differ by extract.
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 trimipramine.
Label describes a sedative component and explicitly names tryptophan and St John’s wort in serotonin warnings. Cardiovascular and anticholinergic precautions apply.
How this applies: RxNorm IN10834 / PIN71532 maleate; mesylate PIN236189 is distinct. Oral maleate capsules only.
No universal supplement interval, event rate or preparation equivalence established.
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: Preparation-specific original evidence; no untested antidepressant or route transfer.
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: Preparation-specific original evidence; no untested antidepressant or route transfer.
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: 2a8d7c4dd5e6e0c4
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.
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Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.