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Can you take Amlodipine with St. john's wort?

1 drug interaction and 11 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

amLODIPine St. John's wort

Applies to: amlodipine and st. john's wort

Talk to your doctor before using amLODIPine together with St. John's wort. Combining these medications may reduce the blood levels and effects of amLODIPine.

Contact your doctor if your symptoms worsen or your condition changes during treatment with these medications.

Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications.

It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

St. John's wort Food/Lifestyle

Applies to: st. john's wort

While you are taking St. John's wort, you must not eat or drink certain foods and beverages that are high in tyramine.

Eating these foods while you are taking St. John's wort can raise your blood pressure to dangerous levels. This may cause life threatening symptoms such as:

  • sudden and severe headache
  • confusion
  • blurred vision
  • problems with speech or balance
  • nausea
  • vomiting
  • chest pain
  • seizure (convulsions)
  • sudden numbness or weakness (especially on one side of the body)

Call your doctor at once if you have any of these symptoms.

Foods that are high in tyramine include:

  • air dried meats
  • aged or fermented meats
  • sausage or salami
  • pickled herring
  • and any spoiled or improperly stored beef, poultry, fish, or liver
  • red wine
  • beer from a tap
  • beer that has not been pasteurize
  • aged cheeses, including blue, brick, brie, cheddar, parmesan, romano, and swiss
  • sauerkraut
  • over the counter supplements or cough and cold medicines that contain tyramine
  • soy beans
  • soy sauce
  • tofu
  • miso soup
  • bean curd
  • fava beans
  • yeast extracts (such as Marmite)

Caffeine intake should be limited as well.

You should avoid or limit the use of alcohol while being treated with St. John's wort. Alcohol can increase the nervous system side effects of St. John's wort such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment.

Talk to your doctor or pharmacist if you have any questions or concerns.

Moderate:

amLODIPine Alcohol (Ethanol)

Applies to: amlodipine

Ethanol and amLODIPine may have additive effects in lowering your blood pressure.

You may experience headache, dizziness, lightheadedness, fainting, or changes in pulse or heart rate, especially when treatment is started, the dose is changed, or treatment is restarted.

Tell your doctor promptly if these symptoms occur and seek urgent medical help if you faint or have severe dizziness.

Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position.

It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate:

amLODIPine multivitamins with minerals

Applies to: amlodipine

Using amLODIPine together with multivitamins with minerals can decrease the effects of amLODIPine.

Talk with your doctor before using amLODIPine and multivitamins with minerals together. You may need a dose adjustment or need your blood pressure checked more often if you take both medications.

It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Minor food/lifestyle interactions

Minor:

amLODIPine Food/Lifestyle

Applies to: amlodipine

The consumption of grapefruit juice may slightly increase plasma concentrations of amlodipine. The mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. Data have been conflicting and the clinical significance is unknown. Monitoring for calcium channel blocker adverse effects (e.g., headache, hypotension, syncope, tachycardia, edema) is recommended.

The information above is from our professional interaction data. Consumer information is not available for this interaction.

Disease interactions

7 potential interactions Applies to: 7 conditions, including Heart Failure, Heart Attack, Hypotension, Liver Disease, and Aortic Stenosis.

Aortic Stenosis

Major:

amlodipine

amLODIPine has a major potential interaction with Aortic Stenosis.

In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.

Cardiogenic Shock

Major:

amlodipine

amLODIPine has a major potential interaction with Cardiogenic Shock.

In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.

Heart Attack

Moderate:

amlodipine

amLODIPine has a moderate potential interaction with Heart Attack.

Calcium channel blockers (CCBs) may have varying degrees of negative inotropic effect. Congestive heart failure (CHF), worsening of CHF, and pulmonary edema have occurred in some patients treated with a CCB, primarily verapamil. Some CCBs have also caused mild to moderate peripheral edema due to localized vasodilation of dependent arterioles and small blood vessels, which can be confused with the effects of increasing left ventricular dysfunction. Although some CCBs have been used in the treatment of CHF, therapy with CCBs should be administered cautiously in patients with severe left ventricular dysfunction (e.g., ejection fraction < 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Likewise, caution is advised in patients with acute myocardial infarction and pulmonary congestion documented by X-ray on admission, since associated heart failure may be acutely worsened by administration of a CCB.

Heart Failure

Moderate:

amlodipine

amLODIPine has a moderate potential interaction with Heart Failure.

Calcium channel blockers (CCBs) may have varying degrees of negative inotropic effect. Congestive heart failure (CHF), worsening of CHF, and pulmonary edema have occurred in some patients treated with a CCB, primarily verapamil. Some CCBs have also caused mild to moderate peripheral edema due to localized vasodilation of dependent arterioles and small blood vessels, which can be confused with the effects of increasing left ventricular dysfunction. Although some CCBs have been used in the treatment of CHF, therapy with CCBs should be administered cautiously in patients with severe left ventricular dysfunction (e.g., ejection fraction < 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Likewise, caution is advised in patients with acute myocardial infarction and pulmonary congestion documented by X-ray on admission, since associated heart failure may be acutely worsened by administration of a CCB.

Hypotension

Major:

amlodipine

amLODIPine has a major potential interaction with Hypotension.

In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.

Ischemic Heart Disease

Major:

amlodipine

amLODIPine has a major potential interaction with Ischemic Heart Disease.

Increased frequency, duration, and/or severity of angina, as well as acute myocardial infarction, have rarely developed during initiation or dosage increase of calcium channel blockers (CCBs), particularly in patients with severe obstructive coronary artery disease and those treated with immediate-release formulations. The mechanism of this effect is not established. Therapy with CCBs should be administered cautiously in patients with significant coronary artery disease.

Liver Disease

Major:

amlodipine

amLODIPine has a major potential interaction with Liver Disease.

Calcium channel blockers (CCBs) are extensively metabolized by the liver. The half-lives of CCBs may be prolonged substantially in patients with severe hepatic impairment, with the potential for significant drug accumulation. In addition, the use of some CCBs has been associated with elevations in serum transaminases, both with and without concomitant elevations in alkaline phosphatase and bilirubin. While these effects may be transient and reversible, some patients have developed cholestasis or hepatocellular injury. Therapy with CCBs should be administered cautiously and often at reduced dosages in patients with significantly impaired hepatic function. Periodic monitoring of liver function is advised.

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More resources

amlodipine

A total of 583 drugs are known to interact with amlodipine.

st. john's wort

A total of 677 drugs are known to interact with st. john's wort.

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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