Use of high-dose St John's Wort extract has, in isolated instances, been associated with interactions with the following drugs, which may lead to reduced therapeutic efficacy : Coumarin-type drugs that inhibit blood clotting (e.g., phenprocoumon, warfarin), cyclosporin, digoxin, indinavir, amitriptyline, nortriptyline, oral contraceptives ("the pill"; risk of intermenstrual bleeding/spotting), theophylline. The photosensitizing effect of other drugs may be increased. Concurrent administration of certain antidepressants (nefazodone, paroxetine, sertraline) may increase undesirable effects (such as nausea, vomiting, anxiety, restlessness, confusion). |