NP-T Ingredients & Drug Interactions
by Pure Herbs
What is this page for?
First and foremost: checking NP-T against your medications. The heart of this page is the interaction checker and the full interaction report — how this product’s ingredients may interact with prescription and over-the-counter medicines you may be taking.
Around that, we add a pharmacist’s high-level view of the product as a whole — what’s inside, the evidence for its stated use, how transparent the label is, and what safety data exists — so you can see the full picture in one place. It’s educational information from our licensed clinical databases and the clinical staff at HelloPharmacist — not medical advice — and we don’t sell or endorse products. Our editorial policy
NP-T is a dietary supplement by Pure Herbs with 4 active ingredients. Its ingredients are commonly taken for mild to moderate depression, anxiety and stress, sleep problems.Based on those ingredients, 1,279 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are St. John's Wort aerial parts extract, Skullcap extract, Oat Straw Aerial Parts Extract. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against NP-T by Pure Herbs
Ask about any prescription or over-the-counter medication and we check it for interactions with NP-T by Pure Herbs — and tell you which ingredient is responsible.
AI summaries are generated from our interaction database for education only — always confirm with your pharmacist. How we use AI
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HelloPharmacist Scorecard of NP-T by Pure Herbs
Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.
What’s inside
Low disclosure
Pure Herbs NP-T is a liquid supplement with 4 active ingredients. The product contains St.
John's Wort aerial parts extract, traditionally used for mood support; Skullcap extract, used in herbal practice for relaxation; Oat Straw Aerial Parts extract, valued for its fiber and nutritional profile; and East Indian Sarsaparilla Root Extract. There are no inactive ingredients listed for this product.
Does it work?
Strong evidence
St. John's Wort is likely effective for depression based on available evidence.
It's possibly effective for somatic symptom disorder and menopausal symptoms, but possibly ineffective for HIV/AIDS and irritable bowel syndrome. Skullcap and Oat Straw lack established evidence for the conditions listed in our data—we simply don't have enough reliable research to rate how well they work for epilepsy, stress, stroke, spasticity, contact dermatitis, or premenstrual dysphoric disorder.
Oat Straw as a food ingredient is likely effective for cholesterol support and heart health.
How safe is it?
Well-documented data
St. John's Wort is generally well tolerated short-term but is not recommended during pregnancy or while breastfeeding because there isn't enough safety data—the facts advise against it.
Skullcap should also be avoided in pregnancy and while breastfeeding due to insufficient safety information. Common side effects of St.
John's Wort include diarrhea, dizziness, dry mouth, fatigue, headache, insomnia, and restlessness. Skullcap may cause sedation, cognitive impairment, and digestive upset, especially at higher doses.
St. John's Wort can increase sun sensitivity (photodermatitis), so sun protection matters when using this product.
Rare but serious effects of St. John's Wort include suicidal thoughts and psychosis; discontinue and contact your healthcare provider if you experience these.
Oat Straw is generally well tolerated, though it may cause bloating, gas, and flatulence as your body adjusts to the fiber.
Meds to double-check
Major interaction found
Before taking this product, check with your doctor or pharmacist if you take digoxin (Lanoxin), phenobarbital or phenytoin (seizure drugs), protease inhibitors (HIV medications), tacrolimus (an immunosuppressant), irinotecan or docetaxel (cancer drugs), insulin, diabetes medications, or CNS depressants like sleep aids or sedatives. These are the medication types with documented interactions in this product's ingredients, and some carry Major severity.
The bottom line
Scorecard at a glanceFormula with limited ingredient disclosure with clinical evidence supporting its stated purpose. Major medication interactions have been identified, and safety information is well characterized.
This product is built around St. John's Wort, which has solid evidence for depression but serious interactions with many common medications—especially heart, seizure, HIV, and cancer drugs.
If you take any prescription medication, digoxin, insulin, sedatives, or seizure medications, talk with your doctor or pharmacist before starting it. Even if you don't take those, review your full medication list with your own healthcare provider, since St.
John's Wort affects how your liver processes dozens of drugs.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 3 of 4 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Nov 22, 2022.
This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed
General information
Key facts about NP-T, straight from the product label.
| Brand | Pure Herbs |
|---|---|
| Net contents | 1 Fluid Ounce(s); 30 mL |
| Market status | On market |
| Date entered into DSLD | Nov 22, 2022 |
| DSLD ID | 280043 |
| Product type | Botanical |
| Supplement form | Liquid |
| Dietary claims / uses | All Other, Structure/Function |
| Intended target group(s) | Adult (18 - 50 Years), Women (not pregnant or lactating) |
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.
Supplement Facts
The label details for NP-T by Pure Herbs, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Proprietary Blend | 1915 mg | -- |
| East Indian Sarsaparilla Root Extract | 0 NP | -- |
| St. John's Wort aerial parts extract | 0 NP | -- |
| Skullcap extract | 0 NP | -- |
| Oat Straw Aerial Parts Extract | 0 NP | -- |
Other ingredients: None
Tap any ingredient to jump to its full detail below.
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
Suggested/Recommended/Usage/Directions
Directions: For adults, mix 2 mL (abt. 1/2 tsp) of extract in 2 fl. oz (60 mL) water one time daily preferably with a meal.
Shake well before use
Formulation
Helps to relieve temporary nervousness.
FDA Disclaimer Statement
This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
Precautions
Warning: Do not use this product while taking any prescription drug(s) without the advice of your prescribing physician. Not intended for use by pregnant or nursing women. If you have a medical condition or are taking medication, consult your doctor prior to use.
Avoid excessive exposure to UV irradiation (e.g., sunlight; tanning) when using this product. Discontinue use and consult with your doctor if any adverse reactions occur.
Keep out of reach of children
Brand IP Statement(s)
Pure Herbs, Ltd. Natural Herbal Extracts
FDA Statement of Identity
Dietary Supplement
General Statements
"No expense has been spared to provide the finest nature has to offer."
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
NP-T by Pure Herbs label
The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.
Label images are published by the NIH Dietary Supplement Label Database for the version of this product on file. Always read your actual product label.
View the full label (PDF)The Ingredients in NP-T by Pure Herbs
These are the 4 active ingredients this product is made of. Select any to open its full monograph.
Serving size2 mL Dosage formLiquid Servings per container15 Amounts shown are per serving.
Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.
Proprietary Blend
- › East Indian Sarsaparilla Root Extract
- › St. John's Wort aerial parts extract
- › Skullcap extract
- › Oat Straw Aerial Parts Extract
Other (inactive) ingredients: None. These complete the product’s ingredient list but are not active constituents.
NP-T by Pure Herbs Drug Interactions
HelloPharmacist Interaction Report
Pure Herbs NP-T interacts with medications through its St.
John's Wort aerial parts extract and Oat Straw Aerial Parts Extract. St.
John's Wort poses the most serious concern: it can reduce digoxin (Lanoxin) levels and effectiveness by about 25%, which is a Major interaction that could weaken control of your heart rhythm. St.
John's Wort also carries Major interactions with phenobarbital and phenytoin (seizure medications), protease inhibitors (HIV drugs), tacrolimus (an immunosuppressant), the cancer drug irinotecan, docetaxel (another cancer drug), and mephenytoin. It speeds up how your liver processes these medications, potentially making them less effective or requiring dose adjustments.
Read the full breakdown — every affected drug type, severity by severity
The Oat Straw extract in this product has Moderate interactions with insulin and diabetes medications—it can lower blood sugar, which might increase your risk of low blood sugar (hypoglycemia) if you're already taking drugs to control it. Skullcap extract carries a Moderate interaction with CNS depressants (sedatives, sleep aids, anxiety medications), as it can add to their drowsiness and cognitive effects.
We could not check East Indian Sarsaparilla Root Extract for interactions because we hold no data on it.
Although this product contains four active ingredients, your specific medications are what matter. Check your exact prescriptions using the interaction search tool on this page before you start.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against NP-T?
Ask about interactions with your drugs in plain English — “Can I take it with lisinopril?” — and we find you the answer in seconds, ingredient by ingredient.
Go to the checkerIngredients driving the most interactions
Individual Drug Interactions
The ingredients in NP-T interact with 1,279 drugs. Click any drug to see the details.
3 of the 4 ingredients in NP-T interact with drugs. Each result below shows which ingredient is responsible. St. John's Wort aerial parts extract Skullcap extract Oat Straw Aerial Parts Extract
Amphotericin, TetracyclineMysteclin-F
How Amphotericin, Tetracycline interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractP-glycoprotein Substrates, Photosensitizing Drugs Major
Interaction Summary
St.
Read the full St. John's Wort Aerial Parts Extract + Amphotericin, Tetracycline interactionAmprenavirAgenerase
How Amprenavir interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractProtease Inhibitors (pis), P-glycoprotein Substrates +1 Major
Amylase, Lipase, Protease (prescription Drug)Pancreatin 10, Pancron 10 Pancreatin
How Amylase, Lipase, Protease (prescription Drug) interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractProtease Inhibitors (pis) Major
Antidiabetes, Dipeptidyl Peptidase-4 (dpp-iv) InhibitorGlyxambi
How Antidiabetes, Dipeptidyl Peptidase-4 (dpp-iv) Inhibitor interacts with NP-T — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractP-glycoprotein Substrates Major
Oat Straw Aerial Parts ExtractAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, oats may have additive effects with antidiabetic agents and might increase the risk of hypoglycemia.
Read the full Oat Straw Aerial Parts Extract + Antidiabetes, Dipeptidyl Peptidase-4 (dpp-iv) Inhibitor interactionApalutamideErleada
How Apalutamide interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 3a4 (cyp3a4) Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Aerial Parts Extract + Apalutamide interactionApixabanEliquis
How Apixaban interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractP-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Major
ApomorphineAPO-go, APO-go Pen, APO-go PFS, Apokyn, Uprima
How Apomorphine interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractP-glycoprotein Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Aerial Parts Extract + Apomorphine interactionApomorphine HydrochlorideKynmobi
How Apomorphine Hydrochloride interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractP-glycoprotein Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Aerial Parts Extract + Apomorphine Hydrochloride interactionApremilastOtezla
How Apremilast interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 3a4 (cyp3a4) Substrates Major
AprepitantCinvanti, Emend
How Aprepitant interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 3a4 (cyp3a4) Substrates Major
Aprobarbital, Butabarbital, PhenobarbitalTriple Barbital
How Aprobarbital, Butabarbital, Phenobarbital interacts with NP-T — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractPhenobarbital (luminal), Cytochrome P450 2b6 (cyp2b6) Substrates Major
Skullcap ExtractCns Depressants Moderate
Interaction Summary
Theoretically, skullcap can have additive effects when used with other CNS depressants.
Read the full Skullcap Extract + Aprobarbital, Butabarbital, Phenobarbital interactionAripiprazoleAbilify, Abilify Maintena, Abilify Mycite
How Aripiprazole interacts with NP-T — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Photosensitizing Drugs +1 Major
Interaction Summary
St.
Read the full St. John's Wort Aerial Parts Extract + Aripiprazole interactionSkullcap ExtractCns Depressants Moderate
Interaction Summary
Theoretically, skullcap can have additive effects when used with other CNS depressants.
Read the full Skullcap Extract + Aripiprazole interactionAripiprazole LauroxilAristada, Aristada Initio Kit
How Aripiprazole Lauroxil interacts with NP-T — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractSerotonergic Drugs, Photosensitizing Drugs +1 Major
Interaction Summary
Theoretically, St.
Read the full St. John's Wort Aerial Parts Extract + Aripiprazole Lauroxil interactionSkullcap ExtractCns Depressants Moderate
Interaction Summary
Theoretically, skullcap can have additive effects when used with other CNS depressants.
Read the full Skullcap Extract + Aripiprazole Lauroxil interactionArmodafinilNuvigil
How Armodafinil interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 3a4 (cyp3a4) Substrates, P-glycoprotein Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Aerial Parts Extract + Armodafinil interactionAspirin, Butalbital, CaffeineFiorinal
How Aspirin, Butalbital, Caffeine interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Aerial Parts Extract + Aspirin, Butalbital, Caffeine interactionAspirin, Butalbital, Caffeine, Codeine PhosphateFiorinal w/ Codeine
How Aspirin, Butalbital, Caffeine, Codeine Phosphate interacts with NP-T — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Major
Skullcap ExtractCns Depressants Moderate
Interaction Summary
Theoretically, skullcap can have additive effects when used with other CNS depressants.
Read the full Skullcap Extract + Aspirin, Butalbital, Caffeine, Codeine Phosphate interactionAspirin, Butalbital, Caffeine, PhenacetinMarnal
How Aspirin, Butalbital, Caffeine, Phenacetin interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Major
Aspirin, CaffeineAnacin
How Aspirin, Caffeine interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Aerial Parts Extract + Aspirin, Caffeine interactionAspirin, Caffeine, Codeine PhosphateAnacin w/ Codeine
How Aspirin, Caffeine, Codeine Phosphate interacts with NP-T — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Major
Skullcap ExtractCns Depressants Moderate
Interaction Summary
Theoretically, skullcap can have additive effects when used with other CNS depressants.
Read the full Skullcap Extract + Aspirin, Caffeine, Codeine Phosphate interactionAspirin, Caffeine, Dihydrocodeine BitartrateSynalgos DC
How Aspirin, Caffeine, Dihydrocodeine Bitartrate interacts with NP-T — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Major
Skullcap ExtractCns Depressants Moderate
Interaction Summary
Theoretically, skullcap can have additive effects when used with other CNS depressants.
Read the full Skullcap Extract + Aspirin, Caffeine, Dihydrocodeine Bitartrate interactionAspirin, Caffeine, Dover's PwdAcedoval, Dovacet
How Aspirin, Caffeine, Dover's Pwd interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Aerial Parts Extract + Aspirin, Caffeine, Dover's Pwd interactionAspirin, Caffeine, HydrocodoneDamason-P
How Aspirin, Caffeine, Hydrocodone interacts with NP-T — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Aerial Parts Extract + Aspirin, Caffeine, Hydrocodone interactionSkullcap ExtractCns Depressants Moderate
Interaction Summary
Theoretically, skullcap can have additive effects when used with other CNS depressants.
Read the full Skullcap Extract + Aspirin, Caffeine, Hydrocodone interactionAspirin, Caffeine, Isobutylallylbarbituric Acid, PhenacetinLanorinal
How Aspirin, Caffeine, Isobutylallylbarbituric Acid, Phenacetin interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Major
Aspirin, Caffeine, OrphenadrineInvagesic, Invagesic Forte, Norgesic, Norgesic Forte, Orphengesic, Orphengesic Forte
How Aspirin, Caffeine, Orphenadrine interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 2b6 (cyp2b6) Substrates +1 Major
Interaction Summary
St.
Read the full St. John's Wort Aerial Parts Extract + Aspirin, Caffeine, Orphenadrine interactionAspirin, Caffeine, Phenacetin, PropoxypheneMargesic Comp. 65
How Aspirin, Caffeine, Phenacetin, Propoxyphene interacts with NP-T — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Major
Skullcap ExtractCns Depressants Moderate
Interaction Summary
Theoretically, skullcap can have additive effects when used with other CNS depressants.
Read the full Skullcap Extract + Aspirin, Caffeine, Phenacetin, Propoxyphene interactionAspirin, Chlorpheniramine, PhenylpropanolamineAlka-Seltzer Plus Cold
How Aspirin, Chlorpheniramine, Phenylpropanolamine interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Photosensitizing Drugs +1 Major
Aspirin, Codeine Phosphate, PhenobarbitalPhenaphen
How Aspirin, Codeine Phosphate, Phenobarbital interacts with NP-T — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractPhenobarbital (luminal), Cytochrome P450 2b6 (cyp2b6) Substrates Major
Skullcap ExtractCns Depressants Moderate
Interaction Summary
Theoretically, skullcap can have additive effects when used with other CNS depressants.
Read the full Skullcap Extract + Aspirin, Codeine Phosphate, Phenobarbital interactionAspirin, HydrocodoneAlor 5 500, Lortab ASA
How Aspirin, Hydrocodone interacts with NP-T — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 3a4 (cyp3a4) Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Aerial Parts Extract + Aspirin, Hydrocodone interactionSkullcap ExtractCns Depressants Moderate
Interaction Summary
Theoretically, skullcap can have additive effects when used with other CNS depressants.
Read the full Skullcap Extract + Aspirin, Hydrocodone interactionAspirin, OmeprazoleYosprala
How Aspirin, Omeprazole interacts with NP-T — through 1 ingredient. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractCytochrome P450 2c9 (cyp2c9) Substrates, Omeprazole (prilosec) +2 Major
Interaction Summary
St.
Read the full St. John's Wort Aerial Parts Extract + Aspirin, Omeprazole interactionAspirin, OxycodonePercodan
How Aspirin, Oxycodone interacts with NP-T — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort Aerial Parts ExtractOxycodone (oxycontin) Major
Interaction Summary
St.
Read the full St. John's Wort Aerial Parts Extract + Aspirin, Oxycodone interactionSkullcap ExtractCns Depressants Moderate
Interaction Summary
Theoretically, skullcap can have additive effects when used with other CNS depressants.
Read the full Skullcap Extract + Aspirin, Oxycodone interactionEach ingredient & the kinds of drugs it affects
For each ingredient in NP-T with known interactions, here are the types of medications they can affect. Open any type for the detail — or search your exact drug in the checker above.
St. John's Wort aerial parts extract
Alprazolam (Xanax)
St. John's wort increases the clearance of alprazolam and decreases its effects.
Alprazolam, which is used as a probe for cytochrome P450 3A4 (CYP3A4) activity, has a two-fold increase in clearance when given with St. John's wort. St. John's wort reduces the half-life of alprazolam from 12.4 hours to 6 hours.
Contraceptive Drugs
St. John's wort increases the clearance of contraceptive drugs and reduces their clinical effects.
Females taking St. John's wort and oral contraceptives concurrently should use an additional or alternative form of birth control. St. John's wort can decrease norethindrone and ethinyl estradiol levels by 13% to 15%, resulting in breakthrough bleeding, irregular menstrual bleeding, or unplanned pregnancy. Bleeding irregularities usually occur within a week of starting St. John's wort and regular cycles usually return when St. John's wort is discontinued. Unplanned pregnancy has occurred with concurrent use of oral contraceptives and St. John's wort extract. St. John's wort is thought to induce the cytochrome P450 1A2 (CYP1A2), 2C9 (CYP2C9), and 3A4 (CYP3A4) enzymes, which are responsible for metabolism of progestins and estrogens in contraceptives.
Cyclosporine (Neoral, Sandimmune)
St. John's wort reduces the levels and clinical effects of cyclosporine.
Concomitant use can decrease plasma cyclosporine levels by 30% to 70%. Using St. John's wort with cyclosporine in patients with heart, kidney, or liver transplants can cause subtherapeutic cyclosporine levels and acute transplant rejection. This interaction has occurred with a St. John's wort extract standardized to 0.3% hypericin and dosed at 300-600 mg per day. Withdrawal of St. John's wort can result in a 64% increase in cyclosporine levels. St. John's wort induces cytochrome P450 3A4 (CYP3A4) and the multi-drug transporter, P-glycoprotein/MDR-1, which increases cyclosporine clearance.
Cytochrome P450 3A4 (Cyp3A4) Substrates
St. John's wort increases the metabolism and reduces the levels of CYP3A4 substrates.
St. John's wort induces CYP3A4 enzymes and increases metabolism of CYP3A4 substrates. Clinically significant interactions have been reported with St. John's wort products containing hyperforin 1 mg or more.
Digoxin (Lanoxin)
St. John's wort reduces the levels and clinical effects of digoxin.
St. John's wort can reduce the bioavailability, serum levels, and therapeutic effects of digoxin. Taking an extract of St. John's wort 900 mg, containing hyperforin 7.5 mg or more, daily for 10-14 days, can reduce serum digoxin levels by 25% in healthy people. St. John's wort is thought to affect the multidrug transporter, P-glycoprotein, which mediates the absorption and elimination of digoxin and other drugs. St. John's wort products providing less than 7.5 mg of hyperforin daily do not appear to affect digoxin levels.
Docetaxel (Taxotere)
St. John's wort reduces the levels and clinical effects of docetaxel.
Clinical research shows that taking a specific St. John's wort product (Hyperiplant, VSM) 300 mg three times daily for 14 days increases docetaxel clearance by about 14%, resulting in decreased plasma concentrations of docetaxel in cancer patients. This is most likely due to induction of cytochrome P450 3A4 (CYP3A4) by St. John's wort.
Imatinib (Gleevec)
St. John's wort reduces the levels and clinical effects of imatinib.
Taking St. John's wort 900 mg daily for 2 weeks reduces the bioavailability and half-life of a single dose of imatinib and decreases its serum levels by 30% in healthy volunteers. This is most likely due to induction of cytochrome P450 3A4 (CYP3A4) by St. John's wort, which increases clearance of imatinib.
Irinotecan (Camptosar)
St. John's wort reduces the levels and clinical effects of irinotecan.
St. John's wort 900 mg daily for 18 days decreases serum levels of irinotecan by at least 50%. Clearance of the active metabolite of irinotecan, SN-38, is also increased, resulting in a 42% decrease in the area under the concentration-time curve. This is thought to be due to induction of cytochrome P450 3A4 (CYP3A4) by St. John's wort.
Mephenytoin (Mesantoin)
St. John's wort reduces the levels and clinical effects of mephenytoin.
Preliminary clinical research in healthy males shows that taking St. John's wort for 14 days induces cytochrome P450 2C19 (CYP2C19) and significantly increases metabolism of mephenytoin (Mesantoin). In people with wild-type 2C19, metabolism was almost 4-fold greater in subjects who received St. John's wort compared to placebo. In contrast, patients with 2C19*2/*2 and *2/*3 genotypes did not demonstrate a similar increase in metabolism.
Non-Nucleoside Reverse Transcriptase Inhibitors (Nnrtis)
St. John's wort decreases the levels and clinical effects of NNRTIs.
St. John's wort increases the oral clearance of nevirapine (Viramune) by 35%. Subtherapeutic concentrations are associated with therapeutic failure, development of viral resistance, and development of drug class resistance. St. John's wort induces intestinal and hepatic cytochrome P450 3A4 (CYP3A4) and intestinal P-glycoprotein/MDR-1, a drug transporter.
Omeprazole (Prilosec)
St. John's wort decreases the levels and clinical effects of omeprazole.
Taking St. John's wort, 300 mg orally three times daily for 14 days, reduces serum concentrations of omeprazole by inducing its metabolism via cytochrome P450 (CYP) 2C19 and 3A4. The reduction of omeprazole serum levels is dependent on CYP2C19 genotype, with reductions up to 50% in extensive metabolizers and 38% in poor metabolizers.
Oxycodone (Oxycontin)
St. John's wort decreases the levels and clinical effects of oxycodone.
St. John's wort can increase oxycodone metabolism by inducing cytochrome P450 3A4 (CYP3A4), reducing plasma levels and analgesic activity.
P-Glycoprotein Substrates
St. John's wort decreases the levels and clinical effects of P-glycoprotein substrates.
St. John's wort induces P-glycoprotein. P-glycoprotein is a carrier mechanism responsible for transporting drugs and other substances across cell membranes. When P-glycoprotein is induced in the gastrointestinal (GI) tract, it can prevent the absorption of some medications. In addition, induction of p-glycoprotein can decrease entry of drugs into the central nervous system (CNS) and decrease access to other sites of action.
Phenobarbital (Luminal)
St. John's wort decreases the levels and clinical effects of phenobarbital.
St. John's wort may increase the metabolism of phenobarbital. Plasma concentrations of phenobarbital should be monitored carefully. The dose of phenobarbital may need to be increased when St. John's wort is started and decreased when it is stopped.
Phenprocoumon (Marcoumar, Others)
St. John's wort decreases the levels and clinical effects of phenprocoumon.
St. John's wort appears to increase the metabolism of phenprocoumon (an anticoagulant that is not available in the US) by increasing the activity of the cytochrome P450 2C9 (CYP2C9) enzyme. This may result in decreases in the anticoagulant effect and international normalized ratio (INR).
Phenytoin (Dilantin)
St. John's wort decreases the levels and clinical effects of phenytoin.
St. John's wort may increase the metabolism of phenytoin. Plasma concentrations of phenytoin should be monitored closely. The dose of phenytoin may need to be increased when St. John's wort is started and decreased when it is stopped.
Protease Inhibitors (Pis)
St. John's wort reduces the levels and clinical effects of PIs.
In healthy volunteers, St. John's wort can reduce the plasma concentrations of indinavir (Crixivan) by inducing cytochrome P450 3A4 (CYP3A4). This might result in treatment failure and viral resistance. St. John's wort also induces P-glycoprotein, which can result in decreased intracellular protease inhibitor concentrations and increased elimination.
Rivaroxaban (Xarelto)
St. John's wort decreases the levels and clinical effects of rivaroxaban.
A small pharmacokinetic study in healthy volunteers shows that taking a single dose of rivaroxaban 20 mg after using a specific St. John's wort extract (Jarsin, Vifor SA) 450 mg orally twice daily for 14 days reduces the bioavailability of rivaroxaban by 24% and reduces rivaroxaban's therapeutic inhibition of factor Xa by 20%.
Tacrolimus (Prograf)
St. John's wort decreases the levels and clinical effects of tacrolimus.
Taking a St. John's wort extract (Jarsin) 600 mg daily significantly decreases tacrolimus serum levels. Dose increases of 60% may be required to maintain therapeutic tacrolimus levels in patients taking St. John's wort. St. John's wort is thought to lower tacrolimus levels by inducing cytochrome P450 3A4 (CYP3A4) enzymes. A small clinical study in healthy adults also shows that taking St. John's wort 300 mg three times daily for 10 days decreases the total systemic exposure to tacrolimus by 27% and 33% after taking a single 5 mg dose of immediate-release or prolonged-release tacrolimus, respectively.
Warfarin (Coumadin)
St. John's wort decreases the levels and clinical effects of warfarin.
Taking St. John's wort significantly increases clearance of warfarin, including both its R- and S-isomers. This is likely due to induction of cytochrome P450 (CYP) 1A2 and CYP3A4. St. John's wort can also significantly decrease International Normalized Ratio (INR) in people taking warfarin. In addition, taking warfarin at the same time as St. John's wort might reduce warfarin bioavailability. When a dried extract is mixed with warfarin in an aqueous medium, up to 30% of warfarin is bound to particles, reducing its absorption.
Aminolevulinic Acid
St. John's wort might have additive phototoxic effects with aminolevulinic acid.
Concomitant use with St. John's wort extract may cause synergistic phototoxicity. Delta-aminolevulinic acid can cause a burning erythematous rash and severe swelling of the face, neck, and hands when taken with St. John's wort.
Bupropion (Wellbutrin)
St. John's wort might reduce the levels and effects of bupropion.
Clinical research shows that taking St. John's wort 325 mg three times daily for 14 days along with bupropion reduces the area under the concentration-time curve by approximately 14% and increases the clearance of bupropion by approximately 20%. This effect is attributed to the induction of cytochrome P450 2B6 (CYP2B6) by St. John's wort.
Clopidogrel (Plavix)
St. John's wort might increase the levels and effects of clopidogrel.
Taking St. John's wort with clopidogrel seems to increase the activity of clopidogrel. In clopidogrel non-responders, taking St. John's wort seems to induce metabolism of clopidogrel to its active metabolite by cytochrome P450 enzymes 3A4 and 2C19. This leads to increased antiplatelet activity. Theoretically, this might lead to an increased risk of bleeding in clopidogrel responders.
Clozapine (Clozaril)
St. John's wort might decrease the levels and clinical effects of clozapine.
A case report describes a female with schizophrenia controlled on clozapine who had a return of symptoms when she started taking St. John's wort. The plasma concentration of clozapine was reduced, likely because its clearance was increased due to induction of the cytochrome P450 enzymes 3A4, 1A2, 2C9, and 2C19 by St. John's wort.
Cytochrome P450 1A2 (Cyp1A2) Substrates
St. John's wort may increase the metabolism and reduce the levels of CYP1A2 substrates.
Clinical and in vitro research shows that St. John's wort induces CYP1A2, but to a lesser extent than CYP3A4.
Skullcap extract
Cns Depressants
Theoretically, skullcap can have additive effects when used with other CNS depressants.
Animal and clinical research suggests that skullcap can cause sedation and cognitive impairment.
Oat Straw Aerial Parts Extract
Antidiabetes Drugs
Theoretically, oats may have additive effects with antidiabetic agents and might increase the risk of hypoglycemia.
Consuming oats can decrease blood glucose in patients with diabetes. In those who require insulin, taking oats 100 grams daily for 2 days reduces the insulin dose required to achieve metabolic control.
Insulin
Concomitant use of oats and insulin might increase the risk of hypoglycemia.
In patients with insulin-dependent type 2 diabetes, taking oats 100 grams daily for 2 days reduces the insulin dose required to achieve metabolic control.
Brand information
Manufacturer and brand details for NP-T, from the product label.
Pure Herbs
See all Pure Herbs products- Name
- Pure Herbs, Ltd.
- City
- Sterling Heights
- State
- MI
- Phone Number
- (800) 860-4372
- Web Address
- www.pureherbs.com
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Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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The Full Monographs Behind NP-T’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
St. John's Wort
Interacts with 1,143 drugsSt. John's wort is a well-studied herb most often used for mild to moderate depression, and some research suggests it may help with this. However, it has many serious interactions with presc...
Read the full St. John's Wort monograph → Herb & supplement monographSkullcap
Interacts with 248 drugsAmerican skullcap is an herb traditionally used to calm anxiety and promote relaxation, but solid human evidence is very limited. It is generally considered relatively safe for short-term us...
Read the full Skullcap monograph → Herb & supplement monographOats
Interacts with 86 drugsOats are a well-studied whole grain whose soluble fiber (beta-glucan) can help lower cholesterol and support heart health when eaten regularly. As a food, oats are safe for most people, and...
Read the full Oats monograph →Sources & How We Checked
NP-T's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.
- NIH Dietary Supplement Label Database (DSLD) — The official product label on file for this supplement.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference behind the ingredient interaction data.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.
The 168 references behind this product’s interaction data
Every citation that drives the interaction findings for this product’s ingredients, from the evidence-graded Natural Medicines (TRC Healthcare) database. Open an ingredient to browse its citations — links open the study on PubMed or the publisher’s site.
St. John's Wort 152 references
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- Eich-Hochli, D., Oppliger, R., Golay, K. P., Baumann, P., and Eap, C. B. Methadone maintenance treatment and St. John's Wort - a case report. Pharmacopsychiatry 2003;36(1):35-37. PubMed
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- Kawaguchi, A., Ohmori, M., Tsuruoka, S., Nishiki, K., Harada, K., Miyamori, I., Yano, R., Nakamura, T., Masada, M., and Fujimura, A. Drug interaction between St John's Wort and quazepam. Br.J.Clin Pharmacol. 2004;58(4):403-410. PubMed
- Dresser, G. K., Schwarz, U. I., Wilkinson, G. R., and Kim, R. B. Coordinate induction of both cytochrome P4503A and MDR1 by St John's wort in healthy subjects. Clin Pharmacol Ther 2003;73(1):41-50. PubMed
- Patel, J., Buddha, B., Dey, S., Pal, D., and Mitra, A. K. In vitro interaction of the HIV protease inhibitor ritonavir with herbal constituents: changes in P-gp and CYP3A4 activity. Am.J.Ther. 2004;11(4):262-277. PubMed
- Xu, H., Williams, K. M., Liauw, W. S., Murray, M., Day, R. O., and McLachlan, A. J. Effects of St John's wort and CYP2C9 genotype on the pharmacokinetics and pharmacodynamics of gliclazide. Br.J.Pharmacol. 2008;153(7):1579-1586.
- Wang, L. S., Zhou, G., Zhu, B., Wu, J., Wang, J. G., Abd El-Aty, A. M., Li, T., Liu, J., Yang, T. L., Wang, D., Zhong, X. Y., and Zhou, H. H. St John's wort induces both cytochrome P450 3A4-catalyzed sulfoxidation and 2C19-dependent hydroxylation of omepr
- Hojo, Y., Echizenya, M., Ohkubo, T., and Shimizu, T. Drug interaction between St John's wort and zolpidem in healthy subjects. J.Clin.Pharm.Ther. 2011;36(6):711-715. PubMed
- Izzo, A. A. and Ernst, E. Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs 2009;69(13):1777-1798. PubMed
- Barbenel, D. M., Yusufi, B., O'Shea, D., and Bench, C. J. Mania in a patient receiving testosterone replacement postorchidectomy taking St John's wort and sertraline. J Psychopharmacol 2000;14(1):84-86.
- Ratz, A. E., von Moos, M., and Drewe, J. [St. John's wort: a pharmaceutical with potentially dangerous interactions]. Schweiz Rundsch.Med Prax. 5-10-2001;90(19):843-849.
- Guzelcan, Y., Scholte, W. F., Assies, J., and Becker, H. E. [Mania during the use of a combination preparation with St. John's wort (Hypericum perforatum)]. Ned.Tijdschr.Geneeskd. 10-6-2001;145(40):1943-1945.
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