Interactions Between Nonprescription Products and Psychotropic Medications

W. Steven Pray, PhD, DPh


US Pharmacist. 2007;32(11):12-15. 

In This Article

Nonlabeled Psychotropic Interactions

The medical literature mentions numerous potential interactions between nonprescription products and psychotropic medications. Despite their inclusion in the literature, many are not included on the FDA-required label. Thus, the patient contemplating purchase of products without physician advice encounters no label warning and can rely only on the help of an informed pharmacist. For instance, cimetidine can interact with benzodiazepines, a fact not required on the cimetidine label.

Dietary supplements seldom, if ever, carry drug interaction warnings. Nevertheless, they can be the source of interactions with psychotropic medications. The following have been observed: St. John's wort and other SSRI antidepressants (serotonin syndrome); St. John's wort and lowered plasma concentration when used with amitriptyline, alprazolam, or midazolam; black cohosh and sedatives/hypnotics; capsicum and barbiturates or MAOIs; cat's claw and Halcion; chamomile and benzodiazepines or sedatives; coenzyme Q10 and phenothiazines or tricyclics; ephedra and MAOIs or tricyclics; eucalyptus and amphetamines or barbiturates; fish oil and antipsychotics; gingko and MAOIs; ginseng and MAOIs or stimulants; and kava and numerous psychotropics.[7,8,9,10]


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