Fluoxetine
Prozac, Sarafem
Ibogaine and St John's Wort
Also known as: St Johns Wort, Hypericum, Hyperforin
Serotonergic + CYP enzyme inducer. Serotonin syndrome risk.
Severity
Moderate caution
Mechanism
Serotonergic activity (serotonin syndrome)
Protocol Status
Pre-arrival washout (under your prescribing physician)
Restart Delay
Physician discretion
What "Moderate caution" Means
Use with caution. Often requires a brief hold, dose reduction, or enhanced monitoring rather than full discontinuation.
Clinical Action
What our medical team does for patients on St John's Wort.
Discontinue minimum 14 days before treatment (long enzyme induction effects).
Where the Washout Happens
Pre-arrival washout (under your prescribing physician)
Discontinuation is completed before arrival, under the patient's own prescribing physician, with the medication-specific washout interval observed before the flood dose.
Pre-Treatment Washout Window
14 days minimum before treatment.
Post-Treatment Restart
Restart at physician discretion once acute window closes.
The Pharmacology
How St John's Wort interacts with ibogaine: serotonergic activity (serotonin syndrome).
Noribogaine is a potent serotonin reuptake inhibitor. Combining it with another drug that raises synaptic serotonin (SSRIs, SNRIs, MAOIs, triptans, tramadol, MDMA, St John's Wort) can trigger serotonin syndrome — autonomic instability, hyperthermia, neuromuscular hyperactivity, and altered mental state. This is a leading cause of preventable harm in psychedelic medicine and the reason serotonergic medications carry the longest washout windows.
Same Mechanism
Other medications that interact via serotonergic activity (serotonin syndrome).
Same Severity Tier
Other moderate caution medications (different mechanism).
QT-interval prolongation
Ondansetron
Zofran
QT-interval prolongation
Azithromycin
Zithromax, Z-Pack
Cardiac conduction (bradycardia / AV node)
Metoprolol
Lopressor, Toprol
Cardiac conduction (bradycardia / AV node)
Atenolol
Tenormin
Cardiac conduction (bradycardia / AV node)
Propranolol
Inderal
Cardiac conduction (bradycardia / AV node)
Carvedilol
Coreg
Common Questions
St John's Wort and ibogaine treatment.
Can I take ibogaine if I am on St John's Wort?
Moderate caution. Serotonergic + CYP enzyme inducer. Serotonin syndrome risk. Discontinue minimum 14 days before treatment (long enzyme induction effects).
How long do I need to be off St John's Wort before ibogaine treatment?
Pre-arrival washout (under your prescribing physician). Discontinuation is completed before arrival, under the patient's own prescribing physician, with the medication-specific washout interval observed before the flood dose. 14 days minimum before treatment.
What is the mechanism of the interaction?
Serotonergic activity (serotonin syndrome). Noribogaine is a potent serotonin reuptake inhibitor. Combining it with another drug that raises synaptic serotonin (SSRIs, SNRIs, MAOIs, triptans, tramadol, MDMA, St John's Wort) can trigger serotonin syndrome — autonomic instability, hyperthermia, neuromuscular hyperactivity, and altered mental state. This is a leading cause of preventable harm in psychedelic medicine and the reason serotonergic medications carry the longest washout windows.
Can I switch to a different medication so I can have ibogaine treatment?
In many cases yes. Our medical team works with your prescribing physician to taper or substitute medications safely before treatment. The right substitution depends on the underlying condition you are treating with St John's Wort — contact us for an individual review.
Checking more than one medication? Use the interactive Drug Interaction Checker to screen your full medication list at once.
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DA
Medically reviewed by Dr. Arellano, M.D.
Clinical Director, MindScape Retreat · Board-certified physician specializing in ibogaine-assisted detoxification with over 900 patients treated.
Last reviewed: May 2026 · See full medical team