SSRIs St John s wort

Drugs that may affect ritonavir include clarithromycin, didanosine, azole antifungals, nevirapine, SSRIs, St. John s wort, and rifamycins. 

The most recent systematic review and meta-analysis involved 37 randomized, double-blind, controlled trials (26 compared St. John s wort to placebo, 7 to tricyclic antidepressants, and 7 to selective serotonin reuptake inhibitors [SSRIs]). St. John s wort was reported to be more efficacious than placebo and equivalent to prescription reference treatments including the SSRIs for mild to moderate depression. Most trials used 900 mg/d (for mild to moderate depression) of St. John s wort for 4-12 weeks. 

For reports of the serotonin syndrome and other adverse effects when St John s wort was taken together with SSRIs, see SSRIs + St John s wort Hypericumperforatum) p.l224. 

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