I am aware that it is unwise to combine the herbal remedy St John's Wort with most prescription meds this is usually due to the fact that some anti-depressants increase serotonin (or at least stop it from being re-absorbed) as does SJW.

However I am taking lofepramine (Gamanil) an older style tricyclic. The patient information leaflet says not to take with SJW as it may affect the way the tablets work.

Can anyone explain the exact reasons. Would it cause serotonin syndrome, or would it render the lofepramine ineffective ? what would the implications be ?

I hope I've made myself clear ! and hope someone can help ? Thanks !