St. John's Wort and Ketamine Therapy | Tovani Health
Hypericum perforatum (St. John's Wort) — Herbal antidepressant (CYP3A4 inducer, serotonergic)
Verdict at Tovani Health
Two real concerns: CYP3A4 induction may reduce ketamine exposure, and the serotonergic load is additive.
St. John's Wort and ketamine warrant individual evaluation. Two specifics: St. John's Wort is a potent CYP3A4 inducer, similar in magnitude to carbamazepine, which can reduce ketamine plasma levels. And it has serotonergic activity like an SSRI, which we monitor accordingly. We typically ask patients to taper off before starting KAP.
If you take Hypericum perforatum regularly and are considering at-home ketamine therapy, the combination is depends on your specific situation. This page covers the brief pharmacologic context and what we do at intake.
How Hypericum perforatum interacts with ketamine
Hyperforin in St. John's Wort potently induces CYP3A4 (and CYP1A2, 2C9, 2C19) and P-glycoprotein. Hypericin and other compounds have serotonergic activity. The CYP induction also reduces effectiveness of many other prescription medications (including OCPs, anticoagulants, and antiretrovirals).
What we do at intake
Disclose dose, brand, and how long you have been taking it. Stopping abruptly is not typically dangerous but may unmask depression symptoms. We coordinate a taper plan with you.
Bottom line
St. John's Wort and ketamine warrant individual evaluation. Two specifics: St. John's Wort is a potent CYP3A4 inducer, similar in magnitude to carbamazepine, which can reduce ketamine plasma levels. And it has serotonergic activity like an SSRI, which we monitor accordingly. We typically ask patients to taper off before starting KAP.
Frequently Asked Questions
If I stop St. John's Wort, how long until KAP is appropriate?
We typically wait 2 weeks after stopping for CYP3A4 activity to normalize.
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Hypericum perforatum (St. John's Wort) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 16, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.