Drug General Information (ID: DDIIF8H2E7)
  Drug Name Almotriptan Drug Info St. John's Wort Drug Info
  Drug Type Small molecule Natural product
  Therapeutic Class Antimigraine Agents Herbal Products/Antidepressants

 Mechanism of Almotriptan-St. John's Wort Interaction (Severity Level: Moderate)
     Additive serotonergic effects Click to Show/Hide Mechanism Graph
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      Drug Name Almotriptan St. John's Wort
      Mechanism Serotonergic effects
5-HT 1 receptor  Agonist
Serotonergic effects
      Key Mechanism Factor 1
Factor Name 5-HT 1 receptor Structure Sequence
Protein Family G-protein coupled receptor 1 family
Protein Function
G-protein coupled receptor for 5-hydroxytryptamine (serotonin). Also functions as a receptor for various drugs and psychoactive substances. Ligand binding causes a conformation change that triggers signaling via guanine nucleotide-binding proteins (G proteins) and modulates the activity of down-stream effectors, such as adenylate cyclase. Beta-arrestin family members inhibit signaling via G proteins and mediate activation of alternative signaling pathways. Signaling inhibits adenylate cyclase activity and activates a phosphatidylinositol-calcium second messenger system that regulates the release of Ca(2+) ions from intracellular stores. Plays a role in the regulation of 5-hydroxytryptamine release and in the regulation of dopamine and 5-hydroxytryptamine metabolism. Plays a role in the regulation of dopamine and 5-hydroxytryptamine levels in the brain, and thereby affects neural activity, mood and behavior. Plays a role in the response to anxiogenic stimuli.
    Click to Show/Hide
      Mechanism Description
  • Additive serotonergic effects by the combination of Almotriptan and St. John's Wort 

Recommended Action
      Management In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Some authorities recommend that St. John's wort should be stopped during treatment with 5-HT1 agonists.

References
1 Patel S, Robinson R, Burk M "Hypertensive crisis associated with St. John's Wort." Am J Med 112 (2002): 507-8. [PMID: 11959071]
2 Product Information. Amerge (naratriptan). Glaxo Wellcome, Research Triangle Park, NC.