What is the interaction between St. John's Wort and tramadol?

St. John's Wort is known to be a potent inducer of certain cytochrome P450 enzymes, particularly CYP3A4 and CYP2D6. When taken alongside tramadol, which is metabolized by these enzymes, St. John's Wort can increase the risk of serotonin syndrome. This syndrome occurs when there is an excess of serotonin in the central nervous system, which can happen if tramadol’s serotonergic effects are amplified due to the interaction with St. John's Wort.

Tramadol has a dual mechanism; it acts as an opioid and also has serotonergic effects. By inducing the enzymes involved in tramadol metabolism, St. John's Wort can lead to potentially higher levels of tramadol and increased serotonin release. This elevation can precipitate symptoms of serotonin syndrome, such as confusion, agitation, rapid heart rate, and potentially life-threatening complications.

In contrast, the other options do not accurately describe the relationship between St. John's Wort and tramadol. For example, St. John's Wort generally does not enhance the absorption of tramadol, nor does it decrease its metabolism; instead, it can alter how tramadol is processed. Additionally, while tramadol can cause respiratory depression, St. John's Wort does not specifically increase this effect. Thus, the