Herb Interactions with Lurasidone and Divalproex Acid

Critical Herb Contraindications

St. John's Wort (Hypericum perforatum) is problematic with divalproex acid, as it induces CYP3A4 and can reduce levels of multiple medications, according to the American Heart Association and the European Association for the Study of the Liver 1, 2
St. John's Wort can cause serotonin syndrome when combined with other serotonergic agents, and may decrease platelet aggregation, adding bleeding risk, as reported by the Mayo Clinic 3

Kava (Piper methysticum) should be held 2 weeks before any procedure due to potential additive sedation with anesthetics and benzodiazepines, and may act additively or synergistically with CNS depressants, causing excessive sedation, as noted by the Mayo Clinic 4
Valerian (Valeriana officinalis) may cause additive CNS depression when combined with sedatives, and the American Academy of Sleep Medicine suggests against its use for restless legs syndrome, indicating limited evidence for efficacy 4, 5

Ginkgo (Ginkgo biloba) displaces platelet-activating factor, may potentiate bleeding with warfarin or aspirin, as reported by the Mayo Clinic 4
Saw palmetto may increase bleeding time, and turmeric inhibits platelet aggregation via thromboxane metabolism, according to the Mayo Clinic 3
Garlic (Allium sativum) inhibits thromboxane synthetase and decreases platelet aggregation, and ginger (Zingiber officinale) has laboratory evidence of decreased platelet aggregation, as noted by the Mayo Clinic 4

Goldenseal (Hydrastis canadensis) should be held 2 weeks due to high potential for drug interactions through CYP3A4 and CYP2D6 metabolism, as reported by the Mayo Clinic 4
Schisandra should be held 2 weeks due to effects on drug metabolism, and has multiple bioactive compounds that may interact with medications, according to the Mayo Clinic 3

Lemon balm (Melissa officinalis) should be held 2 weeks as combination with sedatives or alcohol may result in additive CNS depression, as noted by the Mayo Clinic 4
Skullcap (Scutellaria lateriflora) should be held 2 weeks due to dose-dependent sedation, and concern for additive CNS depressive effects, as reported by the Mayo Clinic 3
Hops (Humulus lupulus) should be used cautiously, as sedative effects may be additive with valerian, according to the Mayo Clinic 4

Gymnema should be held 2 weeks as it inhibits glucose absorption and increases insulin secretion, as reported by the Mayo Clinic 4

Quality control issues with herbal preparations lack standardization, making interactions unpredictable, as noted by the American Heart Association 1