Vitamin B12

Increased serum B12 levels


One clinical study reported that combined long-term use of phenobarbital and phenytoin resulted in significantly increased serum B12 levels — clinical significance unknown


Vitamin B6 (pyridoxine)

Reduced drug effects

Caution — monitor for reduced drug effectiveness

B6 in high doses may lower plasma levels and efficacy of drug and decrease seizure control

Phenytoin and valproate

Vitamin D

Reduced side-effects

Beneficial interaction possible

Anticonvulsants induce catabolism of vitamin D through liver induction — prolonged use is associated with increased risk of developing rickets and osteomalacia, therefore increased intake may be useful with long-term therapy



Potential outcome




Antidepressants including SSRIs, SNRIs, tricyclics and MAOIs


Additive effects


Increased risk of serotonergic syndrome is theoretically possible, as the herb increases serotonin levels, according to in vivo studies — clinical significance unknown

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