St. John's wort has been used for depression.
Some herbal/dietary supplement products have been found to contain possibly harmful impurities/additives. Check with your pharmacist for more details about the brand you use.
The FDA has not reviewed this product for safety or effectiveness. Consult your doctor or pharmacist for more details.
Take this product by mouth as directed. Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist. Do not take more than the recommended amount. It may take about 3 weeks of regular use before you notice the benefits of this product.
Do not suddenly stop taking this product. Some conditions may become worse when this product is abruptly stopped. You may need to gradually reduce your dose. Consult your doctor or pharmacist for details.
If your condition persists or worsens, or if you think you may have a serious medical problem, seek immediate medical attention.
Trouble sleeping, restlessness, upset stomach, dizziness, headache, or numbness/tingling of the hands/feet may occur. If any of these effects persist or worsen, contact your doctor or pharmacist promptly.
Tell your doctor immediately if any of these rare but very serious side effects occur: black/bloody/tarry stools, vomit that looks like coffee grounds, easy bruising/bleeding.
This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.
A very serious allergic reaction to this product is rare. However, seek immediate medical attention if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US -
Before taking St. John's wort, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
If you have any of the following health problems, consult your doctor or pharmacist before using this product: personal or family history of bipolar/manic-depressive disorder.
This product may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths, and sunlamps. Use a sunscreen and wear protective clothing when outdoors.
Liquid forms of this product may contain sugar and/or alcohol. Caution is advised if you have diabetes, alcohol dependence, or liver disease. Ask your doctor or pharmacist about using this product safely.
Before having surgery, tell your doctor or dentist that you are using this product.
St. John's wort is not recommended for use during pregnancy. Consult your doctor before using this product.
Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.
St. John's wort interacts with many medications and products. The following drugs are just some of the products that may interact with St. John's wort.
Before using this product, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: drugs used to prevent organ rejection (e.g., cyclosporine, sirolimus, tacrolimus), drugs used to treat cancer (e.g., cyclophosphamide, etoposide, irinotecan, paclitaxel, tamoxifen), heart medications (e.g., digoxin, beta blockers such as metoprolol, calcium channel blockers such as diltiazem), anti-seizure drugs (e.g., carbamazepine, phenytoin, phenobarbital), tricyclic antidepressants (e.g., amitriptyline, nortriptyline), sympathomimetic drugs (e.g., albuterol, phenylephrine), drugs used to treat HIV infection (including protease inhibitors such as indinavir/nelfinavir/ritonavir, non-nucleoside reverse transcriptase inhibitors - NNRTIs such as delavirdine/efavirenz/nevirapine/etravirine, entry inhibitors such as maraviroc, a certain combination HIV medication such as elvitegravir/cobicistat/emtricitabine/tenofovir), drugs that can cause bleeding/bruising (e.g., antiplatelet drugs such as clopidogrel, "blood thinners" such as warfarin and heparin, NSAIDs such as ibuprofen).
The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.
Aspirin can increase the risk of bleeding when used with this product. If your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81-325 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Discuss the risks and benefits with your doctor.
This product may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Discuss with your doctor or pharmacist if you should use additional reliable birth control methods while using this product. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.
The interactions listed above are not a complete listing of all possible drug interactions. St. John's wort may also interact with many other drugs by affecting how they are absorbed by your body or removed from your body. These effects may change how well these other drugs work. Therefore, before using St. John's wort, talk with your doctor or pharmacist about all medications and products you take.
Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.
This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
Keep all regular medical and laboratory appointments.
Check the product labeling carefully to make sure you have the correct product. St. John's wort is a species called Hypericum perforatum and should not be confused with other Hypericum species.
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
Refer to storage information printed on the package. If you have any questions about storage, ask your pharmacist. Keep all medications and herbal products away from children and pets.
Information last revised October 2013. Copyright(c) 2013 First Databank, Inc.
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