ST. JOHN'S WORT

OTHER NAME(S):

Amber, Amber Touch-and-Heal, Barbe de Saint-Jean, Chasse-diable, Demon Chaser, Fuga Daemonum, Goatweed, Hardhay, Herbe à la Brûlure, Herbe à Mille Trous, Herbe Aux Fées, Herbe Aux Mille Vertus, Herbe Aux Piqûres, Herbe de Saint Éloi, Herbe de la Saint-Jean, Herbe du Charpentier, Herbe Percée, Hierba de San Juan, Hypereikon, Hyperici Herba, Hypericum perforatum, Klamath Weed, Millepertuis, Millepertuis Perforé, Rosin Rose, Saynt Johannes Wort, SJW, Tipton Weed.<br/><br/>

Overview

Overview Information

St. John's wort is a plant with yellow, star-shaped flowers and five petals that grows in Europe, North and South America, Australia, New Zealand, and Eastern Asia. The plant grows in sunny, well-drained areas. It grows to be 50-100 cm tall.

St. John's wort might cause serious interactions with some medications. Because of this, France has banned the use of St. John's wort in products. In other countries St. John's wort is only available with a prescription.

St. John's wort is most commonly used for "the blues" or depression and symptoms that sometimes go along with mood such as nervousness, tiredness, poor appetite, and trouble sleeping. There is some strong scientific evidence that it is effective for mild to moderate depression.

St. John's wort is also used for symptoms of menopause such as hot flashes and mood changes.

An oil can be made from St. John's wort. Some people apply this oil to their skin to treat wounds. Applying St. John's wort directly to the skin is risky. It can cause serious sensitivity to sunlight.

How does it work?

For a long time, scientists thought a chemical in St. John's wort called hypericin was responsible for its effects on improving mood. More recent information suggests other chemicals like hyperforin may play a larger role. These chemicals act on messengers in the nervous system that regulate mood.

Uses

Uses & Effectiveness?

Likely Effective for

  • Depression. Taking St. John's wort extracts by mouth improves mood and decreases nervousness and tiredness related to depression. It seems to be about as effective as many prescription drugs. The American College of Physicians-American Society of Internal Medicine guidelines suggest that St. John's wort can be considered an option along with prescription medications for short-term treatment of mild depression. However, since St. John's wort causes many drug interactions, the guidelines suggest it might not be a good choice for many people. St. John's wort might not be as effective for more severe cases of depression.

Possibly Effective for

  • Symptoms related to menopause. Most research shows that taking St. John's wort by mouth can help reduce hot flashes and other symptoms of menopause. Some evidence suggests that specific combinations of St. John's wort plus black cohosh (Remifemin; Remifemin Plus; Gynoplus) can also improve some symptoms of menopause such as hot flashes and mood changes. But not all St. John's wort combination products seem to be beneficial.
  • The condition of mental feelings causing bodily symptoms (somatization disorder). Treatment with a specific St. John's wort product (LI 160, Lichtwer Pharma) daily for 6 weeks seems to reduce symptoms of somatization disorder.
  • Wound healing. Applying an ointment containing St. John's wort three times daily for 16 days seems to improve wound healing and reduce scar formation after a Cesarean section (C-section).

Possibly Ineffective for

  • Pain in the mouth (burning mouth syndrome). Taking St. John's wort three times daily for 12 weeks does not reduce pain from burning mouth syndrome.
  • Hepatitis C infection. Taking St. John's wort by mouth does not seem to be effective for treating adults with hepatitis C infection.
  • HIV/AIDS. Taking St. John's work by mouth does not seem to be effective for treating HIV-infected adults.
  • Irritable bowel syndrome (IBS). Early research shows that taking a specific St. John's wort extract (St. John's Wort Extract Extra Strength, Enzymatic Therapy) twice daily is not effective for reducing symptoms of IBS.
  • Nerve pain. Taking St. John's wort by mouth does not seem to relieve nerve pain in diabetic or non-diabetic people.
  • Social nervousness. Taking St. John's wort daily does not seem to improve social nervousness.

Insufficient Evidence for

  • A procedure to widen blocked arteries (angioplasty). Early research shows that in people who do not respond to a prescription blood thinner medication called clopidogrel or Plavix and aspirin, taking St. John's wort three times daily for 2 weeks after a procedure to clear blocked arteries might improve outcomes of the procedure. It is thought that St. John's wort might help the blood thinning medications work better in some people.
  • Anxiety. Some reports suggest that taking St. John's wort alone or together with valerian might improve nervousness. Taking one capsule of a specific product that contains St. John's wort and valerian root (Sedariston Concentrate, Aristo Pharma GmbH) by mouth daily for one week, then one or two capsules twice daily for another week, reduces nervousness more than the prescription medication diazepam.
  • The condition of difficulty paying attention and controlling behaviors (attention deficit-hyperactivity disorder or ADHD). A report of 3 males aged 14-16 with ADHD showed that taking St. John's wort daily for 4 weeks might improve attention and activity. But other research shows that taking a St. John's wort extract for 8 weeks does not improve ADHD symptoms in children ages 6-17 years.
  • A genetic condition of that causes bilirubin to build up in the body. A case report shows that taking St. John's wort by mouth three times daily for two 8-week periods might decrease bilirubin levels, reduce jaundice, and improve fatigue in people with this condition.
  • Brain tumor. Early research shows that taking hypericin, a chemical in St. John's wort, by mouth for up to 3 months might reduce tumor size and improve the survival rate in people with brain tumors.
  • Herpes. Early research suggests that using a specific combination of St. John's wort and copper sulfate pentahydrate might help reduce symptoms, including stinging, burning and pain, in people with cold sores or genital herpes.
  • Migraine headache. Early research suggests that taking a specific St. John's wort product three times daily improves migraine pain but does not reduce how often migraines occur.
  • The condition of difficult to control thoughts and behaviors that are repeated (obsessive-compulsive disorder or OCD). The evidence about the effectiveness of St. John's wort for OCD is not clear. Study results have been mixed.
  • Skin redness and irritation (plaque psoriasis). Early research suggests that applying St. John's wort liquid or ointment to the skin decreases the severity and the size of psoriasis patches.
  • Premenstrual syndrome (PMS). The evidence about the use of St. John's wort for treating PMS is not clear. Some early research suggests that St. John's wort might help reduce PMS symptoms, including sleeping problems, confusion, crying, headache, tiredness, food cravings and swelling, by as much as 50% in some women. However, other research shows that taking St. John's wort does not reduce nervousness or other PMS symptoms.
  • Mood condition related to changes in the season (seasonal affective disorder). Early studies suggest that St. John's wort might help improve symptoms of nervousness, decreased sex drive, and sleep problems in people with seasonal mood changes. It is useful alone or in combination with light therapy.
  • Smoking cessation. Early research suggests that taking a St. John's wort extract once or twice daily starting one week before and continuing for 3 months after quitting smoking does not improve long-term quit rates.
  • Tooth pulling. Early research suggests that applying a homeopathic St. John's wort preparation does not improve dental pain after a tooth is pulled or after dental surgery.
  • Bruises.
  • Cancer.
  • Chronic fatigue syndrome (CFS).
  • Excitability.
  • Extreme tiredness (chronic fatigue syndrome).
  • Muscle pain.
  • Nerve pain.
  • Pain in the lower back or hip that radiates to the leg (sciatica).
  • Skin conditions.
  • Stomach upset.
  • Weight loss.
  • Other conditions.
More evidence is needed to rate St. John's wort for these uses.

Side Effects

Side Effects & Safety

St. John's wort is LIKELY SAFE when taken by mouth for up to 12 weeks. Some evidence suggests it can be used safely for over one year. It can cause some side effects such as trouble sleeping, vivid dreams, difficulty sitting still, nervousness, irritability, stomach upset, tiredness, dry mouth, dizziness, headache, skin rash, diarrhea, and skin tingling. Take St. John's wort in the morning or take a lower the dose if it seems to be causing sleep problems.

St. John's wort is POSSIBLY UNSAFE when taken by mouth in large doses. When taken by mouth in large doses, it might cause severe skin reactions to sun exposure. Women may be at risk of severe skin reactions even at usual doses of St. John's wort. Wear sun block outside, especially if you are light-skinned.

St. John's wort interacts with many drugs (see the section below). Let your healthcare provider know if you want to take St. John's wort. Your healthcare provider will want to review your medications to see if there could be any problems.

There isn't enough reliable information available to know if St. John's wort is safe when it is applied to the skin. St. John's wort might cause severe skin reactions to sun exposure.

Special Precautions & Warnings:

Pregnancy and breast-feeding: St. John's wort is POSSIBLY UNSAFE when taken by mouth during pregnancy. There is some evidence that it can cause birth defects in unborn rats. No one yet knows whether it has the same effect in unborn humans. Nursing infants of mothers who take St. John's wort can experience colic, drowsiness, and fussiness. Until more is known, do not use St. John's wort if you are pregnant or breast-feeding.

Children: St. John's work is POSSIBLY SAFE when taken by mouth for up to 8 weeks in children 6-17 years-old.

Alzheimer's disease: There is concern that St. John's wort might contribute to dementia in people with Alzheimer's disease.

Anesthesia: Use of anesthesia in people who have used St. John's wort for 6 months may lead to serious heart complications during surgery. Stop using St. John's wort at least 2 weeks before a scheduled surgery.

Attention deficit-hyperactivity disorder (ADHD): There is some concern that St. John's wort might worsen symptoms of ADHD, especially in people taking the medication methylphenidate for ADHD. Until more is known, don't use St. John's wort if you are taking methylphenidate.

Bipolar disorder: People with bipolar disorder cycle between depression and mania, a state marked by excessive physical activity and impulsive behavior. St. John's wort can bring on mania in these individuals and can also speed up the cycling between depression and mania.

Depression: In people with major depression, St. John's wort might bring on mania, a state marked by excessive physical activity and impulsive behavior.

Infertility: There are some concerns that St. John's wort might interfere with conceiving a child. If you are trying to conceive, don't use St. John's wort, especially if you have known fertility problems.

Schizophrenia: St. John's wort might bring on psychosis in some people with schizophrenia.

Surgery: St. John's wort might affect serotonin levels in the brain and as a result interfere with surgical procedures. Stop using St. John's wort at least two weeks before a scheduled surgery.

Interactions

Interactions?

Major Interaction

Do not take this combination

!
  • Alprazolam (Xanax) interacts with ST. JOHN'S WORT

    Alprazolam (Xanax) is commonly used for anxiety. The body breaks down alprazolam (Xanax) to get rid of it. St. John's wort can increase how fast the body gets rid of alprazolam (Xanax). Taking St. John's wort along with alprazolam (Xanax) might decrease the effectiveness of alprazolam (Xanax).

  • Aminolevulinic acid interacts with ST. JOHN'S WORT

    Aminolevulinic acid can make your skin sensitive to the sunlight. St. John's wort might also increase your sensitivity to sunlight. Taking St. John's wort along with aminolevulinic acid might increase the chances of sunburn, blistering or rashes on areas of skin exposed to sunlight. Be sure to wear sunblock and protective clothing when spending time in the sun.

  • Amitriptyline (Elavil) interacts with ST. JOHN'S WORT

    The body breaks down amitriptyline (Elavil) to get rid of it. St. John's wort can increase how quickly the body gets rid of some medications. St. John's wort might decrease the effectiveness of amitriptyline (Elavil) by increasing how quickly the body breaks down amitriptyline (Elavil).

  • Birth control pills (Contraceptive drugs) interacts with ST. JOHN'S WORT

    Some birth control pills contain estrogen. The body breaks down the estrogen in birth control pills to get rid of it. St. John's wort might increase the break down of estrogen. Taking St. John's wort along with birth control pills might decrease the effectiveness of birth control pills. If you take birth control pills along with St. John's wort, use an additional form of birth control such as a condom.<br /><br /> Some birth control pills include ethinyl estradiol and levonorgestrel (Triphasil), ethinyl estradiol and norethindrone (Ortho-Novum 1/35, Ortho-Novum 7/7/7), and others.

  • Cyclosporine (Neoral, Sandimmune) interacts with ST. JOHN'S WORT

    The body breaks down cyclosporine (Neoral, Sandimmune) to get rid of it. St. John's wort might increase how quickly the body breaks down cyclosporine (Neoral, Sandimmune). By increasing the breakdown of cyclosporine (Neoral, Sandimmune) St. John's wort might decrease the effectiveness of cyclosporine (Neoral, Sandimmune). Do not take St. John's wort if you are taking cyclosporine (Neoral, Sandimmune).

  • Digoxin (Lanoxin) interacts with ST. JOHN'S WORT

    Digoxin (Lanoxin) helps the heart beat more strongly. St. John's wort might decrease how much digoxin (Lanoxin) the body absorbs. By decreasing how much digoxin (Lanoxin) the body absorbs St. John's wort might decrease the effects of digoxin (Lanoxin).

  • Fenfluramine (Pondimin) interacts with ST. JOHN'S WORT

    Fenfluramine (Pondimin) increases a chemical in the brain. This chemical is called serotonin. St. John's wort also increases serotonin. Taking fenfluramine with St. John's wort might cause there to be too much serotonin. This could cause serious side effects including heart problems, shivering, nausea, headache, and anxiety.

  • Imatinib (Gleevec) interacts with ST. JOHN'S WORT

    The body breaks down imatinib to get rid of it. St. John's wort might increase how quickly the body gets rid of imatinib (Gleevec). Taking St. John's wort along with imatinib (Gleevec) might decrease the effectiveness of imatinib (Gleevec). Do not take St. John's wort if you are taking imatinib (Gleevec).

  • Irinotecan (Camptosar) interacts with ST. JOHN'S WORT

    Irinotecan (Camptosar) is used to treat cancer. The body breaks down irinotecan (Camptosar) to get rid of it. St. John's wort might increase how fast the body breaks down irinotecan (Camptosar) and decrease the effectiveness of irinotecan (Camptosar).

  • Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates) interacts with ST. JOHN'S WORT

    Some medications are changed and broken down by the liver. St. John's wort might increase how quickly the liver breaks down some medications. Taking St. John's wort along with some medications that are broken down by the liver can decrease the effectiveness of some medications. Before taking St. John's wort talk to your healthcare provider if you are taking any medications that are changed by the liver.<br /><br /> Some medications changed by the liver include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and many others.

  • Medications for depression (Antidepressant drugs) interacts with ST. JOHN'S WORT

    St. John's wort increases a brain chemical called serotonin. Some medications for depression also increase the brain chemical serotonin. Taking St. John's wort along with these medications for depression might increase serotonin too much and cause serious side effects including heart problems, shivering, and anxiety. Do not take St. John's wort if you are taking medications for depression.<br /><br /> Some of these medications for depression include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Tofranil), and others.

  • Medications for HIV/AIDS (Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)) interacts with ST. JOHN'S WORT

    The body breaks down medications used for HIV/AIDS. St. John's wort can increase how quickly the body breaks down these medications. Taking St. John's wort might decrease how well some medications used for HIV/AIDS work.<br /><br /> Some of these medications used for HIV/AIDS include nevirapine (Viramune), delavirdine (Rescriptor), and efavirenz (Sustiva).

  • Medications for HIV/AIDS (Protease Inhibitors) interacts with ST. JOHN'S WORT

    The body breaks down medications used for HIV/AIDS to get rid of them. Taking St. John's wort might increase how quickly the body breaks down these medications. This could decrease the effectiveness of some medications used for HIV/AIDS.<br /><br /> Some of these medications used for HIV/AIDS include amprenavir (Agenerase), nelfinavir (Viracept), ritonavir (Norvir), and saquinavir (Fortovase, Invirase).

  • Medications for pain (Narcotic drugs) interacts with ST. JOHN'S WORT

    The body breaks down some medications for pain to get rid of them. St. John's Wort might decrease how fast the body gets rid of some medications for pain. By decreasing how fast the body gets rid of some medications for pain, St. John's wort might increase the effects and side effects of some medications for pain.<br /><br /> Some medications for pain include meperidine (Demerol), hydrocodone, morphine, OxyContin, and many others.

  • Medications moved by pumps in cells (P-Glycoprotein Substrates) interacts with ST. JOHN'S WORT

    Some medications are moved by pumps in cells. St. John's wort can make these pumps more active and decrease how much of some medications get absorbed by the body. This might decrease the effectiveness of some medications.<br /><br /> Some medications that are moved by these pumps include etoposide, paclitaxel, vinblastine, vincristine, vindesine, ketoconazole, itraconazole, amprenavir, indinavir, nelfinavir, saquinavir, cimetidine, ranitidine, diltiazem, verapamil, corticosteroids, erythromycin, cisapride (Propulsid), fexofenadine (Allegra), cyclosporine, loperamide (Imodium), quinidine, and others.

  • Medications that increase sensitivity to sunlight (Photosensitizing drugs) interacts with ST. JOHN'S WORT

    Some medications can increase sensitivity to sunlight. St. John's Wort might also increase your sensitivity to sunlight. Taking St. John's wort along with medications that increase sensitivity to sunlight could increase the chances of sunburn, blistering or rashes on areas of skin exposed to sunlight. Be sure to wear sunblock and protective clothing when spending time in the sun.<br /><br /> Some drugs that cause photosensitivity include amitriptyline (Elavil), Ciprofloxacin (Cipro), norfloxacin (Noroxin), lomefloxacin (Maxaquin), ofloxacin (Floxin), levofloxacin (Levaquin), sparfloxacin (Zagam), gatifloxacin (Tequin), moxifloxacin (Avelox), trimethoprim/sulfamethoxazole (Septra), tetracycline, methoxsalen (8-methoxypsoralen, 8-MOP, Oxsoralen), and Trioxsalen (Trisoralen).

  • Meperidine (Demerol) interacts with ST. JOHN'S WORT

    St. John's wort increases a chemical in the brain called serotonin. Meperidine (Demerol) can also increase serotonin in the brain. Taking St. John's wort along with meperidine (Demerol) might cause too much serotonin in the brain and serious side effects including heart problems, shivering, and anxiety.

  • Nefazodone (Serzone) interacts with ST. JOHN'S WORT

    Nefazodone can increase a chemical in the brain. This chemical is called serotonin. St. John's wort can also increase serotonin. Taking St. John's wort with nefazodone might cause there to be too much serotonin. This could lead to serious side effects including heart problems, shivering, and restlessness.

  • Nortriptyline (Pamelor) interacts with ST. JOHN'S WORT

    The body breaks down nortriptyline (Pamelor) to get rid of it. St. John's wort can increase how quickly the body breaks down nortriptyline (Pamelor). This could decrease the effectiveness of nortriptyline (Pamelor).

  • Paroxetine (Paxil) interacts with ST. JOHN'S WORT

    Paroxetine (Paxil) increases a chemical in the brain. This chemical is called serotonin. St. John's wort also increases serotonin. Taking paroxetine (Paxil) and St. John's wort together might cause there to be too much serotonin. This could lead to serious side effects including heart problems, shivering, and weakness.

  • Pentazocine (Talwin) interacts with ST. JOHN'S WORT

    St. John's wort increases a brain chemical called serotonin. Pentazocine (Talwin) also increases serotonin. Taking St. John's wort along with pentazocine (Talwin) might increase serotonin too much. This could cause serious side effects including heart problems, shivering, and anxiety. Do not take St. John's wort if you are taking pentazocine (Talwin).

  • Phenobarbital (Luminal) interacts with ST. JOHN'S WORT

    The body breaks down phenobarbital (Luminal) to get rid of it. St. John's wort might increase how quickly the body breaks down phenobarbital. This could decrease how well phenobarbital works.

  • Phenprocoumon interacts with ST. JOHN'S WORT

    The body breaks down phenprocoumon to get rid of it. St. John's wort increases how quickly the body breaks down phenprocoumon. This decreases the effectiveness of phenprocoumon.

  • Phenytoin (Dilantin) interacts with ST. JOHN'S WORT

    The body breaks down phenytoin (Dilantin) to get rid of it. St. John's wort might increase how quickly the body breaks down phenytoin. Taking St. John's wort and taking phenytoin (Dilantin) might decrease the effectiveness of phenytoin (Dilantin) and increase the possibility of seizures.

  • Reserpine interacts with ST. JOHN'S WORT

    St. John's wort can decrease the effects of reserpine.

  • Sedative medications (Barbiturates) interacts with ST. JOHN'S WORT

    Medications that cause sleepiness and drowsiness are called sedatives. St. John's wort might decrease the effectiveness of sedative medications. It is not clear why this interaction occurs.

  • Sertraline (Zoloft) interacts with ST. JOHN'S WORT

    Sertraline (Zoloft) can increase a chemical in the brain. This chemical is called serotonin. St. John's wort also increases serotonin. This can cause there to be too much serotonin in the brain. This could lead to serious side effects including heart problems, shivering, and irritability.

  • Tacrolimus (Prograf, Protopic) interacts with ST. JOHN'S WORT

    The body breaks down tacrolimus (Prograf, Protopic) to get rid of it. St. John's wort can increase how quickly the body breaks down tacrolimus. This can cause tacrolimus to be less effective.

  • Tramadol (Ultram) interacts with ST. JOHN'S WORT

    Tramadol (Ultram) can affect a chemical in the brain called serotonin. St. John's wort can also affect serotonin. Taking St. John's wort along with tramadol (Ultram) might cause too much serotonin in the brain and side effects including confusion, shivering, stiff muscles, and other side effects.

  • Warfarin (Coumadin) interacts with ST. JOHN'S WORT

    Warfarin (Coumadin) is used to slow blood clotting. The body breaks down warfarin (Coumadin) to get rid of it. St. John's wort might increase the breakdown and decrease the effectiveness of warfarin (Coumadin). Decreasing the effectiveness of warfarin (Coumadin) might increase the risk of clotting. Be sure to have your blood checked regularly. The dose of your warfarin (Coumadin) might need to be changed.

Moderate Interaction

Be cautious with this combination

!
  • Clopidogrel (Plavix) interacts with ST. JOHN'S WORT

    The body breaks down clopidogrel (Plavix) to a chemical that decreases blood clotting in the body. Taking St. John's wort along with clopidogrel (Plavix) might increase how well the body breaks down clopidogrel (Plavix) and decrease blood clotting too much.

  • Dextromethorphan (Robitussin DM, and others) interacts with ST. JOHN'S WORT

    St. John's wort can affect a brain chemical called serotonin. Dextromethorphan (Robitussin DM, others) can also affect serotonin. Taking St. John's wort along with dextromethorphan (Robitussin DM, others) might cause too much serotonin in the brain and serious side effects including heart problems, shivering, and anxiety. Do not take St. John's wort if you are taking dextromethorphan (Robitussin DM, and others).

  • Fexofenadine (Allegra) interacts with ST. JOHN'S WORT

    The body breaks down fexofenadine (Allegra) to get rid of it. St. John's wort might decrease how quickly the body gets rid of fexofenadine. This could cause fexofenadine (Allegra) to stay in the body too long. This could lead to increased effects and side effects of fexofenadine (Allegra).

  • Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates) interacts with ST. JOHN'S WORT

    Some medications are changed and broken down by the liver. St. John's wort might increase how quickly the liver breaks down some medications. Taking St. John's wort along with some medications that are changed by the liver can decrease the effectiveness of some medications. Before taking St. John's wort talk to your healthcare provider if you take any medications that are changed by the liver.<br /><br /> Some of these medications that are changed by the liver include clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), zileuton (Zyflo), zolmitriptan (Zomig), and others.

  • Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates) interacts with ST. JOHN'S WORT

    Some medications are changed and broken down by the liver. St. John's wort might increase how quickly the liver breaks down some medications. Taking St. John's wort along with some medications that are broken down by the liver can decrease the effectiveness of your medication. Before taking St. John's wort talk to your healthcare provider if you take any medications that are changed by the liver.<br /><br /> Some medications that are changed by the liver include amitriptyline (Elavil), diazepam (Valium), zileuton (Zyflo), celecoxib (Celebrex), diclofenac (Voltaren), fluvastatin (Lescol), glipizide (Glucotrol), ibuprofen (Advil, Motrin), irbesartan (Avapro), losartan (Cozaar), phenytoin (Dilantin), piroxicam (Feldene), tamoxifen (Nolvadex), tolbutamide (Tolinase), torsemide (Demadex), warfarin (Coumadin), and others.

  • Medications for depression (MAOIs) interacts with ST. JOHN'S WORT

    St. John's wort increases a chemical in the brain. This chemical is called serotonin. Some medications used for depression also increase serotonin. Taking St. John's wort with these medications used for depression might cause there to be too much serotonin. This could cause serious side effects including heart problems, shivering, and anxiety.<br /><br /> Some of these medications used for depression include phenelzine (Nardil), tranylcypromine (Parnate), and others.

  • Medications for migraine headaches ("Triptans") interacts with ST. JOHN'S WORT

    Some medications for migraine headaches can affect a chemical in the brain called serotonin. St. John's wort can also affect serotonin. Taking St. John's wort along with some medications for migraine headache might cause too much serotonin in the brain and serious side effects including confusion, shivering, stiff muscles, and other side effects.<br /><br /> Some medications for migraine headache include frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig).

  • Procainamide interacts with ST. JOHN'S WORT

    St. John's wort extract might increase how much procainamide the body absorbs. This could increase the effects and side effects of procainamide. But the significance of this potential interaction is not known.

  • Simvastatin (Zocor) interacts with ST. JOHN'S WORT

    The body breaks down simvastatin (Zocor) to get rid of it. St. John's wort increases how quickly the body breaks down simvastatin. This can cause simvastatin to be less effective.

Minor Interaction

Be watchful with this combination

!
  • Methylphenidate (Concerta, Daytrana, Metadate, Ritalin) interacts with ST. JOHN'S WORT

    Taking St. John's wort along with methylphenidate might decrease how well methylphenidate works for controlling symptoms of attention deficit-hyperactivity disorder (ADHD).

  • Theophylline interacts with ST. JOHN'S WORT

    The body breaks down theophylline to get rid of it. St. John's wort might increase how quickly the body gets rid of theophylline. Taking St. John's wort along with theophylline might decrease the effectiveness of theophylline. But it is not clear if this interaction is a big concern.

Dosing

Dosing

The following doses have been studied in scientific research:

ADULTS

BY MOUTH:

  • For mild to moderate low mood or depression:
    • In most studies, St. John's wort extract was standardized to 0.3% hypericin content and used at doses of 300 mg 3 times daily.
    • Some studies have used St. John's wort extract standardized to 0.2% hypericin at doses of 250 mg twice daily.
    • St. John's wort extract standardized to 5% hyperforin has been used at doses of 300 mg 3 times daily.
  • For symptoms of menopause:
    • St. John's wort extract (Hypiran, Poursina Pharmaceutical Mfg. Co., Tehran, Iran) containing 0.2 mg/mL hypericin, taken in doses of 20 drops 3 times daily for 2 months has been used.
    • St. John's wort 300mg 3 times daily for 3-4 months has been used.
  • For the condition of mental feelings causing bodily symptoms (somatization disorder): a specific extract (LI 160, Lichtwer Pharma) 600 mg/day has been used.
APPLIED TO THE SKIN:
  • For wound healing: An ointment containing a 5% St. John's wort extract applied three times daily beginning 24 hours after a C-section and continued for 16 days has been used.
CHILDREN

BY MOUTH:
  • For mild to moderate depression: 150-300 mg of St. John's wort three times daily for 8 weeks in children 6-17 years-old has been used. A specific St. John's wort extract (LI 160, Lichtwer, Pharma) 300-1800 mg in three divided doses daily for up to 6 weeks has been used.
Do not suddenly stop taking St. John's wort. This might cause unpleasant side effects. If you decide to stop taking St. John's wort, reduce the dose slowly over time.

View References

REFERENCES:

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