St John's Wort

St John's Wort is a herbal supplement used for the treatment of depression, obsessive-compulsive disorder, and premenstrual syndrome.

Topical use includes atopic dermatitis, wound healing

• St John's Wort is available under the following different brand names: amber, amber touch & teal, balm-of-warrior's wound, balsana, demon chaser, devil's scourge, goatweed, hypericin, hypericum perforatum, Johanniskraut, klamath weed, millepertuis, rosin rose, tipton weed, walpurgiskraut, witcher's herb

Common side effects of St John's Wort include:

• diarrhea, 
• dizziness, 
• trouble sleeping,
• restlessness, and
• skin tingling

Serious side effects of St John's Wort include:

• Severe skin reactions after sun exposure

Rare side effects of St John's Wort include:

• none

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms such as fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheartedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult dosage

Depression, Mild-moderate

Adult dosage

• Hypericin 0.3% standardized extract
  • 300 mg orally thrice daily, OR
  • 1200 mg orally every day
• Hypericin 0.2% standardized extract: 250 mg orally twice daily
• Hyperforin 5% standardized extract: 300 mg orally thrice daily
• Crude: 2-4 g orally every day to once in three days

Obsessive-compulsive Disorder

Adult dosage

• Hypericin 0.3% standardized extract (XR): 450 mg orally twice daily

Premenstrual Syndrome

Adult dosage

• Hypericin 0.3% standardized extract: 300 mg orally every day

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• St John's Wort has severe interactions with at least 45 other drugs.
• St John's Wort has serious interactions with at least 217 other drugs.
• St John's Wort has moderate interactions with at least 191 other drugs.
• St John's Wort has minor interactions with the following drugs:
  • aliskiren
  • alvimopan
  • ambrisentan
  • armodafinil
  • fexofenadine
  • green tea
  • loratadine

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Hypersensitivity to ingredients
• Coadministration with antineoplastics, anticoagulants, and anti-infectives (including antivirals), as well as cobicistat, boceprevir, voriconazole, and telaprevir
• Alzheimer's disease, bipolar disorder, psychosis, schizophrenia, tyramine-containing foods

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using St John's Wort?”

Long-Term Effects

• See “What Are Side Effects Associated with Using St John's Wort?”

Cautions

• Avoid strong sunlight
• Inducer of CYP3A4
• May reduce the efficacy of oral contraceptives and concentrations of CYP3A4 substrate drugs
• Quality varies widely among commercial products; some contain very low quantities of hypericin
• The drug may cause serious interactions with other medications
• Worsening of dementia in people with Alzheimer's disease suggested
• May precipitate psychotic episodes in patients with schizophrenia
• May precipitate mania symptoms in bipolar patients and may speed up the cycles between mania and depression
• May precipitate mania symptoms in patients with major depression
• May alter serotonin levels in the brain, may interfere with anesthesia, and may lead to serious heart complications during surgery; stop therapy two weeks before surgery

Pregnancy and Lactation

• Not recommended; studies on effects in the developing fetus lacking
• Lactation
  • Hypericin and hyperforin are detected in breast milk; avoid them during lactation until long-term studies show a lack of toxicity in breastfeeding infants