St. John's Wort

• St. John's wort is an herbal preparation most commonly used for the treatment of mild depression or simply as a mood elevator.  It is also used in the treatment of anxiety, stomach upset, insomnia, fluid retention, and hemorrhoids.
• St. John's wort has been used topically in the treatment of nerve and muscle pain, skin inflammation, skin wounds, and burns.
• St. John's wort is also known as Hypericum perforatum, klamath weed, John's wort, amber touch-and-heal, goatweed, rosin rose, and milleperituis.
• Like most herbal preparations, St. John's wort has not been evaluated by the FDA for safety, effectiveness, or purity. All potential risks and/or advantages of St. John's wort may not be known. Additionally, there are no regulated manufacturing standards in place for these compounds. There have been instances where herbal/health supplements have been sold that were contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.
• When considering the use of any herbal supplements, consultation with a primary health care professional is advisable. Additionally, consultation with a practitioner trained in the uses of herbal/health supplements may be beneficial, and coordination of treatment among all health care providers involved may be advantageous.
• As with most herbal supplements, the effects of St. John's wort on pregnancy and nursing are unknown.
• It is estimated that one out of every five people taking prescription anti-depressants are also taking St. John's wort with the hopes of further improvement.  According to a recent study presented at the American Association of Pharmaceutical Scientists meeting, 2000, using St. John's wort may actually decrease the effectiveness of prescription antidepressants.
  
  This study also showed that many other prescription and over-the-counter medications become less effective or even ineffective when combined with St. John's wort. Birth control pills are one glaring example.  Other medicines that may be affected by using St. John's wort simultaneously are:
•   Monoamine oxidase inhibitors, such as tranylcypromine (Nardil), phenelzine (Parnate), or isocarboxazid (Marplan)
• Selective serotonin reuptake inhibitors, such as citalopram (Celexa), fluvoxamine (Luvox), fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft)
• Tricyclic antidepressants, such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil)
• Bupropion (Wellbutrin, Zyban)
• Trazodone (Desyrel) or nefazodone (Serzone)
• Venlafaxine (Effexor)
• Mirtazapine (Remeron)
• HIV/AIDS protease inhibitors, such as indinavir (Crixivan), amprenavir (Agenerase), nelfinavir (Viracept), ritonavir (Norvir), or saquinavir (Fortovase, Invirase)
• HIV/AIDS nonnucleoside reverse transcriptase inhibitors, such as delavirdine (Rescriptor), efavirenz (Sustiva), or nevirapine (Viramune).

• Many people who take St. John's Wort are not aware that it has side effects just like any other medication.  An important summer warning: If you take St. John's wort, avoid prolonged sun exposure. St. John's wort may increase your skin's sun sensitivity.

• St. John's wort is a blood thinner and can affect your blood's ability to clot. Be sure to discontinue use before you have surgery of any kind and inform your healthcare provider that you have been taking St. John's wort.

• Other side effects: Although uncommon, allergic reactions to St. John's wort have been reported. Stop taking St. John's wort and seek emergency medical attention if you experience allergic symptoms including difficulty breathing; throat tightness; facial/lip swelling; or hives.  Other side effects may  include:  rash, abdominal fullness, constipation.

Click here for more information about depression or other mental health issues.

Created: 4/26/2001  -  Donnica Moore, M.D.