St. John's Wort

18/Description

About

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 drugs. Because of this, France has banned the use of St. John's wort in products. Several other countries, including Japan, the United Kingdom, and Canada are in the process of updating warning labels on St. John's wort products.

St. John's wort is most commonly used for depression and conditions that sometimes go along with depression such as anxiety, tiredness, loss of appetite and trouble sleeping. There is some strong scientific evidence that it is effective for mild to moderate depression.

Other uses include heart palpitations, moodiness and other symptoms of menopause, mental disorders that present physical symptoms, premenstrual syndrome (PMS), attention deficit-hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), social phobia, and seasonal affective disorder (SAD).

St. John's wort has been tried to help quit smoking, for fibromyalgia, chronic fatigue syndrome (CFS), burning feelings in the mouth, migraine and other types of headaches, muscle pain, nerve pain and nerve damage throughout the body, pain that travels down the sciatic nerve in the leg, and irritable bowel syndrome. It is also used for cancer (including brain cancer), HIV/AIDS, hepatitis C, herpes simplex, to help with a procedure to unblock clogged arteries, weight loss, and to treat a disease that causes the skin to lose color.

An oil can be made from St. John's wort. Some people take this oil by mouth for indigestion. Some people apply this oil to their skin to treat bruises and scrapes, inflammation and muscle pain, scaly and itchy skin (psoriasis), first degree burns, wounds, tooth pulling, bug bites, hemorrhoids, nerve pain, and to treat a disease that causes the skin to lose color. But applying St. John's wort directly to the skin is risky. It can cause serious sensitivity to sunlight.

In manufacturing, St. John's wort extracts are also used in alcoholic beverages.

The active ingredients in St. John's wort can be deactivated by light. That's why you will find many products packaged in amber containers. The amber helps, but it doesn't offer total protection against the adverse effects of light.

How it works

For a long time, investigators thought a chemical in St. John's wort called hypericin was responsible for its effects against depression. More recent information suggests another chemical, hyperforin, as well as adhyperforin, and several other similar chemicals may play a larger role in depression. Hyperforin and adhyperforin act on chemical messengers in the nervous system that regulate mood.

Effectiveness

Likely Effective
Depression

Taking St. John's wort extracts improves mood and decreases anxiety and insomnia related to depression. It seems to be about as effective in treating depression as many prescription drugs. In fact, clinical guidelines from the American College of Physicians-American Society of Internal Medicine suggest that St. John's wort can be considered an option along with antidepressant medications for short-term treatment of mild depression. However, since St. John's wort does not appear to be more effective or significantly better tolerated than antidepressant medications, and since St. John's wort causes many drug interactions, the guidelines suggest it might not be an appropriate choice for many people, particularly those who take other medications. St. John's wort might not be as effective for more severe cases of depression.

Concerns

Likely safe

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, restlessness, anxiety, irritability, stomach upset, fatigue, dry mouth, dizziness, headache, skin rash, diarrhea, and tingling. Take St. John's wort in the morning or lower the dose if it seems to be causing sleep problems.St

Possibly unsafe

John's wort is POSSIBLY UNSAFE when taken by mouth in large doses. When taken by mouth in large doses, it might cause severe reactions to sun exposure. 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 reactions to sun exposure.

St

18/Warnings

Warnings

Pregnancy and breast-feeding: St. John's wort isPOSSIBLY UNSAFEwhen taken by mouth duringpregnancy. 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.Nursinginfants of mothers who take St. John's wort can experiencecolic, drowsiness, and listlessness. Until more is known, do not use St. John's wort if you arepregnantorbreast-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

Always consult with your doctor.
Major
Alprazolam (Xanax)

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).

Digoxin (Lanoxin)

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 breakdown 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.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.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).

Docetaxel (Docefrez, Taxotere)

St. John's wort might increase how quickly the liver breaks down some medications. In theory, taking St. John's wort along with some medications that are changed by the liver can decrease the effectiveness of some medications, including the cancer drug docetaxel.

Fenfluramine (Pondimin)

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)

The body breaks down imatinib (Gleevec) 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).

Irinotecan (Camptosar)

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).

Ketamine (Ketalar)

Ketamine (Ketalar) is a type of anesthetic. The body breaks down ketamine (Ketalar) to get rid of it. St. John's wort might increase how fast the body breaks down ketamine (Ketalar) and decrease the effectiveness of ketamine (Ketalar).

Mephenytoin (Mesantoin)

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.Some medications that are changed by the liver include amitriptyline (Elavil), carisoprodol (Soma), citalopram (Celexa), diazepam (Valium), lansoprazole (Prevacid), omeprazole (Prilosec), phenytoin (Dilantin), warfarin, and many others.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.Some medications changed by the liver include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and many others.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.Some of these medications used for HIV/AIDS include nevirapine (Viramune), delavirdine (Rescriptor), and efavirenz (Sustiva).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.Some of these medications used for HIV/AIDS include amprenavir (Agenerase), nelfinavir (Viracept), ritonavir (Norvir), and saquinavir (Fortovase, Invirase).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.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.Mephenytoin (Mesantoin) is changed and broken down by the body. St. John's wort increases how quickly this medication is broken down by the body. This might decrease the effectiveness of mephenytoin (Mesantoin).

Omeprazole (Prilosec, Zegerid)

Omeprazole (Prilosec, Zegerid) is a type of antacid. The body breaks down omeprazole (Prilosec, Zegerid) to get rid of it. St. John's wort can increase how quickly the body breaks down omeprazole (Prilosec, Zegerid). This could decrease the effectiveness of omeprazole (Prilosec, Zegerid).

Phenobarbital (Luminal)

Phenobarbital (Luminal) is used to prevent seizures. 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 (Luminal) works.

Phenprocoumon (Marcoumar, Marcumar, Falithrom)

Phenprocoumon (Marcoumar, Marcumar, Falithrom) is a type of blood thinning drug used outside of the U.S. The body breaks down phenprocoumon (Marcoumar, Marcumar, Falithrom) to get rid of it. St. John's wort increases how quickly the body breaks down phenprocoumon (Marcoumar, Marcumar, Falithrom). This decreases the effectiveness of phenprocoumon (Marcoumar, Marcumar, Falithrom).

Phenytoin (Dilantin)

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

Tacrolimus (Prograf, Protopic)

Tacrolimus (Prograf, Protopic) decreases immune system activity, which helps treat eczema. 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 (Prograf, Protopic). This can cause tacrolimus (Prograf, Protopic) to be less effective.

Warfarin (Coumadin)

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
Aminolevulinic acid

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)

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).

Bupropion (Wellbutrin)

Bupropion (Wellbutrin) is a drug used for depression and to help quit smoking. The body breaks down bupropion (Wellbutrin) 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 bupropion (Wellbutrin) by increasing how quickly the body breaks down bupropion (Wellbutrin).

Clopidogrel (Plavix)

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.

Cyclosporine (Neoral, Sandimmune)

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).

Dextromethorphan (Robitussin DM, and others)

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.

Fexofenadine (Allegra)

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).

Gliclazide (Diamicron, Dacadis, Nazdol, Zicron)

The body breaks down gliclazide (Diamicron, Dacadis, Nazdol, Zicron) to get rid of it. St. John's wort might increase how quickly the body gets rid of gliclazide. By increasing the breakdown of gliclazide (Diamicron, Dacadis, Nazdol, Zicron) St. John's wort might decrease the effectiveness of gliclazide (Diamicron, Dacadis, Nazdol, Zicron).

Meperidine (Demerol)

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.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.Some medications are changed and broken down by the liver. St. John's wort might increase how quickly the liver breaks down some medications. In theory, 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.Some of these medications that are changed by the liver include ketamine (Ketalar), phenobarbital, orphenadrine (Norflex), secobarbital (Seconal), and dexamethasone (Decadron).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.Some medications that are changed by the liver include 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.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.Some of these medications for depression include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Tofranil), and others.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.Some of these medications used for depression include phenelzine (Nardil), tranylcypromine (Parnate), and others.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.Some medications for migraine headache include frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig).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.Some medications for pain include meperidine (Demerol), hydrocodone, morphine, oxycodone (OxyContin), and many others.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.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) can increase the amount of a chemical in the brain called serotonin. St. John's wort 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.

Methadone (Dolophine)

Methadone (Dolophine) is a narcotic pain reliever. The body breaks down methadone (Dolophine) to get rid of it. St. John's wort might increase how fast the body breaks down methadone (Dolophine) and decrease the effectiveness of methadone (Dolophine).

Nefazodone (Serzone)

Nefazodone (Serzone) 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 (Serzone) might cause there to be too much serotonin. This could lead to serious side effects including heart problems, shivering, and restlessness.

Nortriptyline (Pamelor)

Nortriptyline (Pamelor) is a tricyclic antidepressant. 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)

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)

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).

Procainamide (Pronestyl, Procan, Procanbid)

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

Reserpine (Raudixin, Serpalan, Serpasil)

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

Sedative medications (Barbiturates)

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. Some of these medications that cause sleepiness include pentobarbital (Nembutal), phenobarbital (Luminal), secobarbital (Seconal), and others.

Sertraline (Zoloft)

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.

Simvastatin (Zocor)

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

Tramadol (Ultram)

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.

Voriconazole (Vfend)

Voriconazole (Vfend) is used for fungal infections. The body breaks down voriconazole (Vfend) to get rid of it. St. John's wort might increase how quickly the body gets rid of voriconazole (Vfend). Taking St. John's wort along with voriconazole (Vfend) might decrease its effectiveness.

Zolpidem (Ambien)

Zolpidem (Ambien) is used for trouble sleeping. The body breaks down zolpidem (Ambien) to get rid of it. St. John's wort might increase how quickly the body breaks down zolpidem (Ambien). Taking St. John's wort and taking zolpidem (Ambien) might decrease the effectiveness of zolpidem (Ambien). However, if is not clear if this potential interaction is a big concern.

Minor
Methylphenidate (Concerta, Daytrana, Metadate, Ritalin)

Methylphenidate (Concerta, Daytrana, Metadate, Ritalin) is used to treat attention deficit-hyperactivity disorder. Taking St. John's wort along with methylphenidate might decrease how well methylphenidate works.

The information provided on this page is for reference purposes and is not meant to be used as a medical advice, diagnosis or treatment. Always consult with a medical professional.