St John's Wort (Herbs/Suppl)

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Brand and Other Names:amber, amber touch & teal, more...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

Suggested Dosing

Depression, Mild-moderate

Hypericin 0.3% standardized extract

  • 300 mg PO TID, OR
  • 1200 mg PO qDay

Hypericin 0.2% standardized extract: 250 mg PO BID

Hyperforin 5% standardized extract: 300 mg PO TID

Crude: 2-4 g PO qDay-TID

Obsessive-compulsive Disorder

Hypericin 0.3% standardized extract (XR): 450 mg PO BID

Premenstrual Syndrome

Hypericin 0.3% standardized extract: 300 mg PO qDay

Glioblastoma Multiforme (Orphan)

Orphan indication sponsor

  • Nexell Therapeutics, Inc; 2751 Centerville Rd., Suite 210; Wilmington, DE 19808

Cutaneous T-Cell Lymphoma (Orphan)

Orphan indication sponsor

  • Nexell Therapeutics, Inc; 2751 Centerville Rd., Suite 210; Wilmington, DE 19808

Other Information

No more than 8 weeks of use

Avoid abrupt discontinuation due to withdrawal

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Suggested Uses

Oral: Depression (mild-moderate), psychosomatic disorder, obsessive-compulsive disorder, anxiety, premenstrual syndrome, burning mouth syndrome, neuropathy

Topical: atopic dermatitis, wound healing

Efficacy

Although controversy exists, available evidence suggests that for depression more effective than placebo & may be as effective as standard antidepressants with less side effects (Cochrane Review 2008)

However a JAMA report (2009) shows no improvement over placebo for severe depression, but then, sertraline didn't perform any better either for 2 of the primary outcomes

Increased rate of healing in 2nd & 3rd degree burns

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Interactions

Interaction Checker

and St John's Wort

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Agitation

            Anxiety

            Dizziness

            Dry mouth

            Fatigue

            GI discomfort

            Headache

            Hypomania

            Insomnia

            Irritability

            Menstrual irregularities

            Paresthesias

            Photosensitivity

            Restlessness

            Skin rash

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            Warnings

            Contraindications

            Hypersensitivity to Hypericum

            Alzheimer's disease, bipolar disorder, psychosis, schizophrenia, tyramine-containing foods

            Cautions

            Avoid strong sunlight

            Inducer of CYP3A4

            May reduce efficacy of oral contraceptives & concentrations of CYP3A4 substrate drugs

            Quality varies widely among commercial products; some contain very low quantities of hypericin

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            Pregnancy & Lactation

            Pregnancy Category: unsafe

            Lactation: unsafe

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Metabolism: N/A

            Excretion: N/A

            Mechanism of Action

            Active constituent: hypericin (others under investigation)

            Possible dopaminergic or SSRI effects

            Topical: antibacterial, increased epithelialization

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