St John's Wort (Herb/Suppl)

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
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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 and 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 and 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 disease, bipolar disorder, psychosis, schizophrenia, tyramine-containing foods

            Cautions

            Avoid strong sunlight

            Inducer of CYP3A4

            May reduce efficacy of oral contraceptives and 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: 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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.