St. Johns Wort
St. John's Wort Video
What is it?
- St. John’s wort is an herb. Its flowers and leaves are used to make medicine.
- 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, attention deficit-hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and seasonal affective disorder (SAD).
- St. John’s wort has been tried for exhaustion, stop-smoking help, fibromyalgia, chronic fatigue syndrome (CFS), migraine and other types of headaches, muscle pain, nerve pain, and irritable bowel syndrome. It is also used for cancer, HIV/AIDS, and hepatitis C.
- An oil can be made from St. John’s wort. Some people apply this oil to their skin to treat bruises and scrapes, inflammation and muscle pain, first degree burns, wounds, bug bites, hemorrhoids, and nerve pain. But applying St. John’s wort directly to the skin is risky. It can cause serious sensitivity to sunlight.
- St. John’s wort is native to Europe but is commonly found in the US and Canada in the dry ground of roadsides, meadows, and woods. Although not native to Australia and long considered a weed, St. John’s wort is now grown there as a crop. Today, Australia produces 20 percent of the world’s supply.
- The use of St. John’s wort dates back to the ancient Greeks. Hippocrates recorded the medical use of St. John’s wort flowers. St. John’s wort was given its name because it blooms about June 24th, the birthday of John the Baptist. “Wort” is an old English word for plant.
- France has banned the use of St. John’s wort products. The ban appears to be based on a report issued by the French Health Product Safety Agency warning of significant interactions between St. John’s wort and some medications. Several other countries, including Japan, the United Kingdom, and Canada, are in the process of including drug-herb interaction warnings on St. John’s wort products.
- 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 effective is it?
Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.The effectiveness ratings for ST. JOHN'S WORT are as follows:
Likely effective for
Mild to moderate 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.Possibly effective for
- Menopausal symptoms. Some research shows that a combination of St. John’s wort plus black cohosh can help improve menopausal symptoms.
- The conversion of mental experiences or states into bodily symptoms (somatization disorder). Treatment with St. John’s wort seems to reduce symptoms after 6 weeks of treatment.
- Wound healing. Some research shows that applying a specific St. John’s wort ointment (Gol-Daru Company) three times daily for 16 days improves wound healing and reduces scar formation after a cesarean section.
Possibly ineffective for
- Hepatitis C virus (HCV) infection.
- HIV/AIDS.
- Irritable bowel syndrome (IBS).
- Pain conditions related to diabetes (polyneuropathy).
Insufficient evidence to rate effectiveness for
- Obsessive compulsive disorder (OCD). There is conflicting evidence about the effectiveness of St. John’s wort for OCD. The reason for contradictory findings could be due to differences in study design, differences in the St. John’s wort products used, or other factors.
- Premenstrual syndrome (PMS). There is preliminary evidence that St. John’s wort might help reduce PMS symptoms, by even as much as 50% in some women.
- Seasonal affective disorder (SAD). Early studies suggest that St. John’s wort might help SAD. It appears to improve symptoms of anxiety, decreased sex drive, and sleep disturbances associated with SAD. It is useful alone or in combination with light therapy.
- Smoking cessation. Research to date suggests that taking a specific St. John’s wort extract (LI-160, Lichtwer Pharma US) 300 mg once or twice daily starting 1 week before and continuing for 3 months after quitting smoking does not improve long-term quit rates.
- Attention deficit-hyperactivity disorder (ADHD).
- Stomach upset.
- Bruises.
- Skin conditions.
- Migraine headache.
- Nerve pain.
- Sciatica.
- Excitability.
- Fibromyalgia.
- Chronic fatigue syndrome (CFS).
- Muscle pain.
- Cancer.
- Weight loss.
- Other conditions.
More evidence is needed to rate St. John’s wort for these uses.
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, may play a larger role in depression. Hypericin and hyperforin act on chemical messengers in the nervous system that regulate mood.
Are there safety concerns?
- St. John’s wort is LIKELY SAFE for most people when taken by mouth short-term. 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. John’s wort seems to be safe when used in children under 12 years of age for up to 6 weeks.
- However, St. John’s wort is POSSIBLY UNSAFE 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.
- Not enough is known about the safety of St. John’s wort when it is applied to the skin. To be safe, don’t use it topically.
- 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.
- Pregnancy and breast-feeding: St. John’s wort is POSSIBLY UNSAFE when taken during pregnancy. 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. Nursing infants of mothers who take St. John’s wort can experience colic, drowsiness, and listlessness. Until more is known, don’t use St. John’s wort if you are pregnant or breast-feeding.
- 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.
- 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.
- Major depression: In people with major depression, St. John’s wort might bring on mania, a state marked by excessive physical activity and impulsive behavior.
- Schizophrenia: St. John’s wort might bring on psychosis in some people with schizophrenia.
- Alzheimer’s disease: There is concern that St. John’s wort might contribute to dementia in people with Alzheimer’s disease.
- Anesthesia and surgery: Use of anesthesia in people who have used St. John’s wort for six months may lead to serious heart complications during surgery. Stop using St. John’s wort at least two weeks before a scheduled surgery.
Are there interactions with medications?
Major
Do not take this combination.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).
- 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.
- 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).
- 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.
- 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). Do not take St. John's wort if you are taking cyclosporine (Neoral, Sandimmune).
- 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).
- 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.
- 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). Do not take St. John's wort if you are taking imatinib (Gleevec).
- 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).
- 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.
- 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.
- 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).
- 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 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.
- 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).
- St. John's wort increases a chemical in the brain called serotonin. Meperidine (Demerol) 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.
- Mephenytoin (Mesantoin) is changed and broken down by the body. St. John's wort might increase how quickly this medication is broken down by the body. Do not take St. John's wort if you are taking mephenytoin (Mesantoin).
- 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)
- 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) 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.
- 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).
- 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 works
- The body breaks down phenprocoumon to get rid of it. St. John's wort increases how quickly the body breaks down phenprocoumon. This decreases the effectiveness of phenprocoumon.
- The body breaks down phenytoin (Dilantin) to get rid of it. St. John's wort might increase how quickly the body breaks down phenytoin. Taking St. John's wort and taking phenytoin (Dilantin) might decrease the effectiveness of phenytoin (Dilantin) and increase the possibility of seizures.
- St. John's wort can decrease the effects of reserpine.
- 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.
- 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.
- 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.
- 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.
- 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
Be cautious with this combination.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.
- 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. Do not take St. John's wort if you are taking dextromethorphan (Robitussin DM, and others).
- 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).
- 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. 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), diazepam (Valium), zileuton (Zyflo), 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 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).
- St. John's wort extract might increase how much procainamide the body absorbs. This could increase the effects and side effects of procainamide. But the significance of this potential interaction is not known.
- 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.
Minor
Be watchful with this combination.Methylphenidate (Concerta, Daytrana, Metadate, Ritalin)
BY MOUTH:
For mild to moderate depression:
- Taking St. John's wort along with methylphenidate might decrease how well methylphenidate works for controlling symptoms of attention deficit-hyperactivity disorder (ADHD).
- The body breaks down theophylline to get rid of it. St. John's wort might increase how quickly the body gets rid of theophylline. Taking St. John's wort along with theophylline might decrease the effectiveness of theophylline. But it is not clear if this interaction is a big concern.
Are there interactions with herbs and supplements?
There are no known interactions with herbs and supplements. Are there interactions with foods? There are no known interactions with foods.What dose is used?
The following doses have been studied in scientific research:BY MOUTH:
For mild to moderate depression:
- When using St. John’s wort extract standardized to 0.3% hypericin content: 300 mg three times daily.
- When using a St. John’s wort extract standardized to 0.2% hypericin: 250 mg twice daily.
- When using a St. John’s wort extract standardized to 5% hyperforin: 300 mg three times daily.
- For children under 12 years of age with depression: St. John’s wort extract standardized to 0.3% hypericin 300 mg daily.
- For premenstrual syndrome (PMS): St. John’s wort extract standardized to 0.3% hypericin dosed at 300 mg once daily.
- For body symptoms associated with depression: 300 mg three times daily of the standardized hypericin extract has been used.
- For somatization disorder: a specific extract (LI 160, Lichtwer Pharma) 600 mg/day has been used. Do not suddenly stop taking St. John’s wort. This might cause unpleasant side effects. If you decide to stop taking St. John’s wort, reduce the dose slowly over time.
Other names
Amber, Amber Touch-and-Heal, Barbe de Saint-Jean, Chasse-diable, Demon Chaser, Fuga Daemonum, Goatweed, Hardhay, Herbe à la Brûlure, Herbe à Mille Trous, Herbe Aux Fées, Herbe Aux Mille Vertus, Herbe Aux Piqûres, Herbe de Saint Éloi, Herbe de la Saint-Jean, Herbe du Charpentier, Herbe Percée, Hierba de San Juan, Hypereikon, Hyperici Herba, Hypericum perforatum, Klamath Weed, Millepertuis, Millepertuis Perforé, Rosin Rose, Saynt Johannes Wort, SJW, Tipton Weed.
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