Saint Johns Wort Supplement Uses & Safety

Overview of Saint Johns Wort

Scientific Name: Hypericum perforatum

Order: Malpighiales

Family: Hypericaceae

Saint John's Wort (or St. John's Wort) is commonly used to treat depression. Although, this plant is widely used, it has a relatively large list of major interactions. Saint John's Wort is sometimes misspelled as St. Johns Wort, St John's Wort, or St Johns Wort.

Evidence

Strong:

insufficient information

Good:

Minor to Mild to Moderate Depression [1-42]
- Clinical trials have found that Saint John’s wort independently or in combination with valerian may be effective. Some suggest the possibility of a placebo effect or that the effects of Saint John’s wort are dose dependent. It appears that Saint John’s wort may affect the response, remission, recovery, relapse, and recurrence of depression

Promising:

Peri-menopausal and Menopausal Complaints, Saint John’s wort in combination with black cohosh or chaste tree [43-48]
Somatic Symptom Disorder [49-51]
Winter Depression [52-54]

Conflicting (Unclear):

Major Depression (Major Depressive Disorder), an NCCAM funded study [Hypericum Depression Trail Study Group 2002] found that Saint John’s wort might not be effective in relieving major depression [55-71]
- Many have reported that Saint John’s wort is effective for major depression, while others have found it to be ineffective

Limited Evidence:

Anti-platelet Agent [72-73]
Atopic Dermatitis (Eczema), a cream containing Saint John’s wort [74]
C-Section Wound Healing, an ointment containing Saint John’s wort [75-76]
Ear Inflammation in Children, drops containing either Saint John’s wort / calendula flowers / mullein in olive oil or Saint John’s wort / garlic / calendula flowers / mullein / lavender / vitamin E in olive oil [77-78]
Herpes, a cream containing Saint John’s wort / copper sulfate pentahydrate [79]
Irritable Bowel Syndrome [80-81]
Non-melanoma Skin Cancer, an ointment containing Saint John’s wort [82]
Obsessive Compulsive Disorder (ODC) [83-84]
Osteomyelitis in the feet of Diabetics, local injection of a mixture of phenothiazine (2% in water) and Saint John’s wort extract (10% in propylene glycol) [85]
Premenstrual Syndrome (PMS) [86]
Schizophrenia [87]
Venous Ulcers, an ointment containing Saint John’s wort / garlic / calendula [88]

No Evidence:

ADHD (Attention Deficit Hyperactivity Disorder) [89]
Autism [90]
Burning Mouth Syndrome [91]
Chronic Pain [92-93]
Cognition and Memory [94-96]
Hepatitis C [97]
Knee Pain, a blend with Saint John’s wort / Arnica montana / Bryonia alba / Ruta graveolens [98]
Social Phobia [99]
Quit Smoking (Smoking Cessation) [100-103]

No Clinical Research:

All other conditions.

Side Effects

Side effects may include:

Allergic Reactions
Constipation
Diarrhea
Dizziness
Dry Mouth
Fatigue
Feeling of Fullness
Frequent Urination
Gastrointestinal Upset
Headache
Indigestion
Insomnia
Itching
Sensitivity to Sunlight
Restlessness
Trouble Sleeping

Precautions and Adverse Events:

Avoid or contact a licensed healthcare practitioner, since some people may have allergic reactions (rashes, itching) to Saint John’s wort, and use caution if you have had a history of mania, photosensitivity, psychiatric disorders.

There have been rare adverse events such as photosensitivity, phototoxic reaction to a laser treatment, mania (from high doses of Saint John’s wort), severe nosebleed (after nasal insertion of Saint John’s wort), schizophrenia relapse, neuropathy, severe anxiety, sleep disorders, psychosis, serotonin syndrome, impotence (erectile dysfunction), decreased sex drive, anorexia, and changes in blood pressure and pulse. If you have any of these adverse events, consult a licensed healthcare practitioner.

A case of scalp and eyebrow hair loss was reported after a schizophrenia patient on olanzapine began taking Saint John’s wort.

A rare serious adverse event (and possibly death) from bone marrow necrosis may have been caused by Saint John’s wort.

Saint John’s wort has a long list of interactions (not a complete list below). If you are taking any medications, consult a licensed healthcare practitioner before using Saint John’s wort.

[104-117]

Pregnant or Nursing

There is not enough research on the use of supplements containing Saint John’s wort during pregnancy and breast-feeding, so consult a licensed healthcare practitioner before use or avoid use. A small study of infants born to mothers using Saint John’s wort reported an increase in colic, drowsiness, and lethargy. Saint John’s wort may have uterine stimulant properties. [104-117]

Interactions

Major:

Avoid using Saint John’s wort if you are taking selective serotonin reuptake inhibitors, anti-coagulants (for example, cyclosporine), oral contraceptives, protease inhibitors (for example, HIV/AIDS drugs)
Saint John’s wort may interact with anesthetics, so do NOT use Saint John’s wort at least 2 weeks before a surgery
Drugs changed by Cytochrome P450s (CYPs) in the liver
Warfarin
Adrenergic Vasopressors
Alprazolam
Amiodarone
Amitriptyline
Amprenavir
Amsacrine
Anesthetics, general
Anti-Coagulants
Anti-Depressants; Saint John’s wort may enhance their activity
Anti-Diabetic Drugs
Atazanavir
Atorvastatin
Barbiturates
Benzodiazepines
Bupropion
Buspirone
Calcium Channel Blockers
Chlorzoxazone
Cyclosporine (Ciclosporin)
Darunavir
Digoxin
Docetaxel
Drugs transported by P-glycoproteins
Eletriptan
Erlotinib
Erythromycin
Ethinyl Estradiol
Etopside
Fenfluramine
Fexofenadine
Finasteride
Fluoxetine
Gliclazide
Heart Beta-Blockers
Hormone-Like Drugs (such as drugs containing estrogen)
Imatinib
Immunosuppressant Drugs
Indinavir
Irinotecan
Ivabradine
Ketodesogestrel
Lapatinib
Linezolid
Loperamide; Saint John’s wort interacts with loperamide and has caused delirium
Lopinavir
Lovastatin
Mephenytoin
Methadone
Methylphenidate
Midazolam
Nefazodone
Nevirapine
Nifedipine
Norethindrone
Nortriptyline
Omeprazole
Opioid Painkillers
Oral Contraceptives; Saint John’s wort may cause failure of contraceptive and inter-menstrual bleeding
Paclitaxel
Paroxetine
Phenprocoumon
Phenytoin
Propofol, an anesthetic
Protease Inhibitors including HIV/AIDS Drugs
Quazepam
Rasagiline
Reserpine
Ritonavir
Rosuvastatin
Saquinavir
Selective Serotonin Reuptake Inhibitors (SSRIs); Saint John’s wort has caused serotonin syndrome (particularly in elderly people) and mania
Selegiline
Sertraline
Sevoflurane, an anesthetic
Simvastatin
Sirolimus
Sunitinib
Tacrolimus
Talinolol
Tamoxifen
Theophylline
Tibolone; Saint John’s wort interacts with tibolone and may cause liver damage
Tramadol
Trazodone
Tricyclic Antidepressants
Tryptophan (which is naturally occurring in many foods, including, diary products, poultry, etc.)
Verapamil
Venlafaxine
Voriconazole

[118-150]

Moderate:

Herbal Medicines Containing Ginkgo (Ginkgo biloba)
Amphetamines
Cerivastatin
Clozapine
Cyclophosphamide
Fluvastatin
Monoamine Oxidase Inhibitors (MAOIs)
Olanzapine
Phenelzine
Serotonin Agonists
Sorafenib
Temozolomide, a drug for radio-chemotherapy
Tranylcypromine

[118-150]

Potential:

Iron-Containing Products; since Saint John’s wort contains tannins, take iron and Saint John’s wort at least several hours apart to prevent non-absorption of iron
Acitretin
Carbamazepine
Cimetidine
Debrisoquine
Caffeine Products (for example, coffee, tea, etc.)
Food Containing Tyramine (for example, wine, beer, aged cheese, etc.)
Saint John’s wort may NOT interact with Dextromethorphan, Ibuprofen, Mycophenolic Acid, Pravastatin, Prednisone, and Tolbutamide (though Saint John’s wort may not interact with Tolbutamide, it may cause an increase in hypoglycemia incidences)

[118-150]

Dosage

Saint John’s wort is not a "drug", so the best doses have not been thoroughly established. Make sure to follow the specific product instructions and take as directed on the label, or consult a licensed healthcare practitioner before use.

Compounds

[Afendi et al. 2012]

References