St. John's Wort

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KEY POINTS

• This remedy has been used to treat several conditions. Studies in humans or animals have not proved that this remedy is safe or effective for all uses. Before using this remedy for a serious condition, you should talk with your healthcare provider.
• The US Food and Drug Administration (FDA) does not approve uses for natural remedies. The FDA does not inspect or regulate natural remedies the way they do prescription medicines. Natural remedies are not always safe.
• This remedy may cause unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• This remedy affects your body and may interact with prescription medicines that you take. Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this remedy?

Type of medicine: natural remedy

Scientific and common names: Hypericum perforatum, St. John's wort, Klamath weed, amber touch and heal, hypereikon, rosin rose, tipton weed

What is St. John's wort?

St. John's wort is plant found in the dry ground of roadsides, meadows, woods, and hedges. The plant has oval-shaped leaves and golden-yellow flowers, which bloom from June to September. The flowers and leaves are used medicinally.

What is it used for?

This remedy has been used to treat several conditions. Studies in humans or animals have not proved that this remedy is safe or effective for all uses. Before using this remedy for a serious condition, you should talk with your healthcare provider.

This remedy is helpful to treat mild to moderate depression. It is not effective in treating major depression.

St. John's wort has been used to treat:

• Anxiety
• Hot flashes
• Seasonal affective disorder
• Somatic symptom disorder

Made into an oil, this remedy has been rubbed on the skin to treat bruises, minor burns, and insect bites, and relieve hemorrhoids.

The US Food and Drug Administration (FDA) does not approve uses for natural remedies. The FDA does not inspect or regulate natural remedies the way they do prescription medicines.

How is it taken?

St. John's wort comes in the form of tablets, capsules, and liquids to be swallowed. It is also available for use on the skin. Follow the directions printed on the product label or given by your healthcare provider.

What if I overdose?

Symptoms of an acute overdose have not been reported.

What should I watch out for?

Do not use St. John's wort if you have:

• Alzheimer's disease
• Bipolar disorder
• Major depression
• Schizophrenia

St. John's wort changes the way many other medicines work. For example:

• This remedy makes some drugs used to treat HIV/AIDS less effective.
• Stop taking St. John's wort 2 weeks before you have surgery. It may delay recovering from anesthesia.
• Do not take this remedy for at least 2 weeks after you have taken a prescription antidepressant. Taking St. John's wort too soon after you stop taking an antidepressant can cause serious side effects. Talk with your healthcare provider about this.
• Do not take this remedy if you take immunosuppressant medicines. It can cause rejection of a transplanted organ.

This remedy may make your skin more sensitive to the sun, which may lead to painful sunburns. While you are taking St. John's wort, avoid long exposure to the sun. Wear protective clothing, a hat, and sunscreen lotion when you need to be outdoors. Do not use a sunlamp. If you get a severe sunburn, contact your healthcare provider right away.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

Talk to your healthcare provider or pharmacist about any natural remedy that you are using or thinking about using. If your provider does not tell you how to take it, follow the directions that come with the package. Do not take more or take it longer than recommended. Ask about anything you do not understand. Remember:

• Natural remedies are not always safe.
• You should not take them if you are pregnant or breast-feeding without your healthcare provider's approval. They should not be taken by infants, children, or older adults without your provider's approval.
• They affect your body and may interact with prescription medicines that you take.
• Natural remedies are not standardized and may have different strengths and effects. They may be contaminated.

What are the possible side effects?

Along with its desirable effects, this remedy may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the remedy. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; chest pain or tightness in your chest; swelling of your lips, tongue, and throat).

Other: Trouble sleeping, restlessness, anxiety, irritability, sensitivity to sunlight, rash, confusion, vivid dreams, tiredness, dry mouth, dizziness, tingling, and headache.

What products might interact with this remedy?

When you take this remedy with other medicines, it can change the way the remedy or the medicines work. Vitamins and certain foods may also interact. Using these products together might cause harmful side effects. Before taking this remedy, talk to your healthcare provider if you take any other medicine, especially:

• Antianxiety medicines such as alprazolam (Xanax), clonazepam (Klonopin), clorazepate (Gen-Xene, Tranxene), diazepam (Valium), lorazepam (Ativan), and oxazepam
• Antibiotics such as amoxicillin (Amoxil, Moxatag), ampicillin, ampicillin/sulbactam (Unasyn), demeclocycline, dicloxacillin, doxycycline (Doryx, Monodox, Vibramycin), isoniazid, minocycline (Dynacin, Minocin, Solodyn), oxacillin, penicillin, rifabutin (Mycobutin), rifampin (Rifadin), and tetracycline
• Antidepressants such as amitriptyline, citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), imipramine (Tofranil), nefazodone, nortriptyline (Pamelor), sertraline (Zoloft), trazodone, and venlafaxine (Effexor)
• Antifungal medicines such as fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral)
• Antipsychotic medicines such as chlorpromazine, clozapine (Clozaril, FazaClo), fluphenazine, haloperidol (Haldol), olanzapine (Zyprexa), perphenazine, prochlorperazine (Compro), risperidone (Risperdal), thioridazine, trifluoperazine, and ziprasidone (Geodon)
• Barbiturates such as butabarbital (Butisol), pentobarbital (Nembutal), phenobarbital, and secobarbital (Seconal)
• Beta blockers such as acebutolol (Sectral), atenolol (Tenormin), carvedilol (Coreg), labetalol (Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), pindolol, and sotalol (Betapace, Sorine)
• Bupropion (Aplenzin, Forfivo, Wellbutrin, Buproban, Zyban)
• Calcium channel blockers such as diltiazem (Cardizem, Cartia, Tiazac), felodipine, isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat CC, Procardia), and verapamil (Calan, Covera, Verelan)
• Cholesterol-lowering medicines such as atorvastatin (Lipitor), lovastatin (Altoprev), rosuvastatin (Crestor), and simvastatin (Zocor)
• Cyclobenzaprine (Amrix)
• Dextromethorphan, an ingredient in many allergy, cold, or cough medicines such as Robitussin-DM
• Diabetes medicines such as glipizide (Glucotrol), glyburide (Glynase), insulin, metformin (Fortamet, Glucophage, Riomet), pioglitazone (Actos), repaglinide (Prandin), and rosiglitazone (Avandia)
• Digoxin (Lanoxin)
• Doxepin (Silenor)
• Fexofenadine (Allegra)
• HIV medicines such as delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir), saquinavir (Invirase), and stavudine (Zerit)
• Hormonal birth control implants, IUDs, patches, pills, shots, and vaginal rings, and hormones such as conjugated estrogens (Premarin), estradiol (Climara, Estrace, Estraderm, Vivelle), medroxyprogesterone (Depo-Provera, Provera), and norethindrone (Aygestin, Micronor)
• Imatinib (Gleevec)
• Immunosuppressants such as azathioprine (Azasan, Imuran), cyclosporine (Gengraf, Neoral, Sandimmune), mycophenolate (CellCept, Myfortic), sirolimus (Rapamune), and tacrolimus (Astagraf, Prograf, Protopic)
• Irinotecan (Camptosar)
• Loperamide (Imodium)
• Losartan (Cozaar)
• MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• Medicines to block or prevent stomach acid such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), and pantoprazole (Protonix)
• Medicines to treat or prevent blood clots such as aspirin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, and warfarin (Coumadin)
• Migraine medicines such as ergotamine (Ergomar), rizatriptan (Maxalt), and zolmitriptan (Zomig)
• Narcotic pain medicines such as codeine, fentanyl (Abstral, Actiq, Duragesic, Fentora, Sublimaze), hydrocodone/acetaminophen (Norco, Vicodin), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin), oxycodone (OxyContin, Roxicodone), and oxycodone/acetaminophen (Percocet, Roxicet)
• Natural remedies such as California poppy, catnip, chamomile, kava, lemon balm, red yeast, SAMe, tryptophan, and valerian
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Phenytoin (Dilantin, Phenytek)
• Propranolol (Hemangeol, Inderal, InnoPran)
• Reserpine
• Zolpidem (Ambien, Edluar, Intermezzo)

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

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Keep all natural remedies and medicines out of the reach of children.

This advisory includes select information only. The information was obtained from scientific journals, study reports, and other documents. The author and publisher make no warranty, expressed or implied, as to the information. The advisory may not include all side effects associated with a remedy or interactions with other medicines. Nothing herein shall constitute a recommendation for the use of any remedy. Ask your healthcare provider or pharmacist for more information.