St. John's Wort

What are other names for this remedy?

Type of medicine: natural remedy

Scientific and common names: Hypericum perforatum, St. John's wort, Kiamath weed, amber touch and heal, goatweed, rosin rose, millepertuis, demon chaser, SJW, hardhay, 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?

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

• mild to moderate depression (It is not effective in treating major depression.)
• anxiety.
• fluid retention (It increases urination to remove excess water from the body.
• high blood pressure
• HIV and AIDS
• gastritis (inflammation of the stomach lining)
• heart palpitations
• insomnia (trouble falling asleep)
• nerve and muscle pain
• obsessive compulsive disorder
• seasonal affective disorder
• symptoms of PMS including cramps, irritability, food cravings, and breast tenderness

This remedy may also be rubbed on the skin to treat bruises, minor burns, and insect bites, and relieve hemorrhoids.

There is no evidence to show that St. John's wort is effective as a way to treat cancer.

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:

• attention deficit/hyperactivity disorder (ADHD)
• Alzheimer's disease
• bipolar disorder
• fertility problems
• schizophrenia

Do not take St. John's wort for more than 2 months unless your healthcare provider approves. Some people have withdrawal symptoms when they stop using this remedy. These symptoms include headache, nausea, dry mouth, loss of appetite, trouble sleeping, dizziness, and confusion

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 can 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.

This remedy may affect your ability to have children whether you are a man or a woman. If you plan to have children, talk with your healthcare provider before you take St. John's wort.

Females of childbearing age: Do not take this remedy if you are pregnant or breast-feeding.

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.

Side effects may include trouble sleeping, restlessness, anxiety, irritability, sensitivity to sunlight, rash, confusion, vivid dreams, stomach upset, 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:

• amitriptyline
• anesthesia
• antibiotics such as ciprofloxacin (Cipro), levofloxacin (Levaquin), gatifloxacin (Tequin), moxifloxacin (Avelox), erythromycin (Ery-Tabs, E.E.S.), sulfamethoxazole/trimethoprim (Bactrim, Septra), clarithromycin (Biaxin), tetracycline (Sumycin), demeclocycline (Declomycin), and minocycline (Dynacin, Myrac, Solodyn, Minocin)
• antidepressants such as amitriptyline, nortriptyline (Pamelor, Aventyl), phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), fluoxetine (Prozac, Sarafem), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), sertraline (Zoloft), nefazodone, and venlafaxine (Effexor)
• antifungals such as ketoconazole (Nizoral) and itraconazole (Sporanox)
• anti-HIV medicines such as omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), and lansoprazole (Prevacid)
• antipsychotics such as clozapine (Clozaril), haloperidol (Haldol), and olanzapine (Zyprexa)
• barbiturates such as phenobarbital, butabarbital (Butisol), pentobarbital (Nembutal), and secobarbital (Seconal)
• benzodiazepines such as alprazolam (Xanax), diazepam (Valium), triazolam (Halcion), chlordiazepoxide (Librium), lorazepam (Ativan), and midazolam (Versed)
• beta blockers such as atenolol (Tenormin), acebutolol (Sectral), pindolol, metoprolol (Lopressor, Toprol XL), sotalol (Betapace), nadolol (Corgard), propranolol (Inderal), labetalol (Normodyne, Trandate), and carvedilol (Coreg)
• birth control pills
• calcium channel blockers such as nifedipine (Adalat, Procardia), isradipine (DynaCirc), felodipine (Plendil), verapamil (Calan, Isoptin), diltiazem (Cardizem), and nicardipine (Cardene)
• cholesterol-lowering medicines (statins) such as atorvastatin (Lipitor), lovastatin (Mevacor), and simvastatin (Zocor)
• cyclobenzaprine (Flexeril)
• dextromethorphan (Robitussin DM)
• digoxin (Lanoxin)
• fexofenadine (Allegra)
• herbs with sedative effects such as calendula, California poppy, catnip, capsicum, Siberian ginseng, German chamomile, goldenseal, gotu kola, kava, lemon balm, sage, sassafras, stinging nettle, and valerian
• imatinib (Gleevec)
• immunosuppressants such as azathioprine (Imuran), cyclosporine (Sandimmune, Neoral), mycophenolate mofetil (CellCept), sirolimus (Rapamune), and tacrolimus (Prograf, Protopic)
• irinotecan (Camptosar)
• loperamide (Imodium)
• losartan (Cozaar)
• medicines used to treat AIDS such as nevirapine (Viramune), delavirdine (Rescriptor), efavirenz (Sustiva), indinavir (Crixivan), amprenavir (Agenerase), nelfinavir (Viracept), ritonavir (Norvir), and saquinavir (Fortovase, Invirase)
• migraine medicines such as frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)
• pain medicines such as hydrocodone (Vicodin, Lortab), morphine, meperidine (Demerol), pentazocine (Talwin), tramadol (Ultram), alfentanil (Alfenta), and fentanyl (Sublimaze)
• phenytoin (Dilantin)
• reserpine
• theophylline
• warfarin (Coumadin)

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.

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