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St. John’s Wort Plant

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(Hypericum perforatum)

Some research shows the St. John’s wort plant can help treat depression and other medical conditions, but experts warn there are some downsides to this herbal supplement.

The St. John’s wort plant is natural. It’s an herbal supplement that doesn’t require a prescription and you can buy it at a health food store.

St. John’s wort plant is most commonly used for “the blues” or depression and symptoms that sometimes go along with mood such as nervousness, tiredness, poor appetite, and trouble sleeping. There is some strong scientific evidence that it is effective for mild to moderate depression.

Researchers suspect that ingredients in the herb (hypericin and hyperforin) may increase levels of certain brain chemicals, like serotonin. People with depression often have low levels of serotonin and other neurotransmitters.

One reason people may wish to try the natural remedy for depression (as opposed to antidepressants that can increase serotonin) is that St. John’s wort tends to have fewer side effects than medications.

Uses: 

  • Anxiety 
  • Menopause-related symptoms
  • Premenstrual syndrome (PMS)
  • Seasonal affective disorder (SAD)
  • Smoking cessation
  • Viral infections

An oil made from St. John’s wort has also been used topically for wound healing and a variety of other skin conditions such as eczema and hemorrhoids.

More than 40 studies have confirmed its effectiveness for relieving mild to moderate depression; may also relieve PMS symptoms and menopausal hot flashes, especially when combined with black cohosh.

St. John’s Wort Plant Preparation and doses:

Standardized extract (standardized to 0.3% hypericin and/or 3–5% hyperforin): Take 300–600 mg 3 times per day.

Concerns with St. John’s Wort Plant: 

Talk to your physician or pharmacist before using if you are taking prescription medications; the chance for herb-drug interaction is high.

St. John's Wort

Interaction of St Johns Wort plant according to Web MD

Major Interaction

Do not take this combination!

Alprazolam (Xanax) interacts with ST. JOHN’S WORT

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 interacts with ST. JOHN’S WORT

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.

Amitriptyline (Elavil) interacts with ST. JOHN’S WORT

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).

Birth control pills (Contraceptive drugs) interacts with ST. JOHN’S WORT

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 break down 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.<br /><br /> 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.

Cyclosporine (Neoral, Sandimmune) interacts with ST. JOHN’S WORT

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) interacts with ST. JOHN’S WORT

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) interacts with ST. JOHN’S WORT

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.

Imatinib (Gleevec) interacts with ST. JOHN’S WORT

The body breaks down imatinib 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) interacts with ST. JOHN’S WORT

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).

Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates) interacts with ST. JOHN’S WORT

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.<br /><br /> Some medications changed by the liver include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and many others.

Medications for depression (Antidepressant drugs) interacts with ST. JOHN’S WORT

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.<br /><br /> Some of these medications for depression include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Tofranil), and others.

Medications for HIV/AIDS (Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)) interacts with ST. JOHN’S WORT

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.<br /><br /> Some of these medications used for HIV/AIDS include nevirapine (Viramune), delavirdine (Rescriptor), and efavirenz (Sustiva).

Medications for HIV/AIDS (Protease Inhibitors) interacts with ST. JOHN’S WORT

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.<br /><br /> Some of these medications used for HIV/AIDS include amprenavir (Agenerase), nelfinavir (Viracept), ritonavir (Norvir), and saquinavir (Fortovase, Invirase).

Medications for pain (Narcotic drugs) interacts with ST. JOHN’S WORT

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, OxyContin, and many others.

Medications moved by pumps in cells (P-Glycoprotein Substrates) interacts with ST. JOHN’S WORT

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.<br /><br /> 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.

Medications that increase sensitivity to sunlight (Photosensitizing drugs) interacts with ST. JOHN’S WORT

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.<br /><br /> 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).

Meperidine (Demerol) interacts with ST. JOHN’S WORT

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.

Nefazodone (Serzone) interacts with ST. JOHN’S WORT

Nefazodone 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 might cause there to be too much serotonin. This could lead to serious side effects including heart problems, shivering, and restlessness.

Nortriptyline (Pamelor) interacts with ST. JOHN’S WORT

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) interacts with ST. JOHN’S WORT

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.

Pentazocine (Talwin) interacts with ST. JOHN’S WORT

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).

Phenobarbital (Luminal) interacts with ST. JOHN’S WORT

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.

Phenprocoumon interacts with ST. JOHN’S WORT

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.

Phenytoin (Dilantin) interacts with ST. JOHN’S WORT

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.

Reserpine interacts with ST. JOHN’S WORT

St. John’s wort can decrease the effects of reserpine.

Sedative medications (Barbiturates) interacts with ST. JOHN’S WORT

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) interacts with ST. JOHN’S WORT

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.

Tacrolimus (Prograf, Protopic) interacts with ST. JOHN’S WORT

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. This can cause tacrolimus to be less effective.

Tramadol (Ultram) interacts with ST. JOHN’S WORT

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) interacts with ST. JOHN’S WORT

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 Interaction with St Johns Wort Plant

Be cautious with this combination!

Clopidogrel (Plavix) interacts with ST. JOHN’S WORT

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.

Dextromethorphan (Robitussin DM, and others) interacts with ST. JOHN’S WORT

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).

Fexofenadine (Allegra) interacts with ST. JOHN’S WORT

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).

Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates) interacts with ST. JOHN’S WORT

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.<br /><br /> 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.

Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates) interacts with ST. JOHN’S WORT

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.<br /><br /> 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.

Medications for depression (MAOIs) interacts with ST. JOHN’S WORT

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.<br /><br /> Some of these medications used for depression include phenelzine (Nardil), tranylcypromine (Parnate), and others.

Medications for migraine headaches (“Triptans”) interacts with ST. JOHN’S WORT

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.<br /><br /> Some medications for migraine headache include frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig).

Procainamide interacts with ST. JOHN’S WORT

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.

Simvastatin (Zocor) interacts with ST. JOHN’S WORT

The body breaks down simvastatin (Zocor) to get rid of it. St. John’s wort increases how quickly the body breaks down simvastatin. This can cause simvastatin to be less effective.

Minor Interaction

Be watchful with this combination!

Methylphenidate (Concerta, Daytrana, Metadate, Ritalin) interacts with ST. JOHN’S WORT

Taking St. John’s wort along with methylphenidate might decrease how well methylphenidate works for controlling symptoms of attention deficit-hyperactivity disorder (ADHD).

Theophylline interacts with ST. JOHN’S WORT

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.