Ask a doctor, pharmacist, or other healthcare provider if it is safe for you to use this product if you have: severe depression, or bipolar disorder (manic depression); attention deficit hyperactivity disorder, especially if you take methylphenidate (Ritalin). This could result in serotonin syndrome. Consider therapy modification.Fycompa October 2012, P-gp/ABCB1 substrates: P-gp/ABCB1 inducers may decrease the serum concentration of P-gp/ABCB1 substrates. Store at room temperature away from moisture, heat, and light. Benefit in reducing some climacteric symptoms in women with natural menopause has also been demonstrated. Improved glucose response may occur that has been shown to result from an acute increase in insulin response, which is independent of the glucose-lowering action of metformin.Stage 2015, Methadone: St. John's wort may decrease the serum concentration of methadone. Anonymous. You should not use this product if you are trying to get pregnant. Select one or more newsletters to continue. Skip the missed dose if it is almost time for your next scheduled dose. Photosensitization may also occur. St. John's wort is a perennial plant native to Europe but found throughout the United States and parts of Canada. If you choose to use St. John's wort, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. A few nonserious adverse events were reported. Avoid combination.Bach 2004, Grubb 2012, Hanna 2014, Harvey 2010, Hencken 2016, Heritier Barras 2010, Izdes 2014, Kartha 2006, Khan 2007, Khavandi 2008, Larson 2015, Majithia 2006, Martindale 2003, Martino 2016, Mathew 2006, McDonnell 2012, Methylene blue September 2014, Ng 2008, Nicolaou 2016, Pollack 2009, Provayblue April 2014, Ramsay 2007, Rowley 2009, Schwiebert 2009, Shanmugam 2008, Smith 2015, Stanford 1999, Stanford 2010, Sweet 2007, Top 2014, Methylphenidate: Methylphenidate may enhance the adverse/toxic effect of serotonin modulators. Avoid combination.Kalydeco January 2012, Ixazomib: St John's wort may decrease the serum concentration of ixazomib. However, it can cause: 1. Risk of bias was low across all domains.Thandar 2017 In a small pilot study (N=10), both St. John's wort and vehicle alone significantly improved erythema, scaling, and thickness in plaques of patients with mild psoriasis. How Does It … Avoid combination.Daklinza July 2015, Dapoxetine: Dapoxetine may enhance the adverse/toxic effect of serotonin modulators. Monitor therapy.Actiq June 2012, Duragesic April 2014, Kharasch 2004, Morii 2007, Takane 2005, Fexofenadine: St. John's wort taken for several days may decrease the serum concentration of Fexofenadine. Wow. Avoid combination.Michelucci 1996, Sular March 2014, Olaparib: CYP3A4 inducers (moderate) may decrease the serum concentration of olaparib. However, no significant difference was found in depression scores. Avoid combination.Alacare March 2015, Ameluz May 2016, Drucker 2011, Gleolan June 2017, Ladner 2001, Lankerani 2004, Levulan March 2010, Naldi 1999, Aminolevulinic acid (topical): Photosensitizing agents may enhance the photosensitizing effect of aminolevulinic acid (topical). Avoid combination.Olysio November 2013, Sofosbuvir: P-gp/ABCB1 inducers may decrease the serum concentration of sofosbuvir. The patients were resistant to previous treatment with neuroleptics or methylphenidate.Niederhofer 2009, The Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the management of perinatal mood disorders (2012) state that St John's wort and other alternative medicines should not be used during pregnancy and lactation based on lack of evidence specific to use in perinatal mood disorders, the risk of drug interactions, and lack of regulation for such products.SIGN 2012, Equivocal results have been reported by 2 studies using St. John's wort 900 mg/day in patients with irritable bowel syndrome (IBS).Saito 2010, Wan 2010 In a small pilot study (N=30), 8 weeks of treatment with St. John's wort significantly improved psychological well-being, with improved scores on anxiety and depression scales (P<0.05). The evidence for St. John's wort suggests that it is not significantly better than placebo for this indication (2 studies, N=261; relative risk [RR], 0.81; 95% CI, 0.26 to 2.53).Hughes 2014 Clinical trials have produced equivocal results regarding a role in smoking cessation, with one small trial (N=24) without a control group showing efficacy in cessation rates with Hypericum at 12 weeksLawvere 2006 and others showing no difference from placebo.Camfield 2013, Parsons 2009, Uzbay 2008 A larger randomized, blinded, placebo-controlled, dose-ranging study similarly found no difference in smoking cessation rates, mean cigarettes smoked per day, withdrawal symptoms, or tobacco cravings in the St. John's wort 900 mg/day or 1,800 mg/day groups compared to placebo. Monitor therapy.Drucker 2011, Lankerani 2004, Naldi 1999, Visudyne June 2012, Vincristine (liposomal): St. John's wort may decrease the serum concentration of vincristine (liposomal). Insomnia 11. 1. The differences reported in the studies were not statistically significantly different compared to women taking prescription antidepressants (4%) or those who were otherwise healthy and/or not exposed (0%). Avoid combination.Aliqopa September 2017, Dresser 2003, Piscitelli 2000, Sugimoto 2001, Wang 2001, Crizotinib: St. John's wort may decrease the serum concentration of crizotinib. Taking St. John's wort with this type of antiviral drug can reduce the drug's effectiveness. Call your doctor if the condition you are treating with St. John's wort does not improve, or if it gets worse while using this product. Interventions included H. perforatum as monotherapy (3 studies) as well as in combination with chaste tree or black cohosh. Avoid combination.Russo 2014, Esomeprazole: St. John's wort may decrease the serum concentration of esomeprazole. Photosensitizing drugs. This could result in serotonin syndrome. Specifically, St. John's wort may increase the metabolism of reverse transcriptase inhibitors (non-nucleoside). Isohypericin and protohypericin are also present. A randomized clinical trial of St. John's wort for smoking cessation. Stomach discomfort 15. Avoid combination.Cotellic November 2015, Codeine: CYP3A4 inducers (moderate) may decrease serum concentrations of the active metabolite(s) of codeine. Avoid combination.Bosulif September 2012, Brentuximab vedotin: P-gp/ABCB1 Inducers may decrease the serum concentration of brentuximab vedotin. It has a strong affinity for GABA, glutamate, and adenosine receptors.Sood 2010 It induces the cytochrome P450 (CYP-450) system, the uridine diphosphate glucuronosyltransferase (UGT) isozyme, and P-glycoprotein.Kummer 2016, Markert 2015, Pereira 2013 Downregulation of beta-adrenergic receptors has also been documented.Russo 2014 The major coactive constituents shown to mediate the broad-spectrum inhibition of neurotransmitter reuptake are hypericin, hyperforin, quercetin, and kaempferol.Chrubasik-Hausmann 2018, Bioactivities of the various constituents in St. John's wort are a result not only of their bioavailability but also of the complex interactions of the constituents themselves, some of which are light dependent. Amphetamines: Amphetamines may enhance the adverse/toxic effect of serotonin modulators. It is not certain whether St. John's wort is effective in treating any medical condition. Consider therapy modification.Smith 2004, Integrase inhibitors: St. John's wort may decrease the serum concentration of integrase inhibitors. Quercetin, amentoflavone, hyperforin, and hypericin have been shown to individually reduce nuclear factor kappa B, tumor necrosis factor alpha (TNF-alpha), cyclooxygenase-2, p38, and other key factors in inflammatory signaling pathways. Avoid combination.Stribild August 2012, Cobimetinib: CYP3A4 inducers (moderate) may decrease the serum concentration of cobimetinib. Limited information, a lack of consistent use of standardized product formulations, as well as potentially high interpatient variability in clinical response warrants cautious interpretation and/or application of these data in practice. Pseudohypericin was a necessary element in the anti-inflammatory process, as it was required for the reduction in prostaglandin E2.Hammer 2014 Similarly, St. John's wort ethanolic extract inhibited the increase in neutrophil recruitment and the inflammatory biomarkers interleukin 1beta (IL-1beta) and TNF-alpha as well as the decrease in glutathione that was induced by acetaminophen toxicity in mice. Contraceptive failure is possible. Gender differences in the dermal expression of interleukins may be involved in this differential response.Hohmann 2016 An interaction of constituents, as found in the whole plant, has been shown to reduce the toxicity of hypericum extracts.Hammer 2014, Long-term treatment (up to 21 days) with St. John's wort significantly increased 2-hour plasma glucose levels (by approximately 40%), total glucose AUC (by 18%), and incremental blood glucose AUC (by 48%) in 10 healthy men. 2010 Jul;16(7):761-7. doi: 10.1089/acm.2009.0445. Do not use this product without medical advice if you are pregnant. A Cochrane review of antidepressants for smoking cessation also examined evidence for herbal products, including St. John's wort. Stop using St. John's wort and call your healthcare provider at once if you have: severe sunburn (redness, burning, blistering) after being outdoors; or. St John's wort may decrease the serum concentration of CYP3A4 substrates. Avoid combination.Samsca February 2012, Shoaf 2012, Trabectedin: St. John's wort may decrease the serum concentration of trabectedin. Medicinal use of this product has not been approved by the FDA. Avoid combination.Ingrezza April 2017, Vandetanib: St. John's wort may decrease the serum concentration of vandetanib. St. John's wort can make you sunburn more easily. Avoid combination.Zykadia April 2014, Clarithromycin: CYP3A4 inducers (moderate) may increase serum concentrations of the active metabolite(s) of clarithromycin. St. John’s Wort is a highly popular herbal remedy for anxiety and depression but it isn’t without side effects or contraindications. It generally reaches a height of 0.3 to 0.61 m, except on the Pacific coast where it has attained heights of 1.5 m.Awang 1991 The plant has oval-shaped leaves and yields golden-yellow flowers that bloom from June to September. Give a list of all your medicines to any healthcare provider who treats you. All 17 patients who reported at least a 70% improvement in symptom severity scores and improved sleep during the 10-day induction phase opted to enter the 3-month continuation phase. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Soothing Topical Uses . People has also tried St. John’s wort to quit smoking and to treat fibromyalgia, burning sensation in the mouth, chronic fatigue syndrome, migraine, nerve pain, nerve damage in the body, and muscle pain. Ask your doctor to help you find the right dose. Restlessness 14. Avoid combination.Portolés 2006, Procoralan August 2010, Ivacaftor: St. John's wort may decrease the serum concentration of ivacaftor. Specifically, concentrations of SN-38 may be reduced. Consider therapy modification.Tafinlar May 2013, Daclatasvir: St John's wort may decrease the serum concentration of daclatasvir. It caused a rapid dramatic fall in ciclosporin blood concentrations, resulting in acute heart transplant rejection in two patients aged 61 and 63 years [406 ]. Consider therapy modification.De Smet 2000, Izzo 2016, Jiang 2004, Xalkori August 2011, Vorapaxar: St. John's wort may decrease the serum concentration of vorapaxar. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. The 4 trials included in the safety analysis showed no difference between treatment and placebo.Liu 2014, The Society of Obstetricians and Gynaecologists of Canada revised clinical practice guidelines on managing menopause (2014) recommend that complementary and alternative medicine that has demonstrated efficacy for mild menopausal symptoms, including St. John's wort for healthy mood balance and associated sleep disturbances, may be offered (level I-B evidence).Reid 2014 Another Canadian organization, the Committee on the Evolution of Practices in Oncology (CEPO), recommends against the use of St. John's wort for managing hot flashes in breast cancer survivors (level II evidence [ie, evidence demonstrated by small randomized trials with uncertain results), as no benefit was shown over placebo; however, the single study reviewed did report significant improvements in sleep and quality-of-life measures in the St. John's wort group (900 mg/day for 3 months).L'Espérance 2013, St. John's wort was investigated in an open-label pilot study in 21 patients with restless legs syndrome. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age. Using different formulations together increases the risk of an overdose. Monitor therapy.Albermann 2005, Callaghan 2008, Gurley 2008, Ho 2005, Kim 2002, Kivistö 2004, Leslie 2005, Mueller 2004, Teng 2008, Pimavanserin: St. John's wort may decrease the serum concentration of pimavanserin. Call your doctor for medical advice about side effects. Specifically 5 of 6 females, but 0 of 6 males, developed dermatologic and neurologic symptoms on sun-exposed areas of the back of the hands and perioral and nasal areas within 6 days of increasing the dose of St. John's wort from 300 mg to 600 mg (3 times daily). Decreased self-administration of ethanol and withdrawal syndrome have been demonstrated in rodents, as well as no increased ethanol intake after periods of deprivation.De Vry 1999, Ebrahimie 2015, Uzbay 2008, Uzbay 2008. This effect was not only sustained but increased at 6 weeks following the last dose (240 to 294 mg of dry extract and 900 mcg total hypericin twice daily). Monitor therapy.Nuplazid April 2016], Piperaquine: St. John's wort may decrease the serum concentration of piperaquine. Application of St. John's wort resulted in greater reduction in erythema scores, scaling scores, and thickness scores, with improvement in scaling being the most pronounced; on a 3-point scale, a mean difference of –1.8 and –0.3 was observed for treatment and vehicle, respectively. Consider therapy modification.Invega April 2014, Invega Sustenna November 2014, Invega Trinza May 2015, Ono 2002, Spina 2000, Vermeulen 2007, Yasui-Furukori 2013, Pantoprazole: St. John's wort may decrease the serum concentration of pantoprazole. St. John’s Wort has a history of misuse by consumers, researchers and manufacturers by using an isolated compound (hypericin) rather than using the whole plant; Cannabis strains and dosage play a huge role in alleviating depression. Strongest minimum inhibitory concentrations (MICs) (200 to 250 mcg/mL) were observed against Enterococcus faecium, Staphylococcus aureus, and Staphylococcus epidermidis by H. humifusum extract and against C. albicans by H. perforatum extract. When considering the use of herbal supplements, seek the advice of your doctor. Beyond its use in depression, it’s been explored as a treatment for chronic fatigue and it appears to exert some anti-inflammatory effects as well. Not all possible interactions are listed in this medication guide. Clinical trials evaluating the efficacy of St. John's wort in depression have commonly used 900 mg of extract daily in 3 divided doses for periods of up to 12 weeks (range, 200 to 1,800 mg/day).Kasper 2008, Linde 2000, Papakostas 2007, Two studies used a topical hypericum cream containing hypericin 1% and 1.5%.Arndt 2013, Tardivo 2012, The use of St. John's wort in perinatal depression has been considered; however, insufficient data exist to support its use.Freeman 2009 There is a lack of systematic evidence on the safety of Hypericum in pregnancy or lactation.Dugoua 2006, Freeman 2009 A small study of case-matched infants born to mothers consuming St. John's wort during pregnancy found an increase in colic, drowsiness, and lethargy.Dugoua 2006, Studies in rats suggest the preparation may have teratogenic and toxic effects,Gregoretti 2004, Lee 2003, Russo 2014 while other studies suggest no changes in cognitive development or long-term behavior.Dugoua 2006 Emmenagogue and abortifacient effects due to uterine stimulant action have been suggested,Brinker 1998, Ernst 2002, Rotblatt 2002, Shipochliev 1981 but evidence is weak.Dugoua 2006, In 2 separate studies, the rates of major postnatal malformations (eg, hypospadias, bilateral hip dislocation, heart septum defect, obstructed ureter) in children of women exposed to St. John's wort while pregnant were 5% and 8.1%. Use with various antineoplastics, anticoagulants, and anti-infectives (including antivirals), as well as boceprevir, cobicistat, telaprevir, and voriconazole is contraindicated. Avoid combination.Cerdelga August 2014, Elvitegravir: St. John's wort may decrease the serum concentration of elvitegravir. After 3 months, median severity score had improved significantly from 24 (±5.1) at baseline to 4.1 (±1) (P<0.0001). Avoid combination.Tivicay June 2015, Doxorubicin (conventional): St. John's wort may decrease the serum concentration of doxorubicin (conventional). St. John's wort is available in time-release capsules. Avoid combination.Odomzo July 2015, Sorafenib: St. John's wort may decrease the serum concentration of sorafenib. Avoid combination.Harvoni October 2014, Linagliptin: P-gp/ABCB1 inducers may decrease the serum concentration of linagliptin. Monitor therapy.Chopra 2004, Duggal 2005, Fisher 2002, Gambassi 2006, Karki 2003, Kaufman 2006, Kim 2007, Kohen 2007, Kontaxakis 2003, Kontaxakis 2003, Marlowe 2006, Matsumoto 2005, Stevens 2008, Verre 2008, Apixaban: St. John's wort may decrease the serum concentration of apixaban. The most commonly described constituents are naphthodianthrones, flavonoids, phloroglucinols, and essential oils. Until today, no scientific studies can claim St John's Wort as an aid in quit smoking programs. Unintended interactions with other drugs and quality control issues need to be considered prior to use. Written by Cerner Multum. Avoid combination.Dutreix 2013, Rydapt April 2017, Mifepristone: St. John's wort may decrease the serum concentration of mifepristone. Researchers suggest that the herb is able to inhibit monoamine oxidase A and B, and is involved in dopamine and noradrenaline reuptake. Avoid combination.Dooley 2012, Sirturo May 2015, Svensson 2013, Benzodiazepines (metabolized by oxidation): St. John's wort may increase the metabolism of benzodiazepines (metabolized by oxidation). Hypericin and pseudohypericin inhibit a variety of encapsulated viruses, including HIV.Upton 1997, 3-Hydroxy lauric acid obtained from H. perforatum exhibited light-independent, anti-HIV activity in an in vitro experiment.Maury 2009, Clinical trials of St. John's wort use in HIV are limited by the prevalence of interactions between St. John's wort and standard HIV therapy. Dizziness 5. CYP3A4 inducers (moderate) may increase serum concentrations of the active metabolite(s) of ifosfamide. Available for Android and iOS devices. The plant has been used in traditional medicine as an antidepressant and a diuretic, as well as for gastritis and insomnia.Hahn 1992, Ng 2017, Russo 2014 Topically, it was traditionally used in the management of wounds, bruises, skin ulcers, cuts, burns, contusions, myalgia, and hemorrhoids, and as an antiseptic.Samadi 2010, Yucel 2017 It is now licensed in many European countries and widely prescribed for depression.Ng 2017, Several reports regarding the chemical components in St. John's wort are available.Butterweck 2007, Mauri 2000, Schmitt 2006, Wurglics 2006 More than 150 constituents have been identified that interact in synergistic, additive, and antagonistic manners to produce a variety of actions. Avoid combination.Tagrisso August 2016, Oxycodone: St. John's wort may decrease the serum concentration of oxycodone. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. St. John's wort should not be used in place of medication prescribed for you by your doctor. Avoid combination.Cresemba March 2015, Ivabradine: St. John's wort may decrease the serum concentration of ivabradine. This may manifest as symptoms consistent with serotonin syndrome or neuroleptic malignant syndrome. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. Due to the lack of rigorous standardization of product purity and potency in the United States, data were deemed insufficient to recommend a place in therapy for St. John's wort in the treatment of MDD.Qaseem 2016, Based on efficacy in depression, Hypericum extracts have been recommended as appropriate therapy in mild or moderate depression with bipolar disorder as an alternative to standard antidepressant therapy.Andreescu 2008 A trial (N=54) evaluating the efficacy of 900 mg of Hypericum extract daily in adolescents with attention-deficit/hyperactivity disorder and a subsequent systematic review found no difference compared with placebo at 8 weeksSarris 2011, Weber 2008 and no difference using the same dosage in burning mouth syndrome.Sardella 2008 St. John's wort 600 mg/day performed better than placebo in 6 primary outcome measures in patients with somatoform disorders.Müller 2004 Equivocal results have been demonstrated for Hypericum extracts in the management of premenstrual symptoms, which may be reflective of the different dosages used.Hicks 2004, Stevinson 2000 Improvement in total, behavioral, and physical symptoms in women diagnosed with premenstrual syndrome (PMS) has been demonstrated with Hypericum compared to placebo in double-blind RCTs that include a small crossover pilot study (N=36) and a larger prospective trial (N=170).Canning 2010, Ghazanfarpour 2011, Seasonal affective disorder, a type of depression in which symptoms occur in fall/winter and resolve in spring/summer, improved with St. John's wort in combination with light therapy.Martinez 1994 In an open-label trial, statistically but not clinically significant improvements in several target behaviors in 3 young autistic males (19 to 22 years of age) were documented after 4 weeks of St. John's wort 20 mg/day. Monitor therapy.Izzo 2016, Methylene blue: Methylene blue may enhance the serotonergic effect of serotonin modulators. The anthraquinone derivatives hypericin and pseudohypericin (also emodin-anthranol and cyclo-pseudohypericin) are the best known components of the plant. I stepped up the dose to a full tobacco pipe bowl. Agitation 2. In major depression cases, however, St John's Wort yields poor results. Patients ranged in age from 7 to 77 years and presented with HSV-1, HSV-2, or combination-type lesions.Tardivo 2012, The cytocidal activity of hyperforin and its effect on tumor growth inhibition have been demonstrated against human cell lines.Business Wire 1998, Hostanska 2003, Lorusso 2009, Schmitt 2006, Stavropoulos 2006, Platelet response improved significantly subsequent to administration of St. John's wort versus placebo in clopidogrel nonresponders with stable angina who underwent elective percutaneous coronary intervention (PCI). Consider therapy modification.Russo 2014, Sugimoto 2001, Ibrutinib: St. John's wort may decrease the serum concentration of ibrutinib. St. John’s wort Preliminary research on this herb has found that is has the ability to help people quit smoking. Avoid combination.Dresser 2003, Ibrance February 2016, Imai 2008, Sugimoto 2001, Wang 2001, Paliperidone: St. John's wort may decrease the serum concentration of paliperidone. These interactions appear to provide a balance of both pro- and anti-inflammatory activities, as well as phototoxic and photoprotective actions. Triptans. Monitor therapy.Peltoniemi 2012, Lapatinib: St. John's wort may decrease the serum concentration of lapatinib. 1 decade ago. Potent inhibition of sperm motility was observed in vitro.Ondrizek 1999. Other possible rare adverse reactions include induction of mania and effects on male and female reproductive capabilities. Many drugs can interact with St. John's wort, and serious drug interactions can occur when certain medicines are used at the same time. Often taken internally as a tea, tincture, or in pill form, herbalists use it for a great deal of ailments because of the numerous healing benefits. Joints are fun too but burn quickly. Although not all side effects are known, St. John's wort is thought to be likely safe when taken by an adult for up to 12 weeks, or by a child age 6-17 for up to 8 weeks. 0 0. Avoid combination.Smith 2009, Tykerb August 2011, Ledipasvir: P-gp/ABCB1 inducers may decrease the serum concentration of ledipasvir. St. John's wort has been used in alternative medicine as a likely effective aid in treating mild to moderate depression and related symptoms such as anxiety or insomnia. St. John's wort may also be used for purposes not listed in this product guide. Oh wow, you see, I was told not to mix them! I was taking 2 st johns wort and one champix a day now I am on half a champix and still the 2 st johns wort. Avoid combination.Xarelto July 2011, Romidepsin: St. John's wort may decrease the serum concentration of romidepsin. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. This could result in serotonin syndrome. I quit smoking with champix on 13th April but ended up smoking half a cig so put my quit date to the 8th May and been ok since, that was when I started taking the st johns wort. St. John’s wort’s ability to soothe the nerves is beloved among herbalists who enjoy using the fresh plant oil topically to ease nerve pain. Many drugs can interact with St. John's wort, and some drugs should not be used together. It is also beneficial for fighting against HIV/AIDS, hepatitis C, cancer (including brain cancer), herpes simplex, and weight loss. 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