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St. John's wort (Hypericum perforatum)

Synonyms/Common Names/Related Substances:

  • Adhyperforin, Amber touch-and-heal, amino acids, arnica of the nerves, balm-of-warrior's wound, balsana, bassant, Blutkraut (German), bossant, Calmigen®, corazoncillo (Spanish), dendlu, devil's scorge, Eisenblut (German), flor de São João (Portuguese), flavonoids, fuga daemonum, goatweed hartheu, heofarigo on, herba de millepertius, herba Hyperici, Herrgottsblut (German), Hexenkraut (German), hierba de San Juan (Spanish), hipericão (Portuguese), hipérico (Spanish), hipericon, HP, hyperforin, hypericin, Hypericum extract ZE 117, Hypericum perforatum L., isorhamnetin, Jarsin, Johanniskraut (German), Klamath weed, Liebeskraut (German), LI 160, LoHyp-57, lord God's wonder plant, melatonin, millepertius pelicao, naphthodianthrones, oligomeric procyanidines, perforate, phloroglucinols, pinillo de oro (Spanish), PM235, pseudohypericin, quercetin, rosin rose, rutin, Sedariston®, SJW, SJW extract LI 160, St. John's wort WS 5572, STW 3-VI, tenturotou, Teufelsflucht (German), touch and heal, Walpurgiskraut (German), witcher's herb, WS® 5570, WS 5572, WS 5573, xanthones, ZE117.

Clinical Bottom Line/Effectiveness

Brief Background:

  • Extracts of Hypericum perforatum L. (St. John's wort) have been used traditionally for a wide range of medical conditions (1;2). The most common modern-day application of St. John's wort is in the treatment of depressive disorders (3;4). Meta-analyses of heterogeneous studies conducted over the past two decades, as well as several subsequent randomized trials, have reported St. John's wort to be more effective than placebo and equally effective as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) in the short-term management of mild-to-moderate depression (1-3 months). Overall, the evidence supporting the efficacy of St. John's wort in mild-to-moderate major depression remains compelling. However, the evidence for severe major depression and other depressive disorders (e.g., seasonal affective disorder) remains unclear.
  • While it is generally well tolerated in clinical use, there is accumulating evidence of significant drug interactions with St. John's wort, particularly when used with medications metabolized by the cytochrome P450 system (5;6). St. John's wort is not recommended for HIV/AIDS patients taking protease inhibitors or non-nucleoside reverse transcriptase inhibitors, patients receiving immunosuppressive therapy (particularly cyclosporine), and users of oral contraceptives, warfarin, or digoxin.
  • St. John's wort may cause nausea, fatigue, allergic reactions, impotence, and photosensitivity. St. John's wort may induce mania in individuals with an underlying mood disorder, and may result in serotonin syndrome if used alone or with other serotonergic agents.

Dosing/Toxicology

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Precautions/Contraindications

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Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

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Mechanism of Action

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History

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Evidence Table

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Evidence Discussion

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Products Studied

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Author Information

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References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.