St. John’s Wort (Hypericum perforatum L.)
Table of contents
- Brand Names
- Drug Combinations
- Chemistry
- Pharmacologic Category
- Mechanism of Action
- Therapeutic Use
- Unlabeled Use
- Pregnancy and Lactation Implications
- Contraindications
- Warnings and Precautions
- Adverse Reactions
- Genes that may be involved
- Substrate of
- Inhibits
- Induces
- Drug Interactions
- Nutrition/Nutraceutical Interactions
- Pharmacokinetics and Pharmacodynamics
- Special Considerations
Brand Names
Europe
Austria: Hypericum, Hyperiforce, Jarsin, Johanicum, Johanniskraut, Kira, Laif, Psychotonin, Remotiv, Sanvita, Sidroga; Belgium: Hyperiplant, Milperinol, Perika, Millepertuis Sint-Janskruid Elusan, Zibrine; Bulgaria: Esbericum; Cyprus: Hypericum; Czech Republic: Hypericum, Hypericum perforatum; Denmark: Esbericum, Hyperiforce, Libramin, Modigen, Nicoplus Perikum, Velzina; Estonia: Hypericum; Finland: Hypericum; France: Hypericum; Germany: Hewepsychon mono, Hyperforat Vitahom Hypericum, Johanniskraut, Johanniskrauttee, Öko; Greece: Movina, Neukan; Hungary: Laif, Remotiv; Ireland: Hypericum; Italy: Hypericum; Lithuania: Aconervin, Cesradyston, Smulkinta jonažolių žolė, Vaistažolių arbata «Jonažolių žolė»; Luxembourg: Hypericum; Malta: Hypericum; Netherlands: Hypericum, Hypericum perforatum, Hyperiplant; Poland: Apatinac, Deprim, Felis, Hypercaps, Hypercin, Hyperherba, Hiperiforce, Hyperosedat, Perfocrat, Perhip, Remotiv, Silenil, Succus Hyperici, Superoptim, Tinctura Hyperici, Zioł.fix Dziurawiec; Portugal: Hipérico, Hypericum; Romania: Hypericum; Slovakia: Hypericum perforatum; Slovenia: Hypericum; Spain: Cirkupaz, Hipcedan, Hipérico, Hyneurín, Hypericum, Hypericum perforatum, Livren, Periká, Quetzal, Vitalium; Sweden: Hypermin, Johannesört Salus, Neurokan; UK: Hypericum, St. John’s Wort.
North America
Canada: Hypericum, Hypericum perforatum, Hyperiforce; USA: Bioforce, Kira, Hypericum, Hypericum perforatum, Perika, St. John’s Wort.
Latin America
Argentina: Amenicil, Hipax Forte; Brazil: Fiotan, Hiperex, Hipericin, Hipérico, Hipersac, Hyperigreen, Iperisan, Motiven, Prazen, Triativ; Mexico: Hiperikan.
Drug combinations
St. John’s Wort: Achillea *millefolium; Acidum *arsenicosum; Acidum *benzoicum; Acidum *hexachloroplatinicum; Acidum *hydrofluoricum; Acidum *phosphoricum; Acidum *picrinicum; Acidum *silicicum; Acidum *sulfuricum; Aconitum *napellus; Actaea *spicata; Adonis *vernalis; Aletris *farinosa; Amanita *muscaria; Ambra *grisea; Ammonium *bromatum; Anamirta *cocculus; Apis *regina; Aqua *silicata; Arctostaphylos uva-ursi**; Argentum nitricum; Arnica montana; Arsenum iodatum; Artemisia abrotanum; Artemisia absinthium; Artemisia vulgaris; Asa foetida; Asarum europaeum; Atropa bella–donna; Atropinum sulfuricum; Atropinum sulfuricum; *Aurum chloratum; Aurum *iodatum; Avena *sativa; Banisteria *caapi; Bellis *perennis; Berberis *vulgaris; Betula *pendula; Bryonia spp.; Caesium *chloratum; Calcium *carbonicum; Calcium *fluoratum; Calcium *phosphoricum; Calendula *officinalis; Camphora; Causticum *hahnemanni; Chamaelirium luteum; Chamomile; Chelidonium *majus; Chininum *sulfuricum; Cicuta *virosa; Cimicifuga *racemosa; Citrullus *colocynthis; Conium *maculatum; Convallaria *majalis; Crataegus spp**.; Crocus sativus; Cuprum metallicum; Cyclamen purpurascens; Dactylopius coccus; Daphne mezereum; Dioscorea villosa; Drosera spp.; Echinacea *purpurea; Equisetum *arvense; Eucalyptus spp**.; Eupatorium perfoliatum; Euphorbia cyparissias; Euspongia officinalis; Ferrum phosphoricum; Ferrum sesquichloratum; Foeniculum vulgare; Fumaria officinalis; Gelsemium sempervirens; Ginkgo biloba; Graphites; Hamamelis virginiana; Harpagophytum procumbens; Hepar sulfuris; Humulus lupulus; Hydrastis canadensis; Hyoscyamus niger; Iris versicolor; *Iron; Juniperus *communis; Kalium carbonicum; Kalium phosphoricum; Kalium stibyltartaricum; Khellinum; Lachesis mutus; Lathyrus sativus; Lavender; Ledum *palustre; Levisticum officinale; Lilium lancifolium; Lithium carbonicum; Lobelia inflata; Lupulinum; Lycopodium clavatum; Lytta vesicatoria; Magnesium sulfuricum; Mandragora e radice siccata; Manganum aceticum; Matricaria recutita; Melissa officinalis; Mercurius solubilis; Myristica fragrans; Naja naja; Natrium chloratum; Natrium tetrachloroauratum; Nitroglycerinum; Oenanthe aquatica; Packera aurea; Panax ginseng; Passiflora incarnata; Peumus boldus; Phosphorus; Physostigminum salicylicum; Pilocarpus spp.; Plantago *major spag.; Platinum metallicum; Plumbum aceticum; Podophyllum peltatum; Primula *veris; Prunus spinosa; Pulsatilla pratensis; Resina thapsiae; Rhus aromatica; Rosa *centifolia; Rosmarinus officinalis; Ruta graveolens; Saccharomyces cerevisiae; Salvia *officinalis; Sambucus nigra; Sanguinaria canadensis; Saponaria officinalis; Secale *cornutum; Selenium; Selenicereus grandiflorus; Sempervivum tectorum; Sepia officinalis; Serenoa repens; Silybum marianum; Solanum dulcamara; Spigelia anthelmia; Stannum *metallicum; Strychnos *ignatii; Strychnos nux-*vomica; Symphytum *officinale; Symphytum *officinale; Taraxacum *officinale; Tellurium *metallicum; Thuja *occidentalis; Toxicodendron *quercifolium; Trillium *erectum; Tussilago *farfara; Urtica *urens; Valeriana *officinalis; Vanadium *metallicum; Verbascum *densiflorum; Veronica *virginica; Viscum *album; Vitex agnus-*castus; Zincum *isovalerianicum; Zincum *metallicum*
Chemistry
St. John’s Wort: Dried flowering tops or aerial parts of Hypericum perforatum Linné (Fam. Hypericaceae).
Pharmacologic Category
Natural Products; Herbs.
Mechanism of action
The major active constituents are considered to be hyperforin and hypericin. Precise mechanism of action for antidepressant effect of St. John’s wort is unclear. It seems that hyperforin inhibits serotonin uptake in association with elevation of free intracellular sodium ion concentrations; this may be secondary to activation of Na^+^/H^+^ exchange as a result of a decrease in intracellular pH. Antibacterial activity of hyperforin against multiresistant S. aureus and Gram-positive bacteria, including Streptococcus pyogenes and Corynebacterium diphtheriae, reported. Hypericin, pseudohypericin inhibit several encapsulated viruses in vitro. Antiviral activity reported for hypericin against human immunodeficiency virus (HIV) and hepatitis C. Antiviral activity of hypericin appears to involve a photoactivation process. In vitro, hypericin has been shown to inhibit tumor necrosis factor-induced activation of the transcription factor NF-κB, specific growth factor-regulated protein kinases and release of arachidonic acid and leukotriene B~4~. Hypericin and pseudohypericin reported to inhibit 12-lipoxygenase activity. Tannins isolated from St. John’s wort are stated to have mild astringent activity.
Therapeutic use
Anxiety. Depression. Excitability. Fibrositis. Menopausal neurosis. Neuralgia. Sciatica. Wounds. Possess astringent and sedative properties, and can be used as a nerve tonic.
Pregnancy and lactiation implications
St. John’s wort should not be taken by women who are pregnant, are trying to become pregnant, or are breastfeeding.
Unlabeled use
Atopic dermatitis. Depressive disorder (severe). Nerve pain. Obsessive-compulsive disorder. Peri-menopausal symptoms. Premenstrual syndrome. Seasonal affective disorder. Somatoform disorders.
Contraindications
Allergy to any ingredient in St. John’s wort. Pregnancy. Concomitant consumption of antidepressants, amphetamines, blood thinners (e.g. warfarin), bromocriptine, narcotic analgesics, pramipexole, or ropinirole. Consumption of a serotonin reuptake blocker (e.g. fluoxetine) within past 14 days. History of severe depression or urge to harm oneself or others.
Warnings and precautions
Individuals with sensitivity towards St. John’s wort may experience allergic reactions. Generally well tolerated at recommended doses for up to 1-3 months. Should not be administered in bipolar disorder. Reported to cause psychiatric symptoms such as suicidal and homicidal thoughts. This product may cause dizziness. May affect hepatic metabolization of other drugs (pseudoephedrine, phenylpropanolamine, tryptophan, herbal phen-fen products, or yohimbine). Do not exceed recommended dose for this herbal product. May cause increased sensitivity to the sun (exposure to sun, sunlamps, tanning booths/beds should be avoided). St. John’s wort may decrease effectiveness of birth control pills. Not recommended for use in children.