What is it?

St. John's Wort is an herbal medicine used to treat mild to moderate depression, anxiety, seasonal affective disorder, premenstrual syndrome, and infection. It is also used to increase memory and concentration. St. John's Wort can be used on the skin to help heal wounds, control pain, and treat menopause symptoms.

Other names for St. John's Wort include: Hypericum perforatum

Ask your doctor, nurse, or pharmacist if you need more information about this medicine or if any information in this leaflet concerns you.

Before Using:

Tell your doctor if you ...

• are taking medicine or are allergic to any medicine (prescription or over-the-counter (OTC) or dietary supplement)
• are pregnant or plan to become pregnant while using this medicine
• are breast feeding
• have any other health problems, such as high blood pressure or heart or blood vessel disease

Dosage:

Talk with your doctor, pharmacist, or nurse about how much St. John's Wort you should take. The amount depends on the strength of the medicine and the reason you are taking St. John's Wort. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more St. John's Wort or take it more often than what is written on the directions.

To store this medicine:

Keep all medicine locked up and away from children. Store medicine away from heat and direct light. Do not store your medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down and not work the way it should work. Throw away medicine that is out of date or that you do not need. Never share your medicine with others.

Drug and Food Interactions:

Do not take St. John's Wort without talking to your doctor first if you are taking:

• Acitretin (Soriatane(R))
• Aminolevulinic acid (Levulan Kerastick(R))
• Amiodarone (Cordarone(R), Pacerone(R))
• Amsacrine (AMSA P-D(R))
• Blood thinning medicine (warfarin (Coumadin(R)))
• Medicines used for diabetes to lower blood sugar (examples: insulin, glyburide (DiaBeta(R), Glynase PresTab(R), Micronase(R)), metformin (Glucophage(R), Glucovance(R)); rosiglitazone (Avandia(R)))
• Buspirone (Buspar(R))
• Medicines to help you sleep, relax, or for seizures (examples: phenobarbital (Luminal(R)), alprazolam (Xanax(R)), lorazepam (Ativan(R)), diazepam (Valium(R)))
• Medicines for high blood pressure or heart problems (examples: atenolol (Tenormin(R)), metoprolol (Toprol(R) Lopressor(R)), diltiazem (Cardizem(R) Dilacor(R)), verapamil (Calan(R) Isoptin(R)), nifedipine (Adalat(R), Procardia(R)))
• Medicines used during anesthesia
• Carbamazepine (Tegretol(R))
• Chlorzoxazone (Paraflex(R))
• Clozapine (Clozaril(R))
• Hormonal contraceptives (birth control) may interact with St. John's Wort, resulting in unplanned pregnancy
• Cyclophosphamide (Cytoxan(R))
• Cyclosporine (Neoral(R), Sandimmune(R))
• Debrisoquin
• Digoxin (Lanoxin(R))
• Etoposide (VePesid(R))
• Fenfluramine (Pondimin(R))
• Imatinib (Gleevec(TM))
• Medicines used to lower cholesterol (examples: atorvastatin (Lipitor(R)), fluvastatin (Lescol(R)), lovastatin (Mevacor(R)), pravastatin (Pravachol(R)), rosuvastatin (Crestor(R)), simvastatin (Zocor(R)))
• Irinotecan (Camptosar(R))
• Loperamide (Imodium(R))
• Methadone
• Midazolam (Versed(R))
• Medicines used to treat pain (examples: codeine, fentanyl (Duragesic(R)), hydrocodone (Vicodin(R), Lorcet(R)), morphine (MS Contin(R), MSIR(R), Oramorph(R)), oxycodone (Endocet(R), Endodan(R), Oxycontin(R), Percocet(R), Percodan(R)), propoxyphene (Darvon(R), Darvocet(R)))
• Omeprazole (Prilosec(R))
• Paclitaxel (Taxol(R))
• Phenytoin (Dilantin(R))
• Medicines used to treat AIDS or HIV disease (protease inhibitors and non-nucleoside reverse transcriptase inhibitors, examples: indinavir (Crixivan(R)), delavirdine (Rescriptor(R)), lamivudine (Epivir(R)), nelfinavir (Viracept(R)), nevirapine (Viramune(R)), ritonavir (Norvir(R)), saquinavir (Invirase(R)), zidovudine (Retrovir(R)))
• Medicines used to treat depression (examples: citalopram (Celexa(R)), fluoxetine (Prozac(R)), paroxetine (Paxil(R)), sertraline (Zoloft(R)) (4,25,30); phenelzine (Nardil(R)), selegiline (Eldepryl(R)) (5); amitriptyline (Elavil(R)), nortiptyline (Pamelor(R)) (20); nefazodone (Serzone(R)) (25); venlafaxine (Effexor(R)))
• Medicines for migraine headaches (examples: sumatriptan (Imitrex(R)), naratriptan (Amerge(R)), rizatriptan (Maxalt(R)), zolmitriptan (Zomig(R))
• Reserpine
• Sirolimus (Rapamune(R))
• Tacrolimus (Prograf(R))
• Tamoxifen (Nolvadex(R))
• Theophylline (TheoDur(R) Respbid(R) SloBid(R))
• Trazodone (Desyrel(R))
• Over the counter cold and flu medicines
• Other medicines which cause your skin to be sensitive to the sun (there are many, ask your doctor or pharmacist)
• Foods which contain tyramine (examples: Anchovies, Avocados, Bananas, Caffeine foods, Cheese, Aged Cheese, Strong Cheese, Chocolate, Canned Figs, Liqueurs, Wine, Chianti Wine, Beer, Tenderized Meat, Beef, Liver, Chicken Liver, Meat Extracts, Genoa Salami, Salami, Hard Salami, Dry Sausage, Bologna, Pepperoni, Smoked Fish, Caviar, Pickled Herring, Soy Sauce, Lebanon, Miso, Raisins, Sauerkraut, Sherry, Sour Cream, Soybean Paste, Brewer's Yeast, Yeast Extract, Yogurt)

Warnings:

• Before taking St. John's Wort, tell your doctor if you are pregnant or breast feeding
• You may need to take this medicine for 2 to 4 weeks before you start to feel any change
• St. John's Wort may interact with many more medicines than are listed here. Talk to your doctor or pharmacist before taking St. John's Wort with any other medicine.
• Talk to your doctor before having any diagnostic tests if you take St. John's Wort
• This medicine may make your skin more sensitive to the sun and cause it to burn. Use sunscreen when in the sun to protect your skin. Be extra careful if you take any medicines that also can make your skin burn more easily.

Side Effects:

Stop taking your medicine right away and talk to your doctor if you have any of the following side effects.

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing, or rash.

Other Side Effects:

You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine.

• Nausea (upset stomach), diarrhea, loss of appetite
• Swelling
• Drowsiness
• Restlessness
• Headache
• Sexual difficulties
• Frequent urination
• Photosensitivity

References:

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2. Peebles KA, Baker RA, Kurz EU et al: Catalytic inhibition of human DNA topoisomerase IIalpha by hypericin, a naphthodianthrome from St. John's Wort (Hypericum perforatum). Biochem Pharmacol 2001; 62(8):1059-1070.

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