Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. 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. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in people with known allergy or sensitivity to St. John's wort or to any of its parts.

Infrequent allergic skin reactions, including rash and itching, have been reported.

Side Effects and Warnings

Extensive research supports the safe use of St. John's wort for a short duration (<3 months) at recommended doses in individuals that lack other medication intake.

St. John's wort may cause anxiety, headache, muscle cramps, sweating, weakness, dry mouth, or skin irritation.

Use with caution when using St. John's wort with drugs metabolized by cytochrome P450, as decreased drug effectiveness may occur.

St. John's wort may increase the risk of photosensitivity. Use cautiously in people with sensitive skin or those taking photosensitizing drugs.

St. John's wort may increase the risk of serotonin syndrome. Use cautiously in people taking agents that increase the risk of serotonin syndrome.

St. John's wort may result in altered menstrual flow, bleeding, unwanted pregnancies, and hormone level changes. Use cautiously in women taking contraceptives or other estrogen agents by mouth.

St. John's wort may alter drug levels. Use cautiously in people taking agents for bacterial or fungal infections, agents for erectile dysfunction, antianxiety agents, antihistamines, fertility agents, P-glycoprotein agents, pain relievers, or theophylline.

St. John's wort may cause mania or psychosis. Use cautiously in people with mental illnesses and those taking antipsychotics.

St. John's wort may change how sugar is processed in the body. Use cautiously in people with diabetes or in those taking anti-diabetic agents.

St. John's wort may cause high levels of thyroid-stimulating hormone (TSH). Use cautiously in people with thyroid disorders or those using thyroid hormones.

Use cautiously in people with cataracts, due to the potential association between an element St. John's wort and cataracts.

St. John's wort may cause heart burn, loss of appetite, diarrhea, nausea, vomiting, and constipation. Use cautiously in people with stomach and intestine problems.

St. John's wort may cause liver damage. Use cautiously in people with liver problems or those taking agents that damage the liver.

St. John's wort may alter blood pressure and cause increased or uneven heart rate. Use cautiously in people with high blood pressure or abnormal heart rhythms.

St. John's wort may cause swelling. Use caution in people prone to swelling.

St. John's wort may cause dizziness, tiredness, insomnia, problems with the nervous system, skin tingling or prickling, and nerve pain. Use cautiously in people taking agents that affect the nervous system.

St. John's wort may lower the seizure threshold. Use cautiously in individuals with seizures, and drugs that may lower the seizure threshold.

St. John's wort may lower cholesterol drug concentration and may increase cholesterol. Use cautiously in people with high cholesterol and those taking agents to lower levels of cholesterol.

St. John's wort may stimulate release of certain hormones. Use cautiously with hormonal agents.

Avoid in people with a known allergy or sensitivity to St. John's wort or to any of its parts.

St. John's wort has decreased levels of drugs for HIV/AIDs. Avoid in people with HIV/AIDS who are taking protease inhibitors or non-nucleoside reverse transcriptase inhibitors, as suggested by the U.S. Food & Drug Administration (FDA).

St. John's wort has decreased levels of drugs that suppress the immune system. Avoid in individuals receiving transplants and taking agents that suppress the immune system (particularly cyclosporine).

Avoid in people with suicidal thoughts.

St. John's wort resulted in difficulty inducing anesthesia and relaxation. Avoid before surgery.

St. John's wort use with cancer agents may result in reduced effectiveness and treatment failure. Avoid in people using cancer agents.

St. John's wort may result in result in reduced digoxin efficacy. Avoid using with cardiac glycosides such as digoxin.

St. John's wort may decrease effectiveness of agents that thin blood. Avoid use in people with bleeding disorders or in those taking drugs that thin blood.

Avoid in pregnant and lactating women due to a lack of information.

Pregnancy and Breastfeeding

There is a lack of scientific evidence on the use of St. John's wort during pregnancy or lactation.

This evidence-based monograph was prepared by The Natural Standard Research Collaboration

www.naturalstandard.com