St. John's Wort, Hypericum perforatum oral dosage forms

What is St. John's wort?

St. John's wort (Centrum® Herbals St. John's Wort, Hypericalm™, Kira®, Movana™, Quanterra™ Emotional Balance) is an herb or dietary supplement that is being promoted for its ability to improve mildly depressed moods. The herb does not appear to be very effective for persons with severe depression. Its yellow flowers are especially bright on June 24, the traditional birthday of St. John the Baptist, hence the name 'St. John's wort'. Other names include 'goat weed' or 'klamath weed'. This herb is not FDA approved at this time. Many different products containing St. John's wort in combination with other herbs are available.

What should I tell my health care provider before I take this medicine?

It is important for you to tell your prescriber or health care professional or other health care professional that you are using St. John's wort. Some herbs exert potent effects and may interact with other drugs you are taking.

You should discuss St. John's wort with your health care professional BEFORE taking it if you have any of these conditions:

• heart disease or high blood pressure

• heart, liver, kidney or other organ transplant

• history of emotional illness, such as anxiety, mania, or depression

• infection with the human immunodeficiency virus (HIV or AIDS)

• kidney disease

• liver disease

• stroke

• thoughts of suicide

• an unusual or allergic reaction to St. John's wort, other medicines, foods, dyes, or preservatives

• pregnant or trying to get pregnant

• breast-feeding

How should I use this medicine?

This herb should be taken orally (i.e., swallowed). Follow the directions on the package labeling, or talk to your health care professional for advice. The effects of St. John's wort take several weeks to appear so it should be taken as directed for several weeks for best results.

Contact your pediatrician or health care professional regarding the use of this herb in children. Special care may be needed.

What if I miss a dose?

Missing a dose is probably not harmful. If you miss a dose, simply resume taking it on your previous schedule. Do not take double doses to catch up, however.

What drug(s) may interact with St. John's wort?

St. John's wort may interact with many prescription and non-prescription medications. Some of these interactions may be very important, including some that could reduce the effectiveness of your prescribed medications. You should check with your health care professional prior to taking St. John's wort if you are taking other medications. Some of the important interactions are listed:

• amiodarone

• birth control pills, injections, implants, or other female hormones

• bosentan

• caffeine

• carbamazepine

• cough syrups

• cyclosporine

• digoxin

• doxcercalciferol

• excessive intake of tyramine-containing foods (see below)

• fexofenadine

• medications for high blood pressure or heart-related health problems

• medications for depression, anxiety, difficulty sleeping, or other emotional or psychiatric problems

• medications for the treatment of cancer (chemotherapy)

• medications for the treatment of HIV infection

• paricalcitol

• red yeast rice

• sirolimus

• some medicines for high cholesterol (atorvastatin, lovastatin, simvastatin)

• some medications for pain

• tacrolimus

• temsirolimus

• theophylline

• warfarin

For many herbs, interactions with other medications are unknown. That is why you should always be careful when mixing herbal remedies with traditional medications. If you take any other medications, consult with your health care professional prior to taking St. John's wort.

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking St. John's wort?

Since St. John's wort is derived from a plant, allergic reactions are possible. Stop using this herb if you develop a rash.

Do not use St. John's wort if you are currently being treated for a mental or emotional problem such as depression or anxiety, except on the advice of your health care professional. St. John's wort may interfere with your treatments. Also do not stop your prescribed treatments without talking to your prescriber or health care professional. If you are treating yourself with St. John's wort, seek medical advice if your mood does not improve in 6—8 weeks or if you have suicidal thoughts.

You should check your blood pressure closely while taking St. John's wort if you have high blood pressure.

Until more is known about the actions of this herb, it may be advisable to limit intake of certain foods and beverages that contain tyramine. Foods that contain tyramine might produce severe headaches, a rise in blood pressure, or irregular heart beat if taken in excess with St. John's wort. Fortunately these problems have not been noted to occur frequently with St. John's wort. Examples of foods that contain significant amounts of tyramine include aged cheeses; aged, smoked, pickled, or processed meats or fish (such as bologna, pepperoni, salami, herring); beers and ales; red wines; sherry; liqueurs; figs; raisins; soy sauce; yeast/protein extracts; bean curd; fava bean pods; or any over-ripe fruit. Ask your prescriber or health care professional, pharmacist, or nutritionist for a complete listing of tyramine-containing foods and whether you should avoid them. Also, limit drinks containing caffeine, such as tea, coffee, chocolate, or cola.

Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water will help.

St. John's wort can increase your sensitivity to the sun and you may burn more easily, or develop stinging pain in sun-exposed areas. Always use sunscreen and protective clothing during long periods outdoors. Do not use tanning booths or sun lamps while on this herb.

Different brands of St. John's wort might contain different amounts of active ingredient so be careful to use the same brand. A standardized product is more likely to contain the same amount of herb from dose to dose. Your health care professional or pharmacist can assist you in finding a standardized product.

Inform your prescriber you are taking this herb prior to scheduling surgery. St. John's wort might interact with medications given during surgery or anesthesia. Usually the herb should be discontinued at least 2 to 3 weeks prior to any surgery. Consult your health care professional for advice.

What side effects may I notice from using St. John's wort?

Side effects that you should report to your prescriber or health care professional as soon as possible:

• confusion, forgetfulness

• difficulty staying awake or alert

• anxiety, nervousness, racing thoughts, or other mood changes

• rapid heartbeat or "palpitations"

• rash

• shortness of breath or difficulty breathing

• sunburns after being in sunlight or ultraviolet light, or "stinging pains" of sun-exposed areas

Minor side effects (report to your prescriber or health care professional if they continue or are bothersome):

Rare or less common:

• sexual difficulties

• difficulty sleeping or restlessness

More common:

• upset stomach

• drowsiness

• dry mouth

Where can I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 8 and 25 degrees C (46 and 77 degrees F); do not freeze. Throw away any unused herb after the expiration date.

GENERAL INFORMATION REGARDING DIETARY SUPPLEMENTS:

Dietary supplements include amino acids, vitamins, minerals, herbs, botanicals, and other plant-derived substances, and extracts of these substances. These products are easy to identify as they must state "Dietary Supplement" on the label. A "Supplement Facts" panel is provided on the label for most products. Supplements are not drugs and are not regulated like drugs. You should note that rigid quality control standards are not required for dietary supplements. Big differences in potency and purity of these products can occur. Scientific data to support the use of a dietary supplement for a certain disease or ailment may not be available. This product is not intended to diagnose, treat, cure or prevent any disease.

The Food and Drug Administration suggests the following to help consumers protect themselves:

• Always read product labels and follow directions.

• "Natural" doesn't mean a product is safe for humans to take.

• Look for products containing ingredients with the "USP" notation. This indicates the manufacturer followed the standards of the US Pharmacopoeia.

• Supplements produced or distributed by a nationally known food or drug company are more likely to be made under tight controls as these companies have standards in place for their other products. You can write to the company for more information about how the product was made.