St. John's Wort
Scientific classification
Kingdom: Plantae Division: Magnoliophyta Class: Magnoliopsida Order: Malpighiales Family: Clusiaceae Genus: Hypericum Species: H. perforatum
Binomial name
Hypericum perforatum L.

St John's wort (IPA pronunciation: [-wɝt], rhyming with hurt, or [-wɔɹt]) used alone refers to the species Hypericum perforatum, also known as Klamath weed or Goat weed, but, with qualifiers, is used to refer to any species of the genus Hypericum. Therefore, H. perforatum is sometimes called Common St. John's wort to differentiate it. The species of Hypericum have been placed by some in the family Hypericaceae, but more recently have been included in the Clusiaceae.^{[citation needed]} Approximately 370 species of the genus Hypericum exist worldwide with a native geographical distribution including temperate and subtropical regions of North America, Europe, Asia Minor, Russia, India and China. Image File history File links Download high resolution version (1600x1067, 264 KB) St. ... Scientific classification or biological classification is a method by which biologists group and categorize species of organisms. ... Divisions Green algae Chlorophyta Charophyta Land plants (embryophytes) Non-vascular plants (bryophytes) Marchantiophyta—liverworts Anthocerotophyta—hornworts Bryophyta—mosses Vascular plants (tracheophytes) †Rhyniophyta—rhyniophytes †Zosterophyllophyta—zosterophylls Lycopodiophyta—clubmosses †Trimerophytophyta—trimerophytes Pteridophyta—ferns and horsetails Seed plants (spermatophytes) †Pteridospermatophyta—seed ferns Pinophyta—conifers Cycadophyta—cycads Ginkgophyta—ginkgo Gnetophyta—gnetae Magnoliophyta—flowering plants... It has been suggested that Angiospermae, and Anthophyta be merged into this article or section. ... Orders See text. ... Families Family Achariaceae Family Balanopaceae Family Bonnetiaceae Family Caryocaraceae Family Chrysobalanaceae Family Clusiaceae Family Ctenolophonaceae Family Dichapetalaceae Family Elatinaceae Family Erythryloxaceae (coca family) Family Euphorbiaceae (spurge family) Family Euphroniaceae Family Goupiaceae Family Humiriaceae Family Hypericaceae (St Johns wort family) Family Irvingiaceae Family Ixonanthaceae Family Lacistemaceae Family Linaceae (flax family... Genera See text Clusiaceae is a family of plants including the over a thousand species of trees and shrubs, often with milky sap and fruits or capsules for seeds. ... Species See text Hypericum is a genus of about 400 species of flowering plants in the family Clusiaceae, formerly often treated separately in their own family the Hypericaceae. ... In biology, binomial nomenclature is the formal method of naming species. ... Carolus Linnaeus, also known after his ennoblement as  , (May 23, 1707[1] – January 10, 1778), was a Swedish botanist, physician and zoologist[2] who laid the foundations for the modern scheme of nomenclature. ... Articles with similar titles include the NATO phonetic alphabet, which has also informally been called the “International Phonetic Alphabet”. For information on how to read IPA transcriptions of English words, see IPA chart for English. ... Species See text Hypericum is a genus of about 400 species of flowering plants in the family Clusiaceae, formerly often treated separately in their own family the Hypericaceae. ... Genera see text Ref: ITIS 2003-09-19 Clusiaceae is a family of plants including the over a thousand species of trees and shrubs, often with milky sap and fruits or capsules for seeds. ... Genera See text Clusiaceae is a family of plants including the over a thousand species of trees and shrubs, often with milky sap and fruits or capsules for seeds. ...

The plant

Hypericum perforatum is a yellow-flowering, rhizomatous, perennial herb indigenous to Europe, which has been introduced to the Americas and grows wild in many meadows. The common name comes from its traditional flowering and harvesting on St John's day, 24 June. The genus name Hypericum is derived from the Greek words hyper (above) and eikon (picture), in reference to the traditional use of the plant to ward off evil, by hanging plants over a picture in the house during St John's day. The species name perforatum refers to the small windows in the leaves, which can be seen when they are held against the light. Ginger rhizome A rhizome is, in botany, a usually underground, horizontal stem of a plant that often sends out roots and shoots from its nodes. ... Red Valerian, a perennial plant. ... Herbs: basil Herbs (IPA: hə()b, or əb; see pronunciation differences) are plants grown for any purpose other than food, wood or beauty. ... For the hip-hop producer with the same name, see John the Baptist (producer). ... June 24 is the 175th day of the year (176th in leap years) in the Gregorian calendar, with 190 days remaining. ... For other uses of the word, please see Genus (disambiguation). ... In biology, a species is one of the basic units of biodiversity. ...

Although Hypericum perforatum is grown commercially in some regions of south east Europe, it is listed as a noxious weed in more than twenty countries. In pastures, St. John’s Wort acts as both a toxic and invasive weed.^[1] It replaces useful vegetation to the extent of making productive land unviable or acts as an alien species in natural ecosystems. Ingestion by livestock can cause photosensitization, central nervous system depression, spontaneous abortion, and can lead to death. Effective herbicides for control of Hypericum include 2,4-D, picloram, and glyphosate. In western North America three beetles Chrysolina quadrigemina, Chrysolina hyperici and Agrilus hyperici have been introduced as biocontrol agents. 2,4-D (or 2,4-dichlorophenoxyacetic acid) is a common systemic herbicide used in the control of broadleaf weeds. ... It has been suggested that Roundup be merged into this article or section. ... World map showing North America A satellite composite image of North America. ... Biological control of pests and diseases Overview A key belief of the organic gardener is that diversity furthers health. ...

Identification

Fuzzy smokes doobies before performing merry music for wind band.

Botanical description

St. John's wort is a perennial plant with extensive, creeping rhizomes. Its stems are erect, branched in the upper section, and can grow to 1m high. It has opposing, stalkless, narrow, oblong leaves which are 12mm long or slightly larger. The leaves are yellow-green in color, with transparent dots throughout the tissue and occasionally with a few black dots on the lower surface. Its flowers measure up to 2.5 cm across, have five petals, and are colored bright yellow with conspicuous black dots. The flowers appear in in broad cymes at the ends of the upper branches. The sepals are pointed, with glandular dots in the tissue. There are many stamens, which are united at the base into three bundles. Red Valerian, a perennial plant. ... In botany, a rhizome is a horizontal, usually underground stem of a plant that often sends out roots and shoots from its nodes. ... Red clover inflorescence (spike) An inflorescence is a group or cluster of flowers on a branch of a plant. ... Flower of the Primrose Willowherb (Ludwigia octovalvis) showing petals and sepals A sepal is one member or part of the calyx of a flower. ... Flower of the spider tree (Crateva religiosa) with its numerous conspicuous stamens The stamen is the male organ of a flower. ...

Ecology

St. John’s Wort has a complex life cycle that includes a mature plant cycle with vegetative and sexual reproduction. It thrives in areas with either a winter- or summer-dominant rainfall pattern; however, distribution is restricted by temperatures too low for seed germination or seedling survival. Altitudes greater than 1500m, rainfall less than 500mm, and a daily mean January temperature greater than 24 degrees are considered limiting thresholds. Depending on environmental and climatic conditions, and rosette age, St. John’s Wort will alter growth form and habit to promote survival. Summer rains are particularly effective in allowing the plant to grow vegetatively, following defoliation by insects or grazing.

Hypericum poisoning (livestock)

Clinical signs

At large doses, St. John's wort is poisonous to grazing livestock (cattle, sheep, goats, horses).^[2] Behavioural signs of poisoning are general restlessness and skin irritation. Restlessness is often indicated by pawing of the ground, head shaking, head rubbing, and occasional hindlimb weakness with knuckling over, panting, confusion and depression. Mania and hyperactivity may also result including running in circles until exhausted. Observations of thick wort infestations by Australian graziers include the appearance of circular patches giving hillsides a ‘crop circle’ appearance, possibly from this phenomenon. Animals typically seek shade and have reduced appetite. Hypersensitivity to water has been noted, and convulsions may occur following a knock to the head. Although general aversion to water is noted, some may seek water for relief. The skull and crossbones symbol (Jolly Roger) traditionally used to label a poisonous substance. ... Sheep are commonly bred as livestock. ...

Severe skin irritation is physically apparent, with reddening of non-pigmented and unprotected areas. This subsequently leads to itch and rubbing, followed by further inflammation, exudation and scab formation. Lesions and inflammation that occur are said to resemble the conditions seen in foot and mouth disease. Sheep have been observed to have face swelling, dermatitis, and wool falling off due to rubbing. Lactating animals may cease or have reduced milk production, pregnant animals may abort. Lesions on udders are often apparent. Horses may show signs of anorexia, depression (with a comatose state), dilated pupils, and injected conjunctiva. Foot-and-mouth disease (FMD), sometimes called hoof-and-mouth disease, is a highly contagious but non-fatal viral disease of cattle and pigs. ... An abortion is the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death. ... A cow udder with 4 teats An udder is the mammary organ of cattle and some other mammals, including goats and sheep. ... Anorexia (deriving from the Greek α(ν)- (a(n)-, a prefix that denotes absence) + όρεξη (orexe) = appetite) is the decreased sensation of appetite. ... Grieving Thai females. ... The conjunctiva is a membrane that covers the sclera (white part of the eye) and lines the inside of the eyelids. ...

Early diagnosis

Increased respiration and heart rate is typically observed while one of the early signs of St. John’s wort poisoning is an abnormal increase in body temperature. Affected animals will lose weight, or fail to gain weight; young animals more affected than old animals. In severe cases death may occur, as a direct result of starvation, or because of secondary disease or septicaemia of lesions. Some affected animals may accidentally drown. Poor performance of suckling lambs (pigmented and non-pigmented) has been noted, suggesting a reduction in the milk production, or the transmission of a toxin in the milk. Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ...

Photosensitisation

Most clinical signs are caused by photosensitisation.^[3] Plants may induce either primary or secondary photosensitisation: primary photosensitisation directly from chemicals contained in ingested plants, or secondary photosensitisation from plant-associated damage to the liver. Araya and Ford (1981) explored changes in liver function and concluded there was no evidence of Hypericum-related effect on the excretory capacity of the liver, or any interference was minimal and temporary. However at high and continuous dose rates changes in blood plasma indicative of some liver damage have been observed. Photosensitivity is the amount to which an object reacts upon receiving photons of light. ...

Photosensitisation causes skin inflammation by a mechanism involving a pigment or photodynamic compound, which when activated by a certain wavelength of light leads to oxidation reactions in vivo. This leads to lesions of tissue, particularly noticeable on and around parts of skin exposed to light. Lightly covered or poorly pigmented areas are most conspicuous. Removal of affected animals from sunlight results in reduced symptoms of poisoning. Illustration of a redox reaction Redox (shorthand for oxidation/reduction reaction) describes all chemical reactions in which atoms have their oxidation number (oxidation state) changed. ... In vivo (Latin for (with)in the living). ... The monarch butterflys distinctive pigmentation reminds potential predators that it is poisonous. ...

Medicinal uses of the herb

The first recorded use of Hypericum for medicinal purposes dates back to ancient Greece, and has been used ever since. Hypericum was also used by Native Americans internally as an abortifacient and externally as an anti-inflammatory, astringent, and antiseptic. The aerial parts of the plant can be cut and dried for later use in the form of herbal tea, which has long been enjoyed both for its pleasant, though somewhat bitter, taste and for its medicinal properties. The Temple to Athena, the Parthenon Ancient Greece is a period in Greek history that lasted for around three thousand years. ... Olmec script These glyphs written in Epi-Olmec script, the earliest examples of writing in the Americas, give a calendar date of 7. ... An abortifacient is a substance that induces abortion. ... Anti-inflammatory refers to the property of a substance or treatment that reduces inflammation. ... An astringent substance is a chemical substance that tends to shrink or constrict body tissues, usually locally after topical medicinal application. ... An antiseptic solution of iodine applied to a cut Antiseptics (Greek αντί, against, and σηπτικός, putrefactive) are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. ... Herbal tea An herbal tea, tisane, or ptisan is an herbal infusion not made from the leaves of the tea bush (Camellia sinensis). ...

In modern medicine, standardized Hypericum extract (obtained from H. perforatum) is commonly used as a treatment for depression and anxiety disorders. In homeopathy, Hypericum is used in the treatment of numerous medical problems, yet the rate of success has not been adequately documented. Historically, the flowers and stems of St John's wort have also been used to produce red and yellow dyes. Clinical depression (also called major depressive disorder, or unipolar depression when compared to bipolar disorder) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ... This article needs additional references or sources to facilitate its verification. ... Samuel Hahnemann, the father of homeopathy Homeopathy (also spelled homœopathy or homoeopathy), from the Greek words όμοιος, hómoios (similar) and πάθος, páthos (suffering)[1], is a pseudoscientific alternative medicine that aims to treat like with like. ... Look up dye in Wiktionary, the free dictionary. ...

St John's wort is today most widely known as a herbal treatment for depression. In some countries, such as Germany, Hypericum is prescribed for mild depression far more commonly than synthetic antidepressant medication.^[4] In most countries, standardized extracts are available over the counter – usually in tablet or capsule form, and also in teabags and tinctures. See separate articles for over-the-counter trading and the medical condition Ornithine Transcarbamylase Deficiency. ... This article or section does not adequately cite its references or sources. ... In pharmacology, encapsulation refers to a range of techniques used to enclose medicines in a relatively stable shell, for example to allow them to be taken orally. ... In medicine, a tincture is an alcoholic extract (e. ...

Clinical evidence

Seedlings of St. John's wort

Clinical studies of St John's wort preparations have mainly focused on the efficacy of the herb in clinical depression. Several studies and meta-analyses have found it to be effective in the treatment of mild to moderate depression, with fewer side effects than many conventional antidepressants. Other studies, including a major NIH study that focused on moderate to severe depression, have shown no improvements. Image File history File links No higher resolution available. ... Image File history File links No higher resolution available. ... Clinical depression (also called major depressive disorder, or unipolar depression when compared to bipolar disorder) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... A recent form of antidepressant medication - Prozac Serotonin-norepinephrine reuptake inhibitor, Venlafaxine An antidepressant, in the most common usage, is a medication taken to alleviate clinical depression or dysthymia (milder depression). ...

Evidence for efficacy

An early meta-study indicated that extracts of Hypericum may be more efficacious than placebo for the treatment of mild to moderately severe depressive disorders.^[5] This study, which covered the results from 23 smaller, earlier studies, is perhaps the most often cited by manufacturers and other supporters of St. John's wort. A meta-analysis is a statistical practice of combining the results of a number of studies. ...

This study was later updated to include further studies, for a total of 27, to form a Cochrane Review. The updated review found that Hypericum preparations were significantly superior to placebo (rate ratio 2.47; 95% confidence interval 1.69 to 3.61) and similarly effective as standard antidepressants (single preparations 1.01; 0.87 to 1.16, combinations 1.52; 0.78 to 2.94).^[6] The Cochrane Library is a collection of databases in medicine and other healthcare specialties provided by the Cochrane Collaboration. ...

Another meta-analysis, with stricter inclusion criteria, found that Hypericum was more efficacious than placebo; and as efficacious as tricyclic antidepressants, with fewer adverse drug reactions.^[7] This meta-analysis showed that the response rate for St. John’s wort was significantly greater than that for placebo (73.2 versus 37.9%, respectively, relative risk 1.48 and 95% CI 1.03–1.92) and similar to that observed with tricyclic antidepressants (64 versus 66.4% for St. John’s wort and tricyclic antidepressants, respectively, relative risk 1.11 and 95% CI 0.92–1.29). Chemical structure of the tricyclic antidepressant amitriptyline. ...

Other, more recent trials have also shown greater efficacy than placebo, and comparable efficacy to standard antidepressants with a superior adverse effect profile.^{[8][9][10][11][12][13][14]}

Additionally, a 2006 study involving 150 patients with minor depressive symptoms or dysthymia found that St. John's Wort has a clinically significant effect in patients with minor depression, but not those suffering from dysthymia. It was concluded that St. John's Wort can be effective in the treatment of people with minor depression with a Hamilton Depression Scale for Depression (HAM-D) score of up to 17.^[15] Dysthymia (pronunciation in IPA: ) or dysthymic disorder is a form of the mood disorder of depression characterized by a lack of enjoyment/pleasure in life that continues for at least two years. ... The Hamilton Depression Rating Scale is a 21-question multiple choice questionnaire which doctors may use to rate the severity of a patients depression. ...

Evidence against efficacy for Major Depressive Disorder

A major study funded by the NIH in the United States, found that Hypericum extract of St John's wort was ineffective in treating moderate to severe cases of major depression (Hypericum Depression Trial Study Group, 2002). This study involved 340 patients, diagnosed with Major Depressive Disorder based on DSM-IV criteria and assessed using Hamilton Depression Rating Scale (HAM-D) and Clinical Global Impression (CGI) scores. The trial was a multi-centre randomised double-blind placebo-controlled trial, comparing one preparation of St John's wort (Li 160) to the antidepressant, sertraline and to placebo. Li 160 improved the symptoms of most subjects, but below the threshold necessary to count as more effective than placebo in alleviating moderately severe major depression. Sertraline was also no better than placebo in this study, based on the primary outcome measure (the HAM-D).^[16] The National Institutes of Health (NIH) is the primary agency of the United States government responsible for medical research. ... The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and other countries. ... The Hamilton Depression Rating Scale is a 21-question multiple choice questionnaire which doctors may use to rate the severity of a patients depression. ... The Clinical Global Impression (CGI) is a scale to assess treatment response in patients with mental disorders. ... “Lustral” redirects here. ...

Pharmacology

The exact mechanism by which St. John's wort — and even conventional antidepressants — functions is unclear and subject to conjecture.

The St. John's wort mechanism is believed to involve inhibition of serotonin (5-HT) reuptake, much like the conventional selective serotonin reuptake inhibitor (SSRI) antidepressants. It may thus be useful to review that information before using, particularly the complications. The link to the Prozac Product/Prescribing Information is provided below. Serotonin (5-hydroxytryptamine, or 5-HT) is a monoamine neurotransmitter synthesized in serotonergic neurons in the central nervous system (CNS) and enterochromaffin cells in the gastrointestinal tract of animals including humans. ... Serotonin Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants used in the treatment of depression, anxiety disorders and some personality disorders. ... Background Fluoxetine hydrochloride (brand names include Prozac®, Symbyax® (compounded with olanzapine), Sarafem®, Fontex® (Sweden), Fluctine (Austria, Germany), Prodep (India), Fludac (India)) is an antidepressant drug used medically in the treatment of depression, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder, and many other disorders. ...

The major active constituents in St John's wort are thought to be hyperforin and hypericin, although other biologically active constituents present, for example, flavonoids and tannins, may also be involved.^[17] Hyperforin is one of the principal constituents identified in St Johns wort. ... Categories: Stub ... Molecular structure of flavone The term flavonoid refers to a class of plant secondary metabolites based around a phenylbenzopyrone structure. ... Tannins are astringent, bitter-tasting plant polyphenols that bind and precipitate proteins. ...

Hyperforin has also been found to have excellent antibacterial properties; in ultrapurified form a concentration of 0.1mg/ml kills methicillin-resistant forms of Staphylococcus aureus (MRSA).^[18] Methicillin (USAN) or meticillin (INN, BAN) is a narrow spectrum beta-lactam antibiotic. ... Binomial name Staphylococcus aureus Rosenbach 1884 Staphylococcus aureus, the most common cause of staph infections, is a spherical bacterium, frequently living on the skin or in the nose of a healthy person, that can cause a range of illnesses from minor skin infections (such as pimples, boils, and cellulitis) and...

Some believe that hyperforin is the major constituent responsible for antidepressant activity, and it has been shown to inhibit the uptake of 5-HT, dopamine, noradrenaline, GABA and glutamate.^[19] Discrepancies in the dose-response relationship imply that constituents other than hyperforin are likely to also be involved.^[20] Also, a hyperforin free extract of St John's wort (Ze 117 - Remotiv) has been shown to have significant antidepressive effects.^[8][9] Therefore current thinking is that the whole extract should be considered the "active ingredient" and that one or two constituents cannot explain the activity of the product. Hyperforin is one of the principal constituents identified in St Johns wort. ... Serotonin (5_hydroxytryptamine, or 5_HT) is a monoamine neurotransmitter synthesised in serotonergic neurons in the central nervous system and enterochromaffin cells in the gastrointestinal tract. ... Dopamine is a phenethylamine naturally produced by the human body. ... Norepinephrine, known as noradrenaline outside the USA, is a catecholamine and a phenethylamine with chemical formula C8H11NO3. ... Gaba may refer to: Gabâ or gabaa (Philippines), the concept of negative karma of the Cebuano people GABA, the gamma-amino-butyric acid neurotransmitter GABA receptor, in biology, receptors with GABA as their endogenous ligand Gaba 1 to 1, an English conversational school in Japan Marianne Gaba, a US model... Glutamate is the anion of glutamic acid. ...

Dosage and formulations

The dosage and content of St John's wort preparations vary greatly between formulations, because of variability in the plant source and preparation processes. The doses of St. John’s wort extract used in clinical trials generally range from 350 to 1800 mg daily (equivalent to 0.4 to 2.7 mg hypericin depending on the preparation).^[6] Because of the variable nature of herbal medicines, the clinical trial results using one product cannot be extrapolated to other products containing the same herb (just as a prize winning wine is not the same as everything else made from grapes). Only a handful of products made from St John's wort have been used in clinical studies (for example, Li 160 and Ze 117).

The recommended dosage for various forms of St John's wort as recommended by the British Herbal Medicine Association Scientific Committee (1983)^{[citation needed]} are as follows:

• dried herb: 2-4 g or by infusion three times daily
• liquid extract 2-4 mL (1:1 in 25% alcohol) three times daily
• tincture 2-4mL (1:10 in 45% alcohol) three times daily

In markets where standardised extracts are not available, the content of marketed products can vary widely. Some brands of over-the-counter St. John's wort can have a totally different chemical profile than others. The same can even be true of two dosage units from different batches of the same brand. Even where extracts are standardised it is debatable whether using hypericin as the standard is useful, since other constituents including hyperforin are biologically active. Categories: Stub ... Hyperforin is one of the principal constituents identified in St Johns wort. ...

As with other antidepressants, Hypericum should be taken for at least four weeks before its effectiveness can be properly assessed.

Adverse effects

St John's wort is generally well tolerated, with an adverse effect profile similar to placebo.^[21] The most common adverse effects reported are gastrointestinal symptoms, dizziness, confusion, tiredness and sedation.^[22]

Since the St. John's wort mechanism is probably inhibition of Serotonin (5-HT) reuptake, much like the conventional SSRI antidepressants, it may be useful to review that information before using, particularly the complications. The link to the PROZAC Product Information is provided below. Serotonin (5-hydroxytryptamine, or 5-HT) is a monoamine neurotransmitter synthesized in serotonergic neurons in the central nervous system (CNS) and enterochromaffin cells in the gastrointestinal tract of animals including humans. ... Serotonin Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants used in the treatment of depression, anxiety disorders and some personality disorders. ...

St John's wort may rarely cause photosensitivity. This can lead to visual sensitivity to light and to sunburns in situations that would not normally cause them.^[21] Photodermatitis is a reaction of the skin to UV rays of the sun. ...

Some research shows that St John's wort may adversely affect fertility in both men and women.^[23]

St. John's wort may interact with birth control pills and may reduce the effectiveness of oral contraceptives. However while breakthrough bleeding was observed to occur in the Swedish MPA study (the sample size of 8 women was small enough that the effect could not be differentiated from common breakthrough bleeding) no cases of pregnancy due to St. John's wort have been found in the literature despite over 20 years of widespread prescription in Germany ^[24][25],^[26]

Use caution when discontinuing use.

Drug interactions

Pharmacokinetic interactions

St John's wort has been shown to cause multiple drug interactions mainly through induction of the cytochrome P450 enzyme CYP3A4, but also CYP2C9. This results in the increased metabolism of those drugs, resulting in decreased concentration and clinical effect. The principal constituent thought to be responsible is hyperforin. For further updating on interactions and appropriate management, see http://www.herbological.com/images/SJW_table.pdf Enzyme induction is a process in which a molecule ( a drug) induces ( initiates or enhances) the expression of an enzyme. ... Cytochrome P450 Oxidase (CYP2E1) Cytochrome P450 oxidase (commonly abbreviated CYP) is a generic term for a large number of related, but distinct, oxidative enzymes (EC 1. ... Cytochrome P450 3A4 (abbreviated CYP3A4) (EC 1. ... Cytochrome P450 2C9 (abbreviated CYP2C9), a member of the cytochrome P450 mixed-function oxidase system, is involved in the metabolism of xenobiotics in the body. ... Hyperforin is one of the principal constituents identified in St Johns wort. ...

The anticonvulsants, sometimes also called antiepileptics, belong to a diverse group of pharmaceuticals used in prevention of the occurrence of epileptic seizures. ... Carbamazepine (sold under the brand-names Biston, Calepsin, Carbatrol, Epitol, Equetro, Finlepsin, Sirtal, Stazepine, Tegretol, Telesmin, Timonil, sometimes abbreviated CBZ) is an anticonvulsant and mood stabilizing drug, used primarily in the treatment of epilepsy and bipolar disorder. ... Phenytoin sodium (marketed as Dilantin® in the USA and as Epanutin® in the UK, by Parke-Davis, now part of Pfizer) is a commonly used antiepileptic. ... The term antiretroviral drugs is used to describe drugs used against HIV infection (HIV is an RNA retrovirus). ... Antiretroviral drugs are medications for the treatment of infection by retroviruses, primarily HIV. Different classes of antiretroviral drugs act at different stages of the HIV life cycle. ... Protease inhibitor can refer to: Protease inhibitor (pharmacology): a class of medication that inhibits viral protease Protease inhibitor (biology): a group of proteins that inhibit proteases. ... Alprazolam 2mg tablets The benzodiazepines (pronounced , or benzos for short) are a class of psychoactive drugs considered as minor tranquilizers with varying hypnotic, sedative, anxiolytic, anticonvulsant, muscle relaxant and amnesic properties, which are brought on by slowing down the central nervous system. ... Alprazolam is a short-acting drug in the benzodiazepine class used to treat anxiety disorders and as an adjunctive treatment for depression. ... Midazolam (marketed under brand names Versed®, Hypnovel®, Dormicum® and Dormonid®, pronounced ) is a drug which is a benzodiazepine derivative. ... Hormonal contraception refers to birth control methods that act on the hormonal system. ... Oral contraceptives come in a variety of formulations. ... Immunosuppression is the medical suppression of the immune system. ... Immunosuppressive drugs or immunosuppressants are drugs that are used in immunosuppressive therapy to inhibit or prevent activity of the immune system. ... Ciclosporin (INN), cyclosporine or cyclosporin (former BAN), is an immunosuppressant drug. ... Tacrolimus (also FK-506 or Fujimycin) is a 23-membered macrolide lactone discovered in 1984 from the fermentation broth of a Japanese soil sample that contained the bacteria Streptomyces tsukubaensis. ... Digoxin (INN) (IPA: ) is a purified cardiac glycoside extracted from the foxglove plant, Digitalis lanata. ... Methadone is a synthetic opioid, used medically as an analgesic and in the treatment of narcotic addiction. ... Omeprazole (INN) (IPA: ) is a proton pump inhibitor (brand names Antra® in Italy) used in the treatment of dyspepsia, peptic ulcer disease (PUD), gastroesophageal reflux disease (GORD/GERD) and Zollinger-Ellison syndrome. ... Phenobarbital (also phenobarbitone or luminal) is a weak acid with the chemical formula C12H12N2O3. ... Theophylline is a methylxanthine drug used in therapy for respiratory diseases such as COPD or asthma under a variety of brand names. ... Warfarin (also known under the brand names of Coumadin, Jantoven, Marevan, and Waran) is an anticoagulant medication that is administered orally or, very rarely, by injection. ...

Pharmacodynamic interactions

St John's Wort may also contribute to serotonin syndrome in combination with other drugs which may elevate 5-HT (serotonin) levels in the central nervous system (CNS).^[27] Serotonin syndrome is a rare, but potentially life-threatening adverse drug reaction that results from intentional self-poisoning, therapeutic drug use, or inadvertent interactions between drugs. ... Serotonin (5_hydroxytryptamine, or 5_HT) is a monoamine neurotransmitter synthesised in serotonergic neurons in the central nervous system and enterochromaffin cells in the gastrointestinal tract. ... A diagram showing the CNS: 1. ...

A recent form of antidepressant medication - Prozac Serotonin-norepinephrine reuptake inhibitor, Venlafaxine An antidepressant, in the most common usage, is a medication taken to alleviate clinical depression or dysthymia (milder depression). ... Monoamine oxidase inhibitors (MAOIs) are a class of antidepressant drugs prescribed for the treatment of depression. ... Chemical structure of the tricyclic antidepressant amitriptyline. ... SSRI is an acronym that stands for several things: It is a class of antidepressants called selective serotonin reuptake inhibitor SSRI also is used as the stock symbol for Silver Standard Resources Inc. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Venlafaxine hydrochloride is a prescription antidepressant first introduced by Wyeth in 1993. ... This article needs additional references or sources to facilitate its verification. ... Tramadol (INN) (IPA: ) is an atypical opioid which is a centrally acting analgesic, used for treating moderate to severe pain. ... Pethidine (INN) or meperidine (USAN) (also referred to as: isonipecaine; lidol; pethanol; piridosal; Algil®; Alodan®; Centralgin®; Demerol®; Dispadol®; Dolantin®; Dolargan® (in Poland);[1] Dolestine®; Dolosal®; Dolsin®; Mefedina®) is a fast-acting opioid analgesic drug. ... Stimulants are drugs that temporarily increase alertness and wakefulness. ... Phentermine is a drug primarily used as an appetite suppressant. ... Diethylpropion (Tenuate®) is a sympathomimetic stimulant drug marketed as an appetite suppressant. ... Amphetamine or Amfetamine (Alpha-Methyl-PHenEThylAMINE), also known as phenyl-isopropylamine, beta-phenyl-isopropylamine, and benzedrine, is a prescription stimulant commonly used to treat Attention-deficit hyperactivity disorder (ADHD) in adults and children. ... Sibutramine (Meridia® in the USA, Reductil® in Europe), usually as sibutramide hydrochloride monohydrate, is an orally administered agent for the treatment of obesity. ... In the field of neurochemistry, 5-HT receptors are receptors for the neurotransmitter and peripheral signal mediator serotonin, also known as 5-hydroxytryptamine or 5-HT. 5-HT receptors are located on the cell membrane of nerve cells and other cell types in animals and mediate the effects of serotonin... Triptans are a family of tryptamine drugs used as abortive medication in the treatment of migraine and cluster headaches. ... MDMA (3,4-methylenedioxy-N-methylamphetamine), most commonly known today by the street name ecstasy, (often abbreviated to E, X, or XTC) is a semisynthetic entactogen of the phenethylamine family. ... “LSD” redirects here. ... Cocaine (see also: crack) is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. ... Selegiline (l-deprenyl, Eldepryl® or Anipryl® [veterinary]) is a drug used for the treatment of early-stage Parkinsons disease and senile dementia. ... Tryptophan is an amino acid and essential in human nutrition. ... Buspirone (brand-names Ansial®, Ansiced®, Anxiron®, Axoren®, Bespar®, BuSpar®, Buspimen®, Buspinol®, Buspisal®, Narol®, Spitomin®) is an anxiolytic agent and a serotonin receptor agonist belonging to the azaspirodecanedione class of compounds. ... Lithium in pharmacology refers to the lithium ion, Li+, used as a drug. ... Linezolid is a synthetic systemic antibiotic drug. ... Dextromethorphan (DM or DXM) is an antitussive drug that is found in many over-the-counter cold and cough preparations, usually in the form of dextromethorphan hydrobromide. ... 5-HTP (5-Hydroxy-tryptophan) is decarboxylated to the neurotransmitter serotonin (5-HT) by the enzyme aromatic-L-amino-acid decarboxylase. ...

References

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... The Australian Medicines Handbook or AMH is a medical reference text commonly used in practice by health professionals (particularly general practitioners and pharmacists) in Australia. ...

Further reading

• British Herbal Medicine Association Scientific Committee (1983). British Herbal Pharmacopoeia. West Yorkshire: British Herbal Medicine Association. ISBN 0-903032-07-4

See also

• Dietary supplement
• EU Food supplements directive

A dietary supplement is intended to supply nutrients, (vitamins, minerals, fatty acids or amino acids) that are missing or not consumed in sufficient quantity in a persons diet. ... ...

External links

• http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary=tru

(UK National Health Service advice sheets about interactions with prescribed medicines)

• See http://www.cc.nih.gov/about/news/press_room/2000/02_10_00_wortfinal.html for an example of drug interactions with St. John's wort
• St. John's wort Includes Food and Drug Administration (FDA) warnings about interference with treatments for heart disease, some cancers, AIDS and others.
• PROZAC Product/Prescribing Information

Wikispecies has information related to:

Hypericum

Wikimedia Commons has media related to:

Hypericum perforatum

Insertformulahere FDA logo The Food and Drug Administration (FDA) is an agency of the United States Department of Health and Human Services and is responsible for regulating food, dietary supplements, drugs, biological medical products, blood products, medical devices, radiation-emitting devices, veterinary products, and cosmetics in the United States. ... GFDL Wikispecies logo File links The following pages link to this file: Solanaceae Species Asterias Homo (genus) Human Wikipedia:Template messages/Links Wikipedia:Template messages/All Homo floresiensis User talk:Tuneguru Template:Wikispecies Categories: GFDL images ... Wikispecies is a sister project supported by the Wikimedia Foundation that anybody can edit with a great potential use to students and researchers. ... Image File history File links Commons-logo. ... The Wikimedia Commons (also called Wikicommons) is a repository of free content images, sound and other multimedia files. ...