ST. JOHN'S WORT: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews

Overview

St. John's wort is a plant native to Europe with yellow, star-shaped flowers. It's often used for depression but can cause serious interactions with some drugs.

St. John's wort is named after John the Baptist. The plant usually begins to flower around the 24th of June, the feast day of St. John the Baptist. It contains many chemicals that act on messengers in the brain that regulate mood.

People most commonly use St. John's wort for depression and mood disorders. There is some strong scientific evidence that it is effective for mild to moderate depression. St. John's wort is also used for symptoms of menopause and many other conditions, but there is no good scientific evidence to support most of these other uses.

St. John's wort is available in dietary supplements in the US. But France has banned its use in products because of drug interaction concerns. In other countries, St. John's wort is only available with a prescription.

Uses & Effectiveness ?

Likely Effective for

Depression. Taking specific St. John's wort extracts by mouth is effective for mild or moderate depression. Certain St. John's wort products might work as well as some prescription drugs and might cause fewer side effects.

Possibly Effective for

Symptoms of menopause. Taking St. John's wort by mouth seems to help reduce hot flashes and other symptoms of menopause.
Emotional distress caused by extreme focus on a physical symptom (somatic symptom disorder). Taking a specific St. John's wort product (LI 160, Lichtwer Pharma) seems to reduce symptoms of this condition.

Possibly Ineffective for

Burning pain in the mouth. Taking St. John's wort by mouth doesn't seem to reduce pain from burning mouth syndrome.
Swelling (inflammation) of the liver caused by the hepatitis C virus (hepatitis C). Taking hypericin, a chemical in St. John's wort, by mouth, doesn't seem to be effective for hepatitis C infection.
HIV/AIDS. Taking hypericin, a chemical in St. John's wort, by mouth or by IV, doesn't seem to be effective for treating HIV in adults. IV products can only be given by a healthcare provider.
A long-term disorder of the large intestines that causes stomach pain (irritable bowel syndrome or IBS). Taking St. John's wort by mouth doesn't seem to reduce symptoms of IBS.
Nerve damage in the hands and feet (peripheral neuropathy). Taking St. John's wort by mouth does not seem to relieve nerve pain due to diabetes or other causes.
A type of anxiety marked by fear in some or all social settings (social anxiety disorder). Taking St. John's wort by mouth does not seem to improve social anxiety.

There is interest in using St. John's wort for a number of other purposes, but there isn't enough reliable information to say whether it might be helpful.

Side Effects

When taken by mouth: St. John's wort is likely safe when used in doses up to 900 mg daily for up to 12 weeks. It can cause some side effects such as diarrhea, dizziness, trouble sleeping, restlessness, and skin tingling. St. John's wort interacts with many drugs. Let your healthcare provider know if you want to take St. John's wort.

St. John's wort is possibly unsafe when taken in large doses. It might cause severe skin reactions after sun exposure. Wear sun block outside, especially if you are light-skinned.

When applied to the skin: St. John's wort is possibly safe when it is applied to the skin once a week for four weeks. However, St. John's wort might cause severe skin reactions after sun exposure.

Special Precautions and Warnings

Pregnancy: St. John's wort is possibly unsafe when taken by mouth during pregnancy. Taking St. John's wort while pregnant might cause birth defects in infants. Until more is known, don't use St. John's wort when pregnant.

Breast-feeding: St. John's wort is possibly unsafe when taken by mouth while breast-feeding. Infants can experience colic, drowsiness, and fussiness. Until more is known, don't use St. John's wort when breast-feeding.

Children: St. John's work is possibly safe when taken by mouth for up to 8 weeks in children 6-17 years-old.

Alzheimer disease: St. John's wort might make dementia worse in people with Alzheimer disease.

Bipolar disorder: St. John's wort can bring on mania in people with bipolar disorder, and can also speed up the cycling between depression and mania.

Depression: In people with major depression, St. John's wort might bring on mania, which can involve impulsive behavior.

Schizophrenia: St. John's wort might bring on psychosis in some people with schizophrenia.

Surgery: St. John's wort might affect serotonin levels in the brain, which could interfere with surgical procedures. Also, in people who have used St. John's wort, using anesthesia may lead to serious heart complications during surgery. Stop using St. John's wort at least two weeks before a scheduled surgery.

Interactions ?

Major Interaction

Do not take this combination

Alprazolam (Xanax) interacts with ST. JOHN'S WORT
The body breaks down alprazolam to get rid of it. St. John's wort can increase how fast the body gets rid of alprazolam. This might decrease the effects of alprazolam.
Birth control pills (Contraceptive drugs) interacts with ST. JOHN'S WORT
Some birth control pills contain estrogen. The body breaks down the estrogen in birth control pills to get rid of it. St. John's wort might increase the breakdown of estrogen. Taking St. John's wort along with birth control pills might decrease the effects of birth control pills. If you take birth control pills along with St. John's wort, use an additional form of birth control such as a condom.
Cyclosporine (Neoral, Sandimmune) interacts with ST. JOHN'S WORT
The body breaks down cyclosporine to get rid of it. St. John's wort can increase how quickly the body breaks down cyclosporine. This might decrease how well cyclosporine works.
Digoxin (Lanoxin) interacts with ST. JOHN'S WORT
St. John's wort might decrease how much digoxin the body absorbs. By decreasing how much digoxin the body absorbs, St. John's wort might decrease the effects of digoxin.
Imatinib (Gleevec) interacts with ST. JOHN'S WORT
The body breaks down imatinib to get rid of it. St. John's wort might increase how quickly the body gets rid of imatinib. Taking St. John's wort along with imatinib might decrease the effects of imatinib.
Irinotecan (Camptosar) interacts with ST. JOHN'S WORT
The body breaks down irinotecan to get rid of it. St. John's wort might increase how fast the body breaks down irinotecan. This might decrease the effects of irinotecan.
Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates) interacts with ST. JOHN'S WORT
Some medications are changed and broken down by the liver. St. John's wort might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications.
Medications for HIV/AIDS (Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)) interacts with ST. JOHN'S WORT
The body breaks down medications used for HIV/AIDS to get rid of them. St. John's wort can increase how quickly the body breaks down these medications. Taking St. John's wort might decrease how well some of these medications work.
Medications for HIV/AIDS (Protease Inhibitors) interacts with ST. JOHN'S WORT
The body breaks down medications used for HIV/AIDS to get rid of them. Taking St. John's wort might increase how quickly the body breaks down these medications. Taking St. John's wort might decrease how well some of these medications work.
Medications moved by pumps in cells (P-Glycoprotein Substrates) interacts with ST. JOHN'S WORT
Some medications are moved in and out of cells by pumps. St. John's wort might change how these pumps work and change how much medication stays in the body. In some cases, this might change the effects and side effects of a medication.
Phenobarbital (Luminal) interacts with ST. JOHN'S WORT
The body breaks down phenobarbital to get rid of it. St. John's wort might increase how quickly the body breaks down phenobarbital. This could decrease how well phenobarbital works and increase the risk of seizures.
Phenprocoumon (Marcoumar, others) interacts with ST. JOHN'S WORT
The body breaks down phenprocoumon to get rid of it. St. John's wort increases how quickly the body breaks down phenprocoumon. This decreases the effects of phenprocoumon.
Phenytoin (Dilantin) interacts with ST. JOHN'S WORT
The body breaks down phenytoin to get rid of it. St. John's wort might increase how quickly the body breaks down phenytoin. This might decrease the effects of phenytoin and increase the possibility of seizures.
Rivaroxaban (Xarelto) interacts with ST. JOHN'S WORT
The body breaks down rivaroxaban to get rid of it. St. John's wort can increase how quickly the body breaks down rivaroxaban. This can decrease the effects of rivaroxaban.
Tacrolimus (Prograf) interacts with ST. JOHN'S WORT
The body breaks down tacrolimus to get rid of it. St. John's wort can increase how quickly the body breaks down tacrolimus. This can decrease the effects of tacrolimus.
Warfarin (Coumadin) interacts with ST. JOHN'S WORT
The body breaks down warfarin to get rid of it. St. John's wort might increase how quickly the body gets rid of warfarin. This might decrease the effects of warfarin and increase the risk of clotting. Be sure to have your blood checked regularly. The dose of your warfarin might need to be changed.
Mephenytoin (Mesantoin) interacts with ST. JOHN'S WORT
Mephenytoin is changed and broken down by the body. St. John's wort increases how quickly this medication is broken down by the body. This might decrease the effects of mephenytoin.
Omeprazole (Prilosec) interacts with ST. JOHN'S WORT
The body breaks down omeprazole to get rid of it. St. John's wort can increase how quickly the body breaks down omeprazole. This could decrease the effects of omeprazole.
Docetaxel (Taxotere) interacts with ST. JOHN'S WORT
The body breaks down docetaxel to get rid of it. St. John's wort can increase how quickly the body breaks down docetaxel. This might decrease how well docetaxel works.
Ketamine (Ketalar) interacts with ST. JOHN'S WORT
The body breaks down ketamine to get rid of it. St. John's wort might increase how fast the body breaks down ketamine. This might decrease the effects of ketamine.
Oxycodone (Oxycontin) interacts with ST. JOHN'S WORT
The body breaks down oxycodone to get rid of it. St. John's wort might increase how fast the body breaks down oxycodone. This might decrease the effects of oxycodone.

Moderate Interaction

Be cautious with this combination

Aminolevulinic acid interacts with ST. JOHN'S WORT
Aminolevulinic acid can make the skin sensitive to sunlight. St. John's wort might also increase sensitivity to sunlight. Taking St. John's wort along with aminolevulinic acid might increase the chances of sunburn, blistering or rashes on areas of skin exposed to sunlight. Be sure to wear sunblock and protective clothing when spending time in the sun.
Clopidogrel (Plavix) interacts with ST. JOHN'S WORT
The body must convert clopidogrel to its active form. Taking St. John's wort increases how quickly the body converts clopidogrel to the active form. This might increase the effects and side effects of clopidogrel, such as bruising and bleeding.
Fexofenadine (Allegra) interacts with ST. JOHN'S WORT
The body breaks down fexofenadine to get rid of it. St. John's wort might decrease how quickly the body gets rid of fexofenadine. This could increase the effects and side effects of fexofenadine.
Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates) interacts with ST. JOHN'S WORT
Some medications are changed and broken down by the liver. St. John's wort might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications.
Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates) interacts with ST. JOHN'S WORT
Some medications are changed and broken down by the liver. St. John's wort might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications.
Medications that increase sensitivity to sunlight (Photosensitizing drugs) interacts with ST. JOHN'S WORT
Some medications might make the skin more sensitive to sunlight. St. John's wort might also make the skin more sensitive to sunlight. Using these products together might increase the risk of sunburn, blistering, or rashes when the skin is exposed to sunlight. Be sure to wear sunblock and protective clothing when spending time in the sun.
Procainamide interacts with ST. JOHN'S WORT
St. John's wort extract might increase how much procainamide the body absorbs. This could increase the effects and side effects of procainamide. But it's not clear if this is a big concern.
Reserpine (Raudixin, others) interacts with ST. JOHN'S WORT
Taking St. John's wort might decrease the effects of reserpine.
Tramadol (Ultram) interacts with ST. JOHN'S WORT
The body breaks down tramadol to get rid of it. St. John's wort might increase how fast the body breaks down tramadol. This might decrease the effects of tramadol.
Medications changed by the liver (Cytochrome P450 2C19 (CYP2C19) substrates) interacts with ST. JOHN'S WORT
Some medications are changed and broken down by the liver. St. John's wort might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications.
Gliclazide (Diamicron, others) interacts with ST. JOHN'S WORT
The body breaks down gliclazide to get rid of it. St. John's wort might increase how quickly the body gets rid of gliclazide. This might decrease the effects of gliclazide.
Methadone (Dolophine) interacts with ST. JOHN'S WORT
The body breaks down methadone to get rid of it. St. John's wort might increase how fast the body breaks down methadone. This might decrease the effects of methadone.
Zolpidem (Ambien) interacts with ST. JOHN'S WORT
The body breaks down zolpidem to get rid of it. St. John's wort might increase how quickly the body breaks down zolpidem. Taking St. John's wort and taking zolpidem might decrease the effects of zolpidem.
Bupropion (Wellbutrin) interacts with ST. JOHN'S WORT
The body breaks down bupropion to get rid of it. St. John's wort might increase how quickly the body breaks down bupropion. This might decrease the effects of bupropion.
Medications changed by the liver (Cytochrome P450 2B6 (CYP2B6) substrates) interacts with ST. JOHN'S WORT
Some medications are changed and broken down by the liver. St. John's wort might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications.
Voriconazole (Vfend) interacts with ST. JOHN'S WORT
The body breaks down voriconazole to get rid of it. St. John's wort might increase how quickly the body gets rid of voriconazole. Taking St. John's wort along with voriconazole might decrease its effects.
Fentanyl interacts with ST. JOHN'S WORT
The body breaks down fentanyl to get rid of it. St. John's wort might increase how quickly the body gets rid of fentanyl. This might decrease the effects of fentanyl.
Finasteride (Proscar, Propecia) interacts with ST. JOHN'S WORT
The body breaks down finasteride to get rid of it. St. John's wort might increase how quickly the body gets rid of finasteride. Taking St. John's wort along with finasteride might decrease its effects.
Ivabradine (Corlanor) interacts with ST. JOHN'S WORT
The body breaks down ivabradine to get rid of it. St. John's wort might increase how fast the body breaks down ivabradine. This might decrease the effects of ivabradine.
Medications used for lowering cholesterol (Statins) interacts with ST. JOHN'S WORT
The body breaks down some medications to get rid of them. St. John's wort can increase how fast the body gets rid of some medications used for lowering cholesterol. Taking St. John's wort along with these medications might decrease their effects.
Clozapine (Clozaril) interacts with ST. JOHN'S WORT
The body breaks down clozapine to get rid of it. St. John's wort might increase how quickly the body breaks down clozapine. This might decrease how well clozapine works.
Indinavir (Crixivan) interacts with ST. JOHN'S WORT
The body breaks down indinavir to get rid of it. St. John's wort might increase how quickly the body breaks down indinavir. This might decrease the effects of indinavir.
Serotonergic drugs interacts with ST. JOHN'S WORT
St. John's wort might increase a brain chemical called serotonin. Some medications also have this effect. Taking St. John's wort along with these medications might increase serotonin too much. This might cause serious side effects including heart problems, seizures, and vomiting.

Minor Interaction

Be watchful with this combination

Methylphenidate (Concerta, others) interacts with ST. JOHN'S WORT
Taking St. John's wort along with methylphenidate might decrease how well methylphenidate works. But it's not clear if this is a big concern.
Theophylline interacts with ST. JOHN'S WORT
The body breaks down theophylline to get rid of it. St. John's wort might increase how quickly the body gets rid of theophylline. Taking St. John's wort along with theophylline might decrease its effects in some people.
Ambrisentan (Letairis) interacts with ST. JOHN'S WORT
The body breaks down ambrisentan to get rid of it. St. John's wort might increase how quickly the body gets rid of ambrisentan. But this effect is probably not a big concern.
Boceprevir (Victrelis) interacts with ST. JOHN'S WORT
St. John's wort contains a chemical called hypericin. Taking St. John's wort with boceprevir might increase the amount of hypericin in the body. This might increase the effects or side effects of St. John's wort.

Dosing

Talk to your healthcare provider before taking St. John's wort. It can interact with many different drugs.

St. John's wort extract is most commonly used by adults in doses of 600-900 mg by mouth daily, taken in 2-3 divided doses, for up to 12 weeks. St. John's wort is also available in ointments, creams, and gels. Speak with a healthcare provider to find out what type of product and dose might be best for a specific condition.

View References

REFERENCES:

Al-Akoum, M., Maunsell, E., Verreault, R., Provencher, L., Otis, H., and Dodin, S. Effects of Hypericum perforatum (St. John's wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause. 2009;16(2):307-314. View abstract.

Andreescu, C., Mulsant, B. H., and Emanuel, J. E. Complementary and alternative medicine in the treatment of bipolar disorder--a review of the evidence. J.Affect.Disord. 2008;110(1-2):16-26. View abstract.

Bancirova, M. and Lasovsky, J. The photodynamic effect: the comparison of chemiexcitation by luminol and phthalhydrazide. Luminescence. 2011;26(6):410-415. View abstract.

Barbenel, D. M., Yusufi, B., O'Shea, D., and Bench, C. J. Mania in a patient receiving testosterone replacement postorchidectomy taking St John's wort and sertraline. J Psychopharmacol 2000;14(1):84-86. View abstract.

Berlanda, J., Kiesslich, T., Engelhardt, V., Krammer, B., and Plaetzer, K. Comparative in vitro study on the characteristics of different photosensitizers employed in PDT. J.Photochem.Photobiol.B 9-2-2010;100(3):173-180. View abstract.

Bernd A, Ramirez-Bosca A, Kippenberger S, and et al. Phototoxic effects of Hypericum extract in cultures of human keratinocytes compared with those of psoralen. Photochem Photobiol 1999;2(69):218-221.

Bhattacharya, S. K., Chakrabarti, A., and Chatterjee, S. S. Activity profiles of two hyperforin-containing hypericum extracts in behavioral models. Pharmacopsychiatry 1998;31 Suppl 1:22-29. View abstract.

Biber, A., Fischer, H., Romer, A., and Chatterjee, S. S. Oral bioavailability of hyperforin from hypericum extracts in rats and human volunteers. Pharmacopsychiatry 1998;31 Suppl 1:36-43. View abstract.

Bladt, S. and Wagner, H. Inhibition of MAO by fractions and constituents of hypericum extract. J Geriatr.Psychiatry Neurol. 1994;7 Suppl 1:S57-S59. View abstract.

Bombardelli E and Morazzoni P. Hypericum perforatum. Fitoterapia 1995;66(1):43-68.

Brattstrom, A. Long-term effects of St. John's wort (Hypericum perforatum) treatment: a 1-year safety study in mild to moderate depression. Phytomedicine. 2009;16(4):277-283. View abstract.

Butterweck, V., Wall, A., Lieflander-Wulf, U., Winterhoff, H., and Nahrstedt, A. Effects of the total extract and fractions of Hypericum perforatum in animal assays for antidepressant activity. Pharmacopsychiatry 1997;30 Suppl 2:117-124. View abstract.

Canning, S., Waterman, M., Orsi, N., Ayres, J., Simpson, N., and Dye, L. The efficacy of Hypericum perforatum (St John's wort) for the treatment of premenstrual syndrome: a randomized, double-blind, placebo-controlled trial. CNS.Drugs 2010;24(3):207-225. View abstract.

Cappuzzo, K. A. Herbal product use in a patient with polypharmacy. Consult Pharm. 2006;21(11):911-915. View abstract.

Carpenter, S. and Kraus, G. A. Photosensitization is required for inactivation of equine infectious anemia virus by hypericin. Photochem.Photobiol. 1991;53(2):169-174. View abstract.

Chatterjee SS, Bhattacharya SK, Singer A, and et al. Hyperforin inhibits synaptosomal uptake of neurotransmitters in vitro and shows antidepressant activity in vivo. Pharmazie 1998;53(3):9.

Clewell, A., Barnes, M., Endres, J. R., Ahmed, M., and Ghambeer, D. K. Efficacy and tolerability assessment of a topical formulation containing copper sulfate and hypericum perforatum on patients with herpes skin lesions: a comparative, randomized controlled trial. J.Drugs Dermatol. 2012;11(2):209-215. View abstract.

Cohen, P. A., Hudson, J. B., and Towers, G. H. Antiviral activities of anthraquinones, bianthrones and hypericin derivatives from lichens. Experientia 2-15-1996;52(3):180-183. View abstract.

Cott, J. M. In vitro receptor binding and enzyme inhibition by Hypericum perforatum extract. Pharmacopsychiatry 1997;30 Suppl 2:108-112. View abstract.

Couldwell, W. T., Gopalakrishna, R., Hinton, D. R., He, S., Weiss, M. H., Law, R. E., Apuzzo, M. L., and Law, R. E. Hypericin: a potential antiglioma therapy. Neurosurgery 1994;35(4):705-710. View abstract.

Couldwell, W. T., Surnock, A. A., Tobia, A. J., Cabana, B. E., Stillerman, C. B., Forsyth, P. A., Appley, A. J., Spence, A. M., Hinton, D. R., and Chen, T. C. A phase 1/2 study of orally administered synthetic hypericin for treatment of recurrent malignant gliomas. Cancer 11-1-2011;117(21):4905-4915. View abstract.

Cui, Y., Ang, C. Y., Beger, R. D., Heinze, T. M., Hu, L., and Leakey, J. In vitro metabolism of hyperforin in rat liver microsomal systems. Drug Metab Dispos. 2004;32(1):28-34. View abstract.

Degar, S., Prince, A. M., Pascual, D., Lavie, G., Levin, B., Mazur, Y., Lavie, D., Ehrlich, L. S., Carter, C., and Meruelo, D. Inactivation of the human immunodeficiency virus by hypericin: evidence for photochemical alterations of p24 and a block in uncoating. AIDS Research and Human Retroviruses 1992;8(11):1929-1936. View abstract.

Demisch L, Holzl J, Gollnik B, and et al. Identification of selective MAO-type-A inhibitors in Hypericum perforatum L. (Hyperforat). Pharmacopsychiat. 1989;22:194.

Di Carlo, G., Nuzzo, I., Capasso, R., Sanges, M. R., Galdiero, E., Capasso, F., and Carratelli, C. R. Modulation of apoptosis in mice treated with Echinacea and St. John's wort. Pharmacol Res 2003;48(3):273-277. View abstract.

Di, Matteo, V, Di Giovanni, G., Di Mascio, M., and Esposito, E. Effect of acute administration of hypericum perforatum-CO2 extract on dopamine and serotonin release in the rat central nervous system. Pharmacopsychiatry 2000;33(1):14-18. View abstract.

Dona, M., Dell'Aica, I., Pezzato, E., Sartor, L., Calabrese, F., Della, Barbera M., Donella-Deana, A., Appendino, G., Borsarini, A., Caniato, R., and Garbisa, S. Hyperforin inhibits cancer invasion and metastasis. Cancer Res 9-1-2004;64(17):6225-6232. View abstract.

Etogo-Asse, F., Boemer, F., Sempoux, C., and Geubel, A. Acute hepatitis with prolonged cholestasis and disappearance of interlobular bile ducts following tibolone and Hypericum perforatum (St. John's wort). Case of drug interaction? Acta Gastroenterol.Belg. 2008;71(1):36-38. View abstract.

Fava, M., Alpert, J., Nierenberg, A. A., Mischoulon, D., Otto, M. W., Zajecka, J., Murck, H., and Rosenbaum, J. F. A Double-blind, randomized trial of St John's wort, fluoxetine, and placebo in major depressive disorder. J.Clin.Psychopharmacol. 2005;25(5):441-447. View abstract.

Feisst, C. and Werz, O. Suppression of receptor-mediated Ca2+ mobilization and functional leukocyte responses by hyperforin. Biochem Pharmacol 4-15-2004;67(8):1531-1539. View abstract.

Gastpar, M., Singer, A., and Zeller, K. Comparative efficacy and safety of a once-daily dosage of hypericum extract STW3-VI and citalopram in patients with moderate depression: a double-blind, randomised, multicentre, placebo-controlled study. Pharmacopsychiatry 2006;39(2):66-75. View abstract.

Ghazanfarpour, M., Kaviani, M., Asadi, N., Ghaffarpasand, F., Ziyadlou, S., Tabatabaee, H. R., and Dehghankhalili, M. Hypericum perforatum for the treatment of premenstrual syndrome. Int.J.Gynaecol.Obstet. 2011;113(1):84-85. View abstract.

Gobbi, M., Moia, M., Funicello, M., Riva, A., Morazzoni, P., and Mennini, T. In vitro effects of the dicyclohexylammonium salt of hyperforin on interleukin-6 release in different experimental models. Planta Med 2004;70(7):680-682. View abstract.

Guzelcan, Y., Scholte, W. F., Assies, J., and Becker, H. E. [Mania during the use of a combination preparation with St. John's wort (Hypericum perforatum)]. Ned.Tijdschr.Geneeskd. 10-6-2001;145(40):1943-1945. View abstract.

Harrer, G., Hubner, W. D., and Podzuweit, H. Effectiveness and tolerance of the hypericum extract LI 160 compared to maprotiline: a multicenter double-blind study. J.Geriatr.Psychiatry Neurol. 1994;7 Suppl 1:S24-S28. View abstract.

Hicks, S. M., Walker, A. F., Gallagher, J., Middleton, R. W., and Wright, J. The significance of "nonsignificance" in randomized controlled studies: a discussion inspired by a double-blinded study on St. John's wort (Hypericum perforatum L.) for premenstrual symptoms. J.Altern.Complement Med. 2004;10(6):925-932. View abstract.

Hostanska, K., Reichling, J., Bommer, S., Weber, M., and Saller, R. Hyperforin a constituent of St John's wort (Hypericum perforatum L.) extract induces apoptosis by triggering activation of caspases and with hypericin synergistically exerts cytotoxicity towards human malignant cell lines. Eur.J Pharm Biopharm. 2003;56(1):121-132. View abstract.

Hudson, J. B., Graham, E. A., and Towers, G. H. Antiviral assays on phytochemicals: the influence of reaction parameters. Planta Med. 1994;60(4):329-332. View abstract.

Hudson, J. B., Lopez-Bazzocchi, I., and Towers, G. H. Antiviral activities of hypericin. Antiviral Res 1991;15(2):101-112. View abstract.

Hunt, E. J., Lester, C. E., Lester, E. A., and Tackett, R. L. Effect of St. John's wort on free radical production. Life Sci 6-1-2001;69(2):181-190. View abstract.

Izzo, A. A. and Ernst, E. Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs 2009;69(13):1777-1798. View abstract.

Kalb, R., Trautmann-Sponsel, R. D., and Kieser, M. Efficacy and tolerability of hypericum extract WS 5572 versus placebo in mildly to moderately depressed patients. A randomized double-blind multicenter clinical trial. Pharmacopsychiatry 2001;34(3):96-103. View abstract.

Kasper, S. Treatment of seasonal affective disorder (SAD) with hypericum extract. Pharmacopsychiatry 1997;30 Suppl 2:89-93. View abstract.

Kasper, S., Gastpar, M., Moller, H. J., Muller, W. E., Volz, H. P., Dienel, A., and Kieser, M. Better tolerability of St. John's wort extract WS 5570 compared to treatment with SSRIs: a reanalysis of data from controlled clinical trials in acute major depression. Int.Clin.Psychopharmacol. 2010;25(4):204-213. View abstract.

Kasper, S., Volz, H. P., Moller, H. J., Dienel, A., and Kieser, M. Continuation and long-term maintenance treatment with Hypericum extract WS 5570 after recovery from an acute episode of moderate depression--a double-blind, randomized, placebo controlled long-term trial. Eur.Neuropsychopharmacol. 2008;18(11):803-813. View abstract.

Kerb, R., Brockmoller, J., Staffeldt, B., Ploch, M., and Roots, I. Single-dose and steady-state pharmacokinetics of hypericin and pseudohypericin. Antimicrob.Agents Chemother. 1996;40(9):2087-2093. View abstract.

Kobak, K. A., Taylor, L. V., Warner, G., and Futterer, R. St. John's wort versus placebo in social phobia: results from a placebo-controlled pilot study. J.Clin Psychopharmacol. 2005;25(1):51-58. View abstract.

Kobak, K. A., Taylor, L., Futterer, R., and Warner, G. St. John's wort in generalized anxiety disorder: three more case reports. J Clin Psychopharmacol. 2003;23(5):531-532. View abstract.

Laird RD and Webb M. Psychotic episode during use of St John's wort. J Herbal Pharmacother 2001;1(2):81-87.

Lavie, G., Valentine, F., Levin, B., Mazur, Y., Gallo, G., Lavie, D., Weiner, D., and Meruelo, D. Studies of the mechanisms of action of the antiretroviral agents hypericin and pseudohypericin. Proc Natl.Acad.Sci U.S.A 1989;86(15):5963-5967. View abstract.

Lecrubier Y. Clinical significance of hyperforin for the efficacy of Hypericum extracts on depressive disorders of different severities. Eur Neuropsychopharmacol 2001;11:105-106.

Lecrubier, Y., Clerc, G., Didi, R., and Kieser, M. Efficacy of St. John's wort extract WS 5570 in major depression: a double-blind, placebo-controlled trial. Am J Psychiatry 2002;159(8):1361-1366. View abstract.

Linde, K., Berner, M. M., and Kriston, L. St John's wort for major depression. Cochrane.Database.Syst.Rev. 2008;(4):CD000448. View abstract.

Linde, K., Berner, M., Egger, M., and Mulrow, C. St John's wort for depression: meta-analysis of randomised controlled trials. Br.J Psychiatry 2005;186:99-107. View abstract.

Lopez-Bazzocchi, I., Hudson, J. B., and Towers, G. H. Antiviral activity of the photoactive plant pigment hypericin. Photochem.Photobiol. 1991;54(1):95-98. View abstract.

Martinez, B., Kasper, S., Ruhrmann, S., and Moller, H. J. Hypericum in the treatment of seasonal affective disorders. J Geriatr.Psychiatry Neurol. 1994;7 Suppl 1:S29-S33. View abstract.

Meruelo, D., Lavie, G., and Lavie, D. Therapeutic agents with dramatic antiretroviral activity and little toxicity at effective doses: aromatic polycyclic diones hypericin and pseudohypericin. Proc.Natl.Acad.Sci U.S.A 1988;85(14):5230-5234. View abstract.

Müller WE, Rolli, M., Schafer, C., and Hafner, U. Effects of hypericum extract (LI 160) in biochemical models of antidepressant activity. Pharmacopsychiatry 1997;30 Suppl 2:102-107. View abstract.

Muller, T., Mannel, M., Murck, H., and Rahlfs, V. W. Treatment of somatoform disorders with St. John's wort: a randomized, double-blind and placebo-controlled trial. Psychosom.Med. 2004;66(4):538-547. View abstract.

Nahrstedt, A. and Butterweck, V. Biologically active and other chemical constituents of the herb of Hypericum perforatum L. Pharmacopsychiatry 1997;30 Suppl 2:129-134. View abstract.

Najafizadeh, P., Hashemian, F., Mansouri, P., Farshi, S., Surmaghi, M. S., and Chalangari, R. The evaluation of the clinical effect of topical St Johns wort (Hypericum perforatum L.) in plaque type psoriasis vulgaris: a pilot study. Australas.J.Dermatol. 2012;53(2):131-135. View abstract.

Nanayakkara, P. W., Meijboom, M., and Schouten, J. A. [Suicidal and aggressive thoughts as a result of taking a Hypericum preparation (St. John's wort)]. Ned.Tijdschr.Geneeskd. 6-11-2005;149(24):1347-1349. View abstract.

Nathan, P. J. Hypericum perforatum (St John's Wort): a non-selective reuptake inhibitor? A review of the recent advances in its pharmacology. J Psychopharmacol. 2001;15(1):47-54. View abstract.

Pajonk, F., Scholber, J., and Fiebich, B. Hypericin-an inhibitor of proteasome function. Cancer Chemother.Pharmacol 2005;55(5):439-446. View abstract.

Panijel M. [Treatment of moderately severe anxiety states]. Therapiewoche 1985;35(41):4659-4668.

Panossian AG, Gabrielian E, Manvelian V, and et al. Immunosuppressive effects of hypericin on stimulated human leukocytes: inhibition of the arachidonic acid release, leukotriene B

Papakostas, G. I., Crawford, C. M., Scalia, M. J., and Fava, M. Timing of clinical improvement and symptom resolution in the treatment of major depressive disorder. A replication of findings with the use of a double-blind, placebo-controlled trial of Hypericum perforatum versus fluoxetine. Neuropsychobiology 2007;56(2-3):132-137. View abstract.

Rahimi, R., Nikfar, S., and Abdollahi, M. Efficacy and tolerability of Hypericum perforatum in major depressive disorder in comparison with selective serotonin reuptake inhibitors: a meta-analysis. Prog.Neuropsychopharmacol.Biol.Psychiatry 2-1-2009;33(1):118-127. View abstract.

Ratz, A. E., von Moos, M., and Drewe, J. [St. John's wort: a pharmaceutical with potentially dangerous interactions]. Schweiz Rundsch.Med Prax. 5-10-2001;90(19):843-849. View abstract.

Roder, C., Schaefer, M., and Leucht, S. [Meta-analysis of effectiveness and tolerability of treatment of mild to moderate depression with St. John's Wort]. Fortschr.Neurol.Psychiatr. 2004;72(6):330-343. View abstract.

Sardella, A., Lodi, G., Demarosi, F., Tarozzi, M., Canegallo, L., and Carrassi, A. Hypericum perforatum extract in burning mouth syndrome: a randomized placebo-controlled study. J.Oral Pathol.Med. 2008;37(7):395-401. View abstract.

Schakau D, Hiller K, Schultz-Zehden W, and et al. Risk/benefit profile of St.John's wort extract: STEI 300 in 2404 patients with various degrees of psychiatric disturbance. Psychopharmakotherapie 1996;3:116-122.

Schempp, C. M., Winghofer, B., Muller, K., Schulte-Monting, J., Mannel, M., Schopf, E., and Simon, J. C. Effect of oral administration of Hypericum perforatum extract (St. John's Wort) on skin erythema and pigmentation induced by UVB, UVA, visible light and solar simulated radiation. Phytother Res 2003;17(2):141-146. View abstract.

Schinazi, R. F., Chu, C. K., Babu, J. R., Oswald, B. J., Saalmann, V., Cannon, D. L., Eriksson, B. F., and Nasr, M. Anthraquinones as a new class of antiviral agents against human immunodeficiency virus. Antiviral Res 1990;13(5):265-272. View abstract.

Schrader E, Meier B, and Brattstrom A. Hypericum treatment of mild-moderate depression in a placebo-controlled study. A prospective, double-blind, randomized, placebo-controlled, multicentre study. Human Psychopharm 1998;13:163-169.

Schulz, H. U., Schurer, M., Bassler, D., and Weiser, D. Investigation of the bioavailability of hypericin, pseudohypericin, hyperforin and the flavonoids quercetin and isorhamnetin following single and multiple oral dosing of a hypericum extract containing tablet. Arzneimittelforschung. 2005;55(1):15-22. View abstract.

Simeon, J., Nixon, M. K., Milin, R., Jovanovic, R., and Walker, S. Open-label pilot study of St. John's wort in adolescent depression. J Child Adolesc.Psychopharmacol. 2005;15(2):293-301. View abstract.

Staffeldt, B., Kerb, R., Brockmoller, J., Ploch, M., and Roots, I. Pharmacokinetics of hypericin and pseudohypericin after oral intake of the hypericum perforatum extract LI 160 in healthy volunteers. J Geriatr.Psychiatry Neurol. 1994;7 Suppl 1:S47-S53. View abstract.

Sultana D, Peindl KS Wisner KL. Rash associated with St. John's wort treatment in premenstrual dysphoric disorder. Arch Women Ment Health 2000;3:99-101.

Suzuki, O., Katsumata, Y., Oya, M., Bladt, S., and Wagner, H. Inhibition of monoamine oxidase by hypericin. Planta Med 1984;50(3):272-274. View abstract.

Tang, J., Colacino, J. M., Larsen, S. H., and Spitzer, W. Virucidal activity of hypericin against enveloped and non-enveloped DNA and RNA viruses. Antiviral Res 1990;13(6):313-325. View abstract.

Thiede, H. M. and Walper, A. Inhibition of MAO and COMT by hypericum extracts and hypericin. J Geriatr.Psychiatry Neurol. 1994;7 Suppl 1:S54-S56. View abstract.

Thiele, B., Brink, I., and Ploch, M. Modulation of cytokine expression by hypericum extract. J Geriatr.Psychiatry Neurol. 1994;7 Suppl 1:S60-S62. View abstract.

van Die, M. D., Burger, H. G., Bone, K. M., Cohen, M. M., and Teede, H. J. Hypericum perforatum with Vitex agnus-castus in menopausal symptoms: a randomized, controlled trial. Menopause. 2009;16(1):156-163. View abstract.

van Gurp, G., Meterissian, G. B., Haiek, L. N., McCusker, J., and Bellavance, F. St John's wort or sertraline? Randomized controlled trial in primary care. Can Fam Physician 2002;48:905-912. View abstract.

Van Strater, A. C. and Bogers, J. P. Interaction of St John's wort (Hypericum perforatum) with clozapine. Int.Clin.Psychopharmacol. 2012;27(2):121-124. View abstract.

Werneke, U., Horn, O., and Taylor, D. M. How effective is St John's wort? The evidence revisited. J Clin.Psychiatry 2004;65(5):611-617. View abstract.

Winkler, C., Wirleitner, B., Schroecksnadel, K., Schennach, H., and Fuchs, D. St. John's wort (Hypericum perforatum) counteracts cytokine-induced tryptophan catabolism in vitro. Biol.Chem 2004;385(12):1197-1202. View abstract.

Woelk H, Burkard G, and Grunwald J. Nutzen und Risikobewertung des Hypericum-extraktes LI 160 auf der Basis einer Drug-Monitoring-Studie mit 3250 patienten. Nervenheilkunde 1993;12:308-313.

Wonnemann, M., Singer, A., and Muller, W. E. Inhibition of synaptosomal uptake of 3H-L-glutamate and 3H-GABA by hyperforin, a major constituent of St. John's Wort: the role of amiloride sensitive sodium conductive pathways. Neuropsychopharmacology 2000;23(2):188-197. View abstract.

Wood S, Huffman J, Weber N, and et al. Antiviral activity of naturally occurring anthraquinones and anthraquinone derivatives. Planta Med 1990;56:651-652.

Wright, C. W., Gott, M., Grayson, B., Hanna, M., Smith, A. G., Sunter, A., and Neill, J. C. Correlation of hyperforin content of Hypericum perforatum (St John's Wort) extracts with their effects on alcohol drinking in C57BL/6J mice: a preliminary study. J Psychopharmacol. 2003;17(4):403-408. View abstract.

Zhou, C., Tabb, M. M., Sadatrafiei, A., Grun, F., Sun, A., and Blumberg, B. Hyperforin, the active component of St. John's wort, induces IL-8 expression in human intestinal epithelial cells via a MAPK-dependent, NF-kappaB-independent pathway. J Clin.Immunol. 2004;24(6):623-636. View abstract.

Zullino, D. and Borgeat, F. Hypertension induced by St. John's Wort - a case report. Pharmacopsychiatry 2003;36(1):32. View abstract.

Abdali K, Khajehei M, Tabatabaee HR. Effect of St John's wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Menopause 2010;17(2):326-31. View abstract.

Abul-Ezz SR, Barone GW, Gurley BJ, et al. Effect of herbal supplements on cyclosporine blood levels and associated acute rejection. Am Soc of Nephrol Ann Mtg, Toronto, CAN 2000;Oct. 11-16:abstract A3754.

Adibelli Z, Karacay I, Demir M, Duran C. St. John's Wort (Hypericum perforatum)-related acute kidney injury. Blood Purif. 2021 Aug 24:1-3. doi: 10.1159/000518349. View abstract.

Agollo MC, Miszputen SJ, Diament J. Hypericum perforatum-induced hepatotoxicity with possible association with copaiba (copaifera langsdorffii desf): a case report. Einstein (Sao Paulo) 2014;12(3):355-7. View abstract.

Anon. A better treatment for depression? UC Berkeley Wellness Letter 1997;13:1-2.

Anon. Final report on the safety assessment of Hypericum perforatum extract and Hypericum perforatum oil. Int J Toxicol 2001;20:31-9. View abstract.

Apaydin EA, Maher AR, Shanman R, et al. A systematic review of St. John's wort for major depressive disorder. Syst Rev. 2016;5(1):148. View abstract.

Arena R, Strazzeri MG, Bianchi T, et al. Hypericum and neem oil for dehisced post-surgical wounds: a randomised, controlled, single-blinded phase III study. J Wound Care 2022;31(6):492-500. View abstract.

Arentz S, Smith CA, Abbott J, Fahey P, Cheema BS, Bensoussan A. Combined Lifestyle and Herbal Medicine in Overweight Women with Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial. Phytother Res. 2017 Sep;31(9):1330-1340. View abstract.

Asher GN, Gartlehner G, Gaynes BN, et al. Comparative Benefits and Harms of Complementary and Alternative Medicine Therapies for Initial Treatment of Major Depressive Disorder: Systematic Review and Meta-Analysis. J Altern Complement Med. 2017;23(12):907-19. View abstract.

Assalian P. Sildenafil for SJW-induced sexual dysfunction. J Sex Marital Ther 2000;26:357-8. View abstract.

Barnes J, Barber N, Wheatley D, Williamson EM. A pilot randomised, open, uncontrolled, clinical study of two dosages of St John's wort (Hypericum perforatum) herb extract (LI-160) as an aid to motivational/behavioural support in smoking cessation. Planta Med 2006;72:378-82. View abstract.

Barone GW, Gurley BJ, Ketel BL, et al. Drug interaction between St. John's wort and cyclosporin. Ann Pharmacother 2000;34:1013-6. View abstract.

Bauer S, Stormer E, Johne A, et al. Alterations in cyclosporin A pharmacokinetics and metabolism during treatment with St John's wort in renal transplant patients. Br J Clin Pharmacol 2003;55:203-11.. View abstract.

Beckman SE, Sommi RW, Switzer J. Consumer use of St. John's wort: A survey of effectiveness, safety, and tolerability. Pharmacotherapy 2000;20:568-74. View abstract.

Bell EC, Ravis WR, Lloyd KB, Stokes TJ. Effects of St. John's wort supplementation on ibuprofen pharmacokinetics. Ann Pharmacother 2007;41:229-34. View abstract.

Bennett DA Jr, Phun L, Polk JF, et al. Neuropharmacology of St. John's Wort (Hypericum). Ann Pharmacother 1998;32:1201-8. View abstract.

Bhopal JS. St John's wort-induced sexual dysfunction. Can J Psychiatry 2001;46:456-457. View abstract.

Bilia AR, Bergonzi MC, Morgenni F, et al. Evaluation of chemical stability of St. John's wort commercial extract and some preparations. Int J Pharm 2001;213:199-208. View abstract.

Bilia AR, Gallori S, Vincieri FF. St. John's wort and depression: efficacy, safety and tolerability-an update. Life Sci 2002;70:3077-96. View abstract.

Booth JN, McGwin G. The association between self-reported cataracts and St. John's Wort. Curr Eye Res 2009;34:863-6. View abstract.

Bove GM. Acute neuropathy after exposure to sun in a patient treated with St. John's Wort. Lancet 1998;352:1121-2. View abstract.

Breidenbach T, Hoffmann MW, Becker T, et al. Drug interaction of St. John's wort with cyclosporin. Lancet 2000;355:1912. View abstract.

Brenner R, Azbel V, Madhusoodanan S, et al. Comparison of an extract of Hypericum (LI 160) and sertraline in the treatment of depression: A double-blind, randomized pilot study. Clin Ther 2000;22:411-9. View abstract.

Briese V, Stammwitz U, Friede M, Henneicke-von Zepelin HH. Black cohosh with or without St. John's wort for symptom-specific climacteric treatment--results of a large-scale, controlled, observational study. Maturitas 2007;57:405-14. View abstract.

Brockmoller J, Reum T, Bauer S, et al. Hypericin and pseudohypericin: pharmacokinetics and effects on photosensitivity in humans. Pharmacopsychiatry 1997;30:94-101. View abstract.

Brown TM. Acute St. John's wort toxicity. Am J Emerg Med 2000;18:231-2. View abstract.

Calapai G, Crupi A, Firenzuoli F, et al. Serotonin, norepinephrine and dopamine involvement in the antidepressant action of hypericum perforatum. Pharmacopsychiatry 2001;34:45-9. View abstract.

Chan LY, Chiu PY, Lau TK. A study of hypericin-induced teratogenicity during organogenesis using a whole rat embryo culture model. Fertil Steril 2001;76:1073-4. View abstract.

Chatterjee SS, Noldner M, Koch E, Erdelmeier C. Antidepressant activity of hypericum perforatum and hyperforin: the neglected possibility. Pharmacopsych 1998;31:7-15. View abstract.

Chavez ML, Chavez PI. Saint John's wort. Hosp Pharm 1997;32:1621-32.

Cheng TO. St. John's wort interaction with digoxin [letter]. Arch Intern Med 2000;160:2548. View abstract.

Chrubasik-Hausmann S, Vlachojannis J, McLachlan AJ. Understanding drug interactions with St John's wort (Hypericum perforatum L.): impact of hyperforin content. J Pharm Pharmacol. 2018. View abstract.

Chung DJ, Kim HY, Park KH, et al. Black cohosh and St. John's wort (GYNO-Plus) for climacteric symptoms. Yonsei Med J 2007;48:289-94. View abstract.

Crowe, S. and McKeating, K. Delayed emergence and St. John's wort. Anesthesiology 2002;96(4):1025-1027. View abstract.

Dasgupta A, Hovanetz M, Olsen M, et al. Drug-herb interaction: effect of St John's wort on bioavailability and metabolism of procainamide in mice. Arch Pathol Lab Med 2007;131:1094-8. View abstract.

Davidson, J. R. and Connor, K. M. St. John's wort in generalized anxiety disorder: three case reports. J Clin Psychopharmacol 2001;21(6):635-636. View abstract.

de los Reyes GC, Koda RT. Determining hyperforin and hypericin content in eight brands of St. John's wort. Am J Health Syst Pharm 2002;59:545-7. View abstract.

de Maat M, Hoetelmans R, Mathot R, et al. Drug interaction between St. John's wort and nevirapine. AIDS 2001;15:420-1. View abstract.

Dean AJ, Moses GM, Vernon JM. Suspected withdrawal syndrome after cessation of St. John's wort. Ann Pharmacother 2003;37:150. View abstract.

Dolton MJ, Mikus G, Weiss J, et al. Understanding variability with voriconazole using a population pharmacokinetic approach: implications for optimal dosing. J Antimicrob Chemother 2014;69(6):1633-41. View abstract.

Draves AH, Walker SE. Analysis of the hypericin and pseudohypericin content of commercially available St John's Wort preparations. Can J Clin Pharmacol 2003;10:114-118.. View abstract.

Dresser, G. K., Schwarz, U. I., Wilkinson, G. R., and Kim, R. B. Coordinate induction of both cytochrome P4503A and MDR1 by St John's wort in healthy subjects. Clin Pharmacol Ther 2003;73(1):41-50. View abstract.

Dugoua JJ, Mills E, Perri D, Koren G. Safety and efficacy of St. John's wort (hypericum) during pregnancy and lactation. Can J Clin Pharmacol 2006;13:e268-76. View abstract.

Durr D, Stieger B, Kullak-Ublick GA, et al. St. John's Wort induces intestinal P-glycoprotein/MDR1 and intestinal and hepatic CYP3A4. Clin Pharmacol Ther 2000;68:598-604. View abstract.

Eich-Hochli, D., Oppliger, R., Golay, K. P., Baumann, P., and Eap, C. B. Methadone maintenance treatment and St. John's Wort - a case report. Pharmacopsychiatry 2003;36(1):35-37.

Ereshefsky B, Gewertz N, Lam YMF, et al. Determination of SJW differential metabolism at CYP2D6 and CYP3A4, using dextromethorphan probe methodology. Abstract Poster Presentations, 39th NCDEU Annual Meeting, 1999:Poster 130 128.

Ernst E, Rand JI, Barnes J, Stevinson C. Adverse effects profile of the herbal antidepressant St. John's wort (Hypericum perforatum L.). Eur J Clin Pharmacol 1998;54:589-94. View abstract.

Ernst E. St. John's Wort supplements endanger the success of organ transplantation. Arch Surg 2002;137:316-9. View abstract.

Findling RL, McNamara NK, O'Riordan MA, et al. An open-label pilot study of St. John's wort in juvenile depression. J Am Acad Child Adolesc Psychiatry 2003;42:908-914. View abstract.

Fisher KA, Patel P, Abualula S, Concepion L. St. John's Wort-Induced Supraventricular Tachycardia. Cureus. 2021 Apr 7;13(4):e14356. View abstract.

Fogle RH, Murphy PA, Westhoff CL, Stanczyk FZ. Does St. John's wort interfere with the antiandrogenic effect of oral contraceptive pills? Contraception 2006;74:245-8. View abstract.

Foster BC, Vandenhoek S, Hana J, et al. In vitro inhibition of human cytochrome P450-mediated metabolism of marker substrates by natural products. Phytomedicine 2003;10:334-42.. View abstract.

Frye RF, Fitzgerald SM, Lagattuta TT, et al. Effect of St. John's wort on imatinib mesylate pharmacokinetics. Clin Pharmacol Ther 2004;76:323-9. View abstract.

Gaster B, Holroyd J. St John's wort for depression. Arch Intern Med 2000;160:152-6. View abstract.

Gewertz N, Ereshefsky B, Lam YWF, et al. Determination of the differential effects of St. John's wort on the CYP1A2 and NAT2 metabolic pathways using caffeine probe methodology. Abstract Poster Presentations, 39th NCDEU Annual Meeting, 1999:Poster 131.

Giuggioli D, Lumetti F, Spinella A, et al. Use of Neem oil and Hypericum perforatum for treatment of calcinosis-related skin ulcers in systemic sclerosis. J Int Med Res 2019:300060519882176. Online ahead of print. View abstract.

Goey AK, Meijerman I, Rosing H, et al. The effect of St John's wort on the pharmacokinetics of docetaxel. Clin Pharmacokinet 2014;53(1):103-10. View abstract.

Golsch S, Vocks E, Rakoski J, et al. [Reversible increase in photosensitivity to UV-B caused by St. John's wort extract]. Hautarzt 1997;48:249-52. View abstract.

Gordon JB. SSRIs and St. John's Wort: possible toxicity? Am Fam Physician 1998;57:950, 953. View abstract.

Gorski JC, Hamman MA, Wang Z, et al. The effect of St. John's wort on the efficacy of oral contraceptives (abstract MPI-80). Clin Pharmacol Ther 2001;71:P25.

Groning R, Breitkreutz J, Muller RS. Physico-chemical interactions between extracts of Hypericum perforatum L. and drugs. Eur J Pharm Biopharm 2003;56:231-6.. View abstract.

Grube, B., Walper, A., and Wheatley, D. St. John's Wort extract: efficacy for menopausal symptoms of psychological origin. Adv Ther 1999;16(4):177-186. View abstract.

Gulick RM, McAuliffe V, Holden-Wiltse J, et al. Phase I studies of hypericin, the active compound in St. John's Wort, as an antiretroviral agent in HIV-infected adults. AIDS Clinical Trials Group Protocols 150 and 258. Ann Intern Med 1999;130:510-4. View abstract.

Gümüs KS, Teegelbekkers A, Sauter M, et al. Effect of Tacrolimus Formulation (Prolonged-Release vs Immediate-Release) on Its Susceptibility to Drug-Drug Interactions with St. John's Wort. Clin Pharmacol Drug Dev 2024. View abstract.

Gurley BJ, Barone GW. Herb-drug interaction involving St. John's wort and cyclosporine. AAPS Ann Mtg & Expo Indianapolis, IN:2000;Oct 29- Nov 2: presentation #3443.

Gurley BJ, Gardner SF, Hubbard MA, et al. Cytochrome P450 phenotypic ratios for predicting herb-drug interactions in humans. Clin Pharmacol Ther 2002;72:276-87.. View abstract.

Gurley BJ, Gardner SF, Hubbard MA. Clinical assessment of potential cytochrome P450-mediated herb-drug interactions. AAPS Ann Mtg & Expo Indianapolis, IN: 2000; Oct 29 - Nov 2:presentation #3460.

Gurok MG, Mermi O, Kilic F, et al. Psychotic episode induced by St. John's wort (Hypericum perforatum): a case report. J Mood Dis 2014;4(1):38-40.

Hall SD, Wang Z, Huang SM, et al. The interaction between St John's wort and an oral contraceptive. Clin Pharmacol Ther 2003;74:525-35. View abstract.

Hammerness P, Basch E, Ulbricht C, et al. St. John's wort: a systematic review of adverse effects and drug interactions for the consultation psychiatrist. Psychosomatics 2003;44:271-82. View abstract.

Haron MH, Dale O, Martin K, et al. Evaluation of the Herb-Drug Interaction Potential of Commonly Used Botanicals on the US Market with Regard to PXR- and AhR-Mediated Influences on CYP3A4 and CYP1A2. J Diet Suppl 2022. View abstract.

Harrer G, Schmidt U, Kuhn U, Biller A. Comparison of equivalence between the St. John's wort extract LoHyp-57 and fluoxetine. Arzneimittelforschung 1999;49:289-96. View abstract.

Henderson L, Yue QY, Bergquist C, et al. St John's wort (Hypericum perforatum): drug interactions and clinical outcomes. Br J Clin Pharmacol 2002;54:349-56.. View abstract.

Hennessy M, Kelleher D, Spiers JP, et al. St Johns wort increases expression of P-glycoprotein: implications for drug interactions. Br J Clin Pharmacol 2002;53:75-82. View abstract.

Hohmann N, Maus A, CarlsA, Haefeli WE, Mikus G. St. John's wort treatment in women bears risks beyond pharmacokinetic drug interactions. Arch Toxico. 2016;90(4):1013-15. doi:10.1007/s00204-015-1532-7. View abstract.

Hojo, Y., Echizenya, M., Ohkubo, T., and Shimizu, T. Drug interaction between St John's wort and zolpidem in healthy subjects. J.Clin.Pharm.Ther. 2011;36(6):711-715. View abstract.

Holme SA, Roberts DL. Erythroderma associated with St John's wort. Br J Dermatol 2000;143:1127-8. View abstract.

Hubner WD, Kirste T. Experience with St. John's Wort (Hypericum perforatum) in children under 12 years with symptoms of depression and psychovegetative disturbances. Phytother Res 2001;15:367-70. View abstract.

Hubner WD, Lande S, Podzuweit H. Hypericum treatment of mild depressions with somatic symptoms. J Geriatr Psychiatry Neurol 1994;7 Suppl 1:S12-4. View abstract.

Hussain MD, Teixeira MG. Saint John's wort and analgesia: effect of Saint John's wort on morphine induced analgesia. AAPS Ann Mtg & Expo Indianapolis, IN:2000;Oct 29- Nov 2:presentation #3453.

Hypericum Depression Trial Study Group. Effect of Hypericum perforatum (St. John's wort) in major depressive disorder: a randomized controlled trial. JAMA 2002;287:1807-14. View abstract.

Irefin S, Sprung J. A possible cause of cardiovascular collapse during anesthesia: long-term use of St. John's Wort. J Clin Anesth 2000;12:498-9. View abstract.

Jackson A, D'Avolio A, Moyle G, et al. Pharmacokinetics of the co-administration of boceprevir and St. John's wort to male and female healthy volunteers. J Antimicrob Chemother 2014;69:1911-1915. View abstract.

Jacobson JM, Feinman L, Liebes L, et al. Pharmacokinetics, safety, and antiviral effects of hypericin, a derivative of St. John's Wort plant, in patients with chronic hepatitis C virus infection. Antimicrob Agents Chemother 2001;45:517-24. View abstract.

Jakovljevic V, Popovic M, Mimica-Dukic N, et al. Pharmacodynamic study of Hypericum perforatum L. Phytomedicine 2000;7:449-53. View abstract.

Jensen AG, Hansen SH, Nielsen EO. Adhyperforin as a contributor to the effect of Hypericum perforatum L. in biochemical models of antidepressant activity. Life Sci 2001;68:1593-605. View abstract.

Jiang X, Blair EY, McLachlan AJ. Investigation of the effects of herbal medicines on warfarin response in healthy subjects: a population pharmacokinetic-pharmacodynamic modeling approach. J Clin Pharmacol 2006;46:1370-8. View abstract.

Jiang X, Williams KM, Liauw WS, et al. Effect of St John's wort and ginseng on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol 2004;57:592-9. View abstract.

Johne A, Brockmoller J, Bauer S, et al. Pharmacokinetic interaction of digoxin with an herbal extract from St John's wort (Hypericum perforatum). Clin Pharmacol Ther 1999;66:338-45. View abstract.

Jones D. Tourian LT, Margolese H. Possible association of syndrome of Inappropriate secretion of antidiuretic hormone with St. John's wort use. J of Clin Psychopharmacol 2014:34(6):759-60. View abstract.

Kaplan V, Hasanoglu Erbasar GN, Cigerim L, Altay Turgut H, Cerit A. Effect of St. John's wort oil and olive oil on the postoperative complications after third molar surgery: randomized, double-blind clinical trial. Clin Oral Investig 2020 Oct 15. doi: 10.1007/s00784-020-03639-0. View abstract.

Karalapillai DC, Bellomo R. Convulsions associated with an overdose of St John's wort. Med J Aust 2007;186:213-4. View abstract.

Karliova M, Treichel U, Malago M, et al. Interaction of Hypericum perforatum (SJW) with cyclosporin A metabolism in a patient after liver transplantation. J Hepatol 2000;33:853-5. View abstract.

Kasper S, Dienel A. Cluster analysis of symptoms during antidepressant treatment with Hypericum extract in mildly to moderately depressed out-patients. A meta-analysis of data from three randomized, placebo-controlled trials. Psychopharmacology (Berl) 2002;164:301-8. View abstract.

Kawaguchi, A., Ohmori, M., Tsuruoka, S., Nishiki, K., Harada, K., Miyamori, I., Yano, R., Nakamura, T., Masada, M., and Fujimura, A. Drug interaction between St John's Wort and quazepam. Br.J.Clin Pharmacol. 2004;58(4):403-410. View abstract.

Khalifa AE. Hypericum perforatum as a nootropic drug: enhancement of retrieval memory of a passive avoidance conditioning paradigm in mice. J Ethnopharmacol 2001;76:49-57. View abstract.

Kim BR, Kim M, Na JI, Huh CH, Shin JW. A randomized split-face study of photodynamic therapy with St. John's Wort and indole-3-acetic acid for the treatment of acne. Dermatol Surg 2023. View abstract.

Kim H, Ha J, Park HY, Choung YH, Jang JH. Efficacy and Safety of Co-Administered St. John's Wort and Ginkgo biloba Extracts in Patients with Subjective Tinnitus: A Preliminary Prospective Randomized Controlled Trial. J Clin Med 2023;12(9):3261. View abstract.

Kim HL, Streltzer J, Goebert D. St. John's wort for depression: A meta analysis of well-defined clinical trials. J Nerv Ment Dis 1999;187:532-9. View abstract.

Kim RB. Drugs as P-glycoprotein substrates, inhibitors, and inducers. Drug Metab Rev 2002;34:47-54. View abstract.

Kleber E, Obry T, Hippeli S, et al. Biochemical activities of extracts from Hypericum perforatum L. 1st Communication: inhibition of dopamine-beta-hydroxylase. Arzneimittelforschung 1999;49:106-9. View abstract.

Kobak KA, Taylor LV, Bystritsky A, et al. St John's wort versus placebo in obsessive-compulsive disorder: results from a double-blind study. Int Clin Psychopharmacol 2005;20:299-304. View abstract.

Komoroski BJ, Zhang S, Cai H, et al. Induction and inhibition of cytochromes P450 by the St. John's wort constituent hyperforin in human hepatocyte cultures. Drug Metab Dispos 2004;32:512-8. View abstract.

Koupparis, L. S. Harmless herbs: a cause for concern? Anaesthesia 2000;55(1):101-102. View abstract.

Kumar V, Jaiswal AK, Singh PN, Bhattacharya SK. Anxiolytic activity of Indian Hypericum perforatum Linn: an experimental study. Indian J Exp Biol 2000;38:36-41. View abstract.

Kummer O, Hammann F, Haschki M, Krähenbül S. Reduction of hyperbilirubinemia with hypericum extract (St. Johns wort) in a patient with Crigler-Najjar syndrome type II. Br J Pharmacol 2016;81:1002-0114. View abstract.

Laakmann G, Dienel A, Kieser M. Clinical significance of hyperforin for the efficacy of Hypericum extracts on depressive disorders of different severities. Phytomedicine 1998;6:435-42.

Laakmann G, Schule C, Baghai T, Kieser M. St. John's wort in mild to moderate depression: the relevance of hyperforin for the clinical efficacy. Pharmacopsych 1998;31:54-9. View abstract.

Ladner DP, Klein SD, Steiner RA, Walt H. Synergistic toxicity of delta-aminolaevulinic acid-induced protoporphyrin IX used for photodiagnosis and hypericum extract, a herbal antidepressant. Br J Dermatol 2001;144:916-8. View abstract.

Laird RD, Webb M. Psychotic episode during use of St. John's wort. J Herb Pharmacother 2001;1:81-7.

Lal S, Iskandar H. St. John's wort and schizophrenia. CMAJ 2000;163:262-3. View abstract.

Lane-Brown MM. Photosensitivity associated with herbal preparations of St. John's wort (Hypericum perforatum). Med J Aust 2000;172:302. View abstract.

Lau WC, Carville DGM, Guyer KE, et al. St. John's Wort Enhances the Platelet Inhibitory Effect of Clopidogrel in Clopidogrel "Resistant" Healthy Volunteers. American College of Cardiology Annual Meeting, Orlando, FL 2005: Presentation 1043-129.

Lee A, Minhas R, Ito S, et al. Safety of St. John's wort during breastfeeding. Clin Pharmacol Ther 2000;67:130, abstract PII-64.

Lee, A., Minhas, R., Matsuda, N., Lam, M., and Ito, S. The safety of St. John's wort (Hypericum perforatum) during breastfeeding. J Clin Psychiatry 2003;64(8):966-968. View abstract.

Lei HP, Yu XY, Xie HT, et al. Effect of St. John's wort supplementation on the pharmacokinetics of bupropion in healthy male Chinese volunteers. Xenobiotica 2010;40(4):275-81. View abstract.

Linde K, Knuppel L. Large-scale observational studies of hypericum extracts in patients with depressive disorders - a systematic review. Phytomedicine 2005;12:148-57. View abstract.

Linde K, Mulrow CD, Berner M, Egger M. St John's Wort for depression. Cochrane Database Syst Rev 2005;(3):CD000448. View abstract.

Linde K, Mulrow CD. St. John's wort for depression. Cochrane Database Syst Rev 2000;(2):CD000448. View abstract.

Linde K, Ramirez G, Mulrow CD, et al. St. John's wort for depression: an overview and meta-analysis of randomized clinical trials. BMJ 1996;313:253-8. View abstract.

Liu YR, Liang YL, Huang RD, et al. Hypericum perforatum preparations L. preparations for menopause: a meta-analysis of efficacy and safety. Climacteric 2014;17:325-335. View abstract.

Logan JL, Ahmed J. Critical hypokalemic renal tubular acidosis due to Sjogren's syndrome: association with the purported immune stimulant echinacea. Clin Rheumatol 2003;22:158-9. View abstract.

Loughren MJ, Kharasch ED, Kelton-Rehkopf MC, Syrjala KL, Shen DD. Influence of St. John's wort on intravenous fentanyl pharmacokinetics, pharmacodynamics, and clinical effects: a randomized clinical trial. Anesthesiology 2020;132(3):491-503. View abstract.

Mai I, Bauer S, Krueger H, et al. Wechselwirkungen von Johaniskraut mit tacrolismus bei nierentransplantierten patienten. Symposium Phytopharmaka VII. Forschung und Klinische Anwendung, Berlin, October, 2001.

Mai I, Kruger H, Budde K, et al. Hazardous pharmacokinetic interaction of Saint John's wort (Hypericum perforatum) with the immunosuppressant cyclosporin. Int J Clin Pharmacol Ther 2000;38:500-2. View abstract.

Mai I, Stormer E, Bauer S, et al. Impact of St John's wort treatment on the pharmacokinetics of tacrolimus and mycophenolic acid in renal transplant patients. Nephrol Dial Transplant 2003;18:819-22.. View abstract.

Mandelbaum A, Pertzborn F, Martin-Facklam M, Wiesel M. Unexplained decrease of cyclosporin trough levels in a compliant renal transplant patient. Nephrol Dial Transplant 2000;15:1473-4. View abstract.

Mansouri P, Mirafzal S, Najafizadeh P, et al. The impact of topical Saint John's Wort (Hypericum perforatum) treatment on tissue tumor necrosis factor-alpha levels in plaque-type psoriasis: A pilot study. J Postgrad Med. 2017;63(4):215-20. View abstract.

Market C, Kastner IM, Hellwig, et al. The effect of induction of CYP3A4 by St. John's wort on ambrisentan plasma kinetics in volunteers of known CY2C19 genotype. Basic & Clinical Pharmacology & Toxicology 2015;116:423-428. View abstract.

Markowitz JS, DeVane CL, Boulton DW, et al. Effect of St. John's wort (Hypericum perforatum) on cytochrome P-450 2D6 and 3A4 activity in healthy volunteers. Life Sci 2000;66:PL 133-9. View abstract.

Markowitz JS, Donovan JL, DeVane CL, et al. Effect of St. John's wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. JAMA 2003;290:1500-4.. View abstract.

Martonfi P, Repcak M, Ciccarelli D, Garbari F. Hypericum perforatum L. - chemotype without rutin from Italy. Biochem Syst Ecol 2001;29:659-61. View abstract.

Mathijssen RH, Verweij J, de Bruijn P, et al. Effects of St. John's wort on irinotecan metabolism. J Natl Cancer Inst 2002;94:1247-9.. View abstract.

Mathijssen RHJ, Verweij J, De Bruijn P, et al. Modulation of irinotecan (CPT-11) metabolism by St. John's wort in cancer patients. American Association for Cancer Research Annual Meeting, San Francisco, April 2002. Abstract 2443.

Miller LG. Herbal Medicinals: Selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 1998;158:2200-11. View abstract.

Mirzaei MG, Sewell RDE, Kheiri S, Refieian-Kopaei M. A clinical trial of the effect of St. John's wort on migraine headaches in patients receiving sodium valproate. J Med Plants Res 2012;6(9):1519-23.

Moore LB, Goodwin B, Jones SA, et al. St. John's wort induces hepatic drug metabolism through activation of the pregnane X receptor. Proc Natl Acad Sci U S A 2000;97:7500-2. View abstract.

Morimoto T, Kotegawa T, Tsutsumi K, et al. Effect of St. John's wort on the pharmacokinetics of theophylline in healthy volunteers. J Clin Pharmacol 2004;44:95-101. View abstract.

Moschella C, Jaber BL. Interaction between cyclosporine and Hypericum perforatum (St. John's wort) after organ transplantation. Amer J Kidney Dis 2001;38:1105-7. View abstract.

Moses EL, Mallinger AG. St. John's wort: Three cases of possible mania induction. J Clin Psychopharmacol 2000;20:115-7. View abstract.

Muller WE, Singer A, Wonnemann M, et al. Hyperforin represents the neurotransmitter reuptake inhibiting constituent of hypericum extract. Pharmacopsychiatry 1998;31:16-21. View abstract.

Murch SJ, Simmons CB, Saxena PK. Melatonin in feverfew and other medicinal plants. Lancet 1997;350:1598-9. View abstract.

Murphy PA, Kern SE, Stanczyk FZ, Westhoff CL. Interaction of St. John's Wort with oral contraceptives: effects on the pharmacokinetics of norethindrone and ethinyl estradiol, ovarian activity and breakthrough bleeding. Contraception 2005;71:402-8. View abstract.

Nebel A, Schneider BJ, Baker RA, et al. Potential metabolic interaction between St. John's wort and theophylline. Ann Pharmacother 1999;33:502. View abstract.

Niederhofer H. St. John's wort may diminish methylphenidate's efficacy in treating patients suffering from attention deficit hyperactivity disorder. Med Hypotheses 2007;68:1189. View abstract.

Niederhofer H. St. John's wort may improve some symptoms of attention-deficit hyperactivity disorder. Nat Prod Res 2010;24(3):203-5. View abstract.

Nierenberg AA, Burt T, Matthews J, et al. Mania associated with St. John's wort. Biol Psychiatry 1999;46:1707-8. View abstract.

O'Breasail AM, Argouarch S. Hypomania and St John's wort. Can J Psychiatry 1998;43:746-7. View abstract.

Obach RS. Inhibition of human cytochrome P450 enzymes by constituents of St. John's wort, an herbal preparation used in the treatment of depression. J Pharmacol Exp Ther 2000;294:88-95. View abstract.

Ondrizek RR, Chan PJ, Patton WC, King A. An alternative medicine study of herbal effects on the penetration of zona-free hamster oocytes and the integrity of sperm deoxyribonucleic acid. Fertil Steril 1999;71:517-22. View abstract.

Ondrizek RR, Chan PJ, Patton WC, King A. Inhibition of human sperm motility by specific herbs used in alternative medicine. J Assist Reprod Genet 1999;16:87-91. View abstract.

Pakseresht S, Boustani H, Azemi ME, et al. Evaluation of pharmaceutical products of St. John's wort efficacy added on tricyclic antidepressants in treating major depressive disorder: a double blind randomized control trial. Jundishapur J Nat Pharm Prod 2012;7(3):106-10. View abstract.

Parker V, Wong AH, Boon HS, Seeman MV. Adverse reactions to St John's Wort. Can J Psychiatry 2001;46:77-9. View abstract.

Patel S, Robinson R, Burk M. Hypertensive crisis associated with St. John's Wort. Am J Med 2002;112:507-8. View abstract.

Patel, J., Buddha, B., Dey, S., Pal, D., and Mitra, A. K. In vitro interaction of the HIV protease inhibitor ritonavir with herbal constituents: changes in P-gp and CYP3A4 activity. Am.J.Ther. 2004;11(4):262-277. View abstract.

Peirce A. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York, NY: William Morrow and Co., 1999.

Peltoniemi MA, Saari TI, Hagelberg NM, et al. St John's wort greatly decreases the plasma concentrations of oral S-ketamine. Fundam Clin Pharmacol 2012;26(6):743-50. View abstract.

Pfrunder A, Schiesser M, Gerber S, et al. Interaction of St John's wort with low-dose oral contraceptive therapy: a randomized controlled trial. Br J Clin Pharmacol 2003;56:683-90. View abstract.

Philipp M, Kohnen R, Hiller KO. Hypericum extract versus imipramine or placebo in patients with moderate depression: randomized multicentre study of treatment for eight weeks. BMJ 1999;319:1534-9. View abstract.

Piscitelli SC, Burstein AH, Chaitt D, et al. Indinavir concentrations and St John's wort. Lancet 2000;355:547-8. View abstract.

Pochet S, Lechon AS, Lescrainier C, et al. Herb-anticancer drug interactions in real life based on VigiBase, the WHO global database. Sci Rep 2022;12(1):14178. View abstract.

Qaseem A, Barry MJ, Kansagara D, et al. Nonpharmacologic versus pharmacologic treatment of adult patients with major depressive disorder: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;164(5):350-9. View abstract.

Raak C, Büssing A, Gassmann G, et al. A systematic review and meta-analysis on the use of Hypericum perforatum (St. John's wort) for pain conditions in dental practice. Homeopathy 2012;101(4):204-10. View abstract.

Rayburn WF, Gonzalez CL, Christensen HD, Stewart JD. Effect of prenatally administered hypericum (St John's wort) on growth and physical maturation of mouse offspring. Am J Obstet Gynecol 2001;184:191-5. View abstract.

Rey JM, Walter G. Hypericum perforatum (St. John's wort) in depression: pest or blessing? Med J Aust 1998;169:583-6. View abstract.

Richter O. Several countries issue restrictions on St. John's wort. Richter's HerbLetter 7/30/00. Available at: www.richters.com (Accessed 01 March 2002).

Roberts JE, Wang RH, Tan IP, et al. Hypericin (active ingredient in St. John's wort) photo-oxidation of lens proteins. Photochem Photobiol 1999;69:42S.

Roby CA, Anderson GD, Kantor E, et al. St. John's wort: Effect on CYP3A4 activity. Clin Pharmacol Ther 2000;67:451-7. View abstract.

Ruschitzka F, Meier PJ, Turina M, et al. Acute heart transplant rejection due to Saint John's wort. Lancet 2000;355:548-9. View abstract.

Saito YA, Rey E, Almazar-Elder AE, et al. A randomized, double-blind, placebo-controlled trial of St. John's wort for treating irritable bowel syndrome. Am J Gastroenterol 2010;105:170-7. View abstract.

Samadi S, Khadivzadeh T, Emami A, et al. The effect of Hypericum perforatum on the wound healing and scar of cesarean. J Altern Complement Med 2010;16:113-7. View abstract.

Sarris J, Ravindran A, Yatham LN, et al. Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce. World J Biol Psychiatry. 2022;23(6):424-455. View abstract.

Schäfer W, Wentzell N, Schink T, Haug U. Characterization of pregnancies exposed to St. John's wort and their outcomes: A claims data analysis. Reprod Toxicol. 2021 Jun;102:90-97. View abstract.

Schempp C, Pelz K, Wittmer A, et al. Antibacterial activity of hyperforin from St. John's wort, against multiresistant Stapylococcus aureus and gram-positive bacteria. Lancet 1999;353:2129. View abstract.

Schempp CM, Kirkin V, Simon-Haarhaus B, et al. Inhibition of tumour cell growth by hyperforin, a novel anticancer drug from St. John's wort that acts by induction of apoptosis. Oncogene 2002;21:1242-50.. View abstract.

Schempp CM, Ludtke R, Winghofer B, Simon JC. Effect of topical application of hypericum perforatum extract on skin sensitivity to solar simulated radiation. Photodermatol Photoimmunol Photomed 2000;16:125-8. View abstract.

Schempp CM, Muller K, Winghofer B, et al. Single-dose and steady-state administration of Hypericum perfotatum extract (St. John's wort) does not influence skin sensitivity to UV radiation, visible light, and solar-stimulated radiation. Arch Dermatol 2001;137:512-3. View abstract.

Schempp CM, Winghofer B, Langheinrich M, et al. Hypericin levels in human serum and interstitial skin blister fluid after oral single-dose and steady state administration of Hypericum perforatum extract (St. John's Wort). Skin Pharmacol Appl Skin Physiol 1999;12:299-304. View abstract.

Schempp CM, Winghofer B, Ludtke R, et al. Topical application of St. John's wort (Hypericum perforatum L.) and its metabolite hyperforin inhibits the allostimulatory capacity of epidermal cells. Br J Dermatol 2000;142:979-84. View abstract.

Schneck C. St. John's wort and hypomania. J Clin Psychiatry 1998;59:689. View abstract.

Scholz I, Liakoni E, Hammann F, et al. Effects of Hypericum perforatum (St. John's wort) on the pharmacokinetics and pharmacodynamics of rivaroxaban in humans. Br J Clin Pharmacol. 2020. doi: 10.1111/bcp.14553. View abstract.

Schrader E. Equivalence of St. John's wort extract (Ze 117) and fluoxetine: a randomized, controlled study in mild-moderate depression. Int Clin Psychopharmacol 2000;15:61-8. View abstract.

Schule C, Baghai T, Ferrera A, Laakmann G. Neuroendocrine effects of Hypericum extract WS 5570 in 12 healthy male volunteers. Pharmacopsychiatry 2001;34:S127-33. View abstract.

Schulz V. Incidence and clinical relevance of the interactions and side effects of Hypericum preparations. Phytomedicine 2001;8:152-60. View abstract.

Schwarz UI, Buschel B, Kirch W. Unwanted pregnancy on self-medication with St John's wort despite hormonal contraception. Br J Clin Pharmacol 2003;55:112-3. View abstract.

Shan MD, Hu LH, Chen ZL. Three new hyperforin Analogues from Hypericum perforatum. J Nat Prod 2001;664:127-30. View abstract.

Shelton RC, Keller MB, Gelenberg A, et al. Effectiveness of St. John's wort in major depression: A randomized, placebo-controlled trial. JAMA 2001;285:1978-86. View abstract.

Shelton RC. St John's Wort for the treatment of depression. Lancet Neurol 2002;1:275. View abstract.

Shimizu K, Nakamura M, Isse K, Nathan PJ. First-episode psychosis after taking an extract of Hypericum perforatum (St John's Wort). Hum Psychopharmacol 2004;19:275-6. View abstract.

Siepmann M, Krause S, Joraschky P, et al. The effects of St John's wort extract on heart rate variability, cognitive function and quantitative EEG: a comparison with amitriptyline and placebo in healthy men. Br J Clin Pharmacol 2002;54:277-82. View abstract.

Sindrup SH, Madsen C, Bach FW, et al. St. John's wort has no effect on pain in polyneuropathy. Pain 2000;91:361-5. View abstract.

Singer A, Wonnemann M, Muller WE. Hyperforin, a major antidepressant constituent of St. John's wort, inhibits serotonin uptake by elevating free intracellular Na+1. J Pharmacol Exp Ther 1999;290:1363-8.. View abstract.

Singhal AB, Caviness VS, Begleiter AF, et al. Cerebral vasoconstriction and stroke after use of serotonergic drugs. Neurology 2002;58:130-3. View abstract.

Smith M, Lin KM, and Zheng YP. PIII-89 an open trial of nifedipine-herb interactions: Nifedipine with St. John's wort, ginseng or ginkgo biloba. Clin Pharm Ther 2001;69:P86.

Soleymani S, Bahramsoltani R, Rahimi R, Abdollahi M. Clinical risks of St John's Wort (Hypericum perforatum) co-administration. Expert Opin Drug Metab Toxicol. 2017;13(10):1047-62. View abstract.

Sönmez DZ, Tasci S. The Effect of St. John's Wort Oil (Hypericum Perforatum L.) in Knee Osteoarthritis: A Randomized Controlled and Qualitative Study. Pain Manag Nurs 2024. View abstract.

Southwell IA, Bourke CA. Seasonal variation in hypericin content of Hypericum perforatum L. (St. John's Wort). Phytochemistry 2001;56:437-41. View abstract.

Spinella M, Eaton LA. Hypomania induced by herbal and pharmaceutical psychotropic medicines following mild traumatic brain injury. Brain Inj 2002;16:359-67. View abstract.

Stevinson C, Ernst E. A pilot study of Hypericum perforatum for the treatment of premenstrual syndrome. BJOG 2000;107:870-6. View abstract.

Sugimoto K, Ohmori M, Tsuruoka S, et al. Different effects of St John's wort on the pharmacokinetics of simvastatin and pravastatin. Clin Pharmacol Ther 2001;70:518-24.. View abstract.

Sultana D, Peindl KS, Wisner KL. Rash associated with St. John's wort treatment in premenstrual dysphoric disorder. Arch Women Ment Health 2000;3:99-101.

Szegedi A, Kohnen R, Dienel A, Kieser M. Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John's wort): randomised controlled double blind non-inferiority trial versus paroxetine. BMJ 2005;330:503. View abstract.

Taylor LH, Kobak KA. An open-label trial of St. John's wort (Hypericum perforatum) in obsessive-compulsive disorder. J Clin Psychiatry 2000;61:575-8. View abstract.

Trana C, Toth G, Wijns W, Barbato E. St. John's Wort in patients non-responders to clopidogrel undergoing percutaneous coronary intervention: a single-center randomized open-label trial (St. John's Trial). J Cardiovasc Transl Res 2013;6(3):411-4. View abstract.

Uebelhack R, Blohmer JU, Graubaum HJ, et al. Black cohosh and St. John's wort for climacteric complaints: a randomized trial. Obstet Gynecol 2006;107(2 Pt 1):247-55. View abstract.

Upton R, ed. St. John's wort, Hypericum perforatum: Quality control, analytical and therapeutic monograph. Santa Cruz, CA: American Herbal Pharmacopoeia 1997;1-32.

Volz HP, Murck H, Kasper S, Moller HJ. St John's wort extract (LI 160) in somatoform disorders: results of a placebo-controlled trial. Psychopharmacology (Berl) 2002;164:294-300. View abstract.

Volz HP. Controlled clinical trials of hypericum extracts in depressed patients - an overview. Pharmacopsychiatry 1997;30 Suppl 2:72-6. View abstract.

Vorbach EU, Arnoldt KH, Hubner WD. Efficacy and tolerability of St. John's wort extract LI 160 versus imipramine in patients with severe depressive episodes according to ICD- 10. Pharmacopsychiatry 1997;30:81-5. View abstract.

Vormfelde SV, Poser W. Hyperforin in extracts of St. John's wort (Hypericum perforatum) for depression [letter]. Arch Intern Med 2000;160:2548-9. View abstract.

Wang LS, Zhu B, Abd El-Aty A, et al. The influence of St. John's wort on CYP2C19 activity with respect to genotype. J Clin Pharmacol 2004;44:577-81. View abstract.

Wang Z, Gorski JC, Hamman MA, et al. The effects of St. John's wort (Hyericum perforatum) on human cytochrome P450 activity. Clin Pharmacol Ther 2001;70:317-26. View abstract.

Wang Z, Hamman MA, Huang SM, et al. Effect of St. John's wort on the pharmacokinetics of fexofenadine. Clin Pharmacol Ther 2002;71:414-20.. View abstract.

Wang, L. S., Zhou, G., Zhu, B., Wu, J., Wang, J. G., Abd El-Aty, A. M., Li, T., Liu, J., Yang, T. L., Wang, D., Zhong, X. Y., and Zhou, H. H. St John's wort induces both cytochrome P450 3A4-catalyzed sulfoxidation and 2C19-dependent hydroxylation of omeprazole. Clin Pharmacol.Ther. 2004;75(3):191-197. View abstract.

Weber W, Vander Stoep A, McCarty RL, et al. Hypericum perforatum (St John's wort) for attention-deficit/hyperactivity disorder in children and adolescents: a randomized controlled trial. JAMA 2008;299:2633-41. View abstract.

Wentworth JM, Agostini M, Love J, et al. St. John's wort, a herbal antidepressant, activates the steroid X receptor. J Endocrinol 2000;166:R11-6. View abstract.

Wheatley D. Hypericum in seasonal affective disorder (SAD). Curr Med Res Opin 1999;15:33-7. View abstract.

Wheatley D. LI 160, an extract of St. John's wort, versus amitriptyline in mildly to moderately depressed outpatients - a controlled 6-week clinical trial. Pharmacopsychiatry 1997;30:77-80. View abstract.

Whiskey E, Werneke U, Taylor D. A systematic review and meta-analysis of Hypericum perforatum in depression: a comprehensive clinical review. Int Clin Psychopharmacol 2001;16:239-52. View abstract.

Wilhelm KP, Biel S, Siegers CP. Role of flavonoids in controlling the phototoxicity of Hypericum perforatum extracts. Phytomedicine 2001;8:306-9. View abstract.

Williams JW, Mulrow CD, Chiquette E, et al. A systematic review of newer pharmacotherapies for depression in adults: Evidence report summary. Ann Intern Med 2000;132:743-56. View abstract.

Woelk H. Comparison of St. John's wort and imipramine for treating depression: randomized controlled trial. BMJ 2000;321:536-9. View abstract.

Xu, H., Williams, K. M., Liauw, W. S., Murray, M., Day, R. O., and McLachlan, A. J. Effects of St John's wort and CYP2C9 genotype on the pharmacokinetics and pharmacodynamics of gliclazide. Br.J.Pharmacol. 2008;153(7):1579-1586. View abstract.

Yechiam E, Ben-Eliezer D, Ashby NJS, Bar-Shaked M. The acute effect of Hypericum perforatum on short-term memory in healthy adults. Psychopharmacology (Berl). 2019;236(2):613-623. View abstract.

Yildirim O, Canan F. A case of panic attack induced by St John's wort. Prim Care Companion CNS Disord 2013;15(1). pii: PCC.12l01453. View abstract.

Yücel A, Kan Y, Yesilada E, Akin O. Effect of St. John's wort (hypericum perforatum) oily extract for the case and treatment of pressure sores; a case report. J Ethnopharmacology 2017;196:236-241. View abstract.

Yue QY, Bergquist C, Gerden B. Safety of St. John's wort (Hypericum perforatum). Lancet 2000;355:576-7. View abstract.

Yuksekdag S. The efficacy of St John's wort oil macerates on intractable skin lesions of patients with idiopathic granulomatous mastitis: preliminary results. J Wound Care 2022;31(11):1006-1010. View abstract.

Lifestyle Changes To Help Bipolar Depression

Treatment-Resistant Depression

Maintenance Medications for Depression

How Different Antidepressants Work

CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

This copyrighted material is licensed from Therapeutic Research Center, LLC. Information from this source is evidence-based and objective, and without commercial influence. For professional medical information on natural medicines, see Natural Medicines Comprehensive Database Professional Version.
Licensed from Therapeutic Research Center, LLC
Copyright © 1995-2024 by Therapeutic Research Center, LLC. All Rights Reserved.

ST. JOHN'S WORT - Uses, Side Effects, and More

Overview

Uses & Effectiveness ?

Likely Effective for

Possibly Effective for

Possibly Ineffective for

Side Effects

Special Precautions and Warnings

Interactions ?

Major Interaction

Alprazolam (Xanax) interacts with ST. JOHN'S WORT

Birth control pills (Contraceptive drugs) interacts with ST. JOHN'S WORT

Cyclosporine (Neoral, Sandimmune) interacts with ST. JOHN'S WORT

Digoxin (Lanoxin) interacts with ST. JOHN'S WORT

Imatinib (Gleevec) interacts with ST. JOHN'S WORT

Irinotecan (Camptosar) interacts with ST. JOHN'S WORT

Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates) interacts with ST. JOHN'S WORT

Medications for HIV/AIDS (Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)) interacts with ST. JOHN'S WORT

Medications for HIV/AIDS (Protease Inhibitors) interacts with ST. JOHN'S WORT

Medications moved by pumps in cells (P-Glycoprotein Substrates) interacts with ST. JOHN'S WORT

Phenobarbital (Luminal) interacts with ST. JOHN'S WORT

Phenprocoumon (Marcoumar, others) interacts with ST. JOHN'S WORT

Phenytoin (Dilantin) interacts with ST. JOHN'S WORT

Rivaroxaban (Xarelto) interacts with ST. JOHN'S WORT

Tacrolimus (Prograf) interacts with ST. JOHN'S WORT

Warfarin (Coumadin) interacts with ST. JOHN'S WORT

Mephenytoin (Mesantoin) interacts with ST. JOHN'S WORT

Omeprazole (Prilosec) interacts with ST. JOHN'S WORT

Docetaxel (Taxotere) interacts with ST. JOHN'S WORT

Ketamine (Ketalar) interacts with ST. JOHN'S WORT

Oxycodone (Oxycontin) interacts with ST. JOHN'S WORT

Moderate Interaction

Aminolevulinic acid interacts with ST. JOHN'S WORT

Clopidogrel (Plavix) interacts with ST. JOHN'S WORT

Fexofenadine (Allegra) interacts with ST. JOHN'S WORT

Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates) interacts with ST. JOHN'S WORT

Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates) interacts with ST. JOHN'S WORT

Medications that increase sensitivity to sunlight (Photosensitizing drugs) interacts with ST. JOHN'S WORT

Procainamide interacts with ST. JOHN'S WORT

Reserpine (Raudixin, others) interacts with ST. JOHN'S WORT

Tramadol (Ultram) interacts with ST. JOHN'S WORT

Medications changed by the liver (Cytochrome P450 2C19 (CYP2C19) substrates) interacts with ST. JOHN'S WORT

Gliclazide (Diamicron, others) interacts with ST. JOHN'S WORT

Methadone (Dolophine) interacts with ST. JOHN'S WORT

Zolpidem (Ambien) interacts with ST. JOHN'S WORT

Bupropion (Wellbutrin) interacts with ST. JOHN'S WORT

Medications changed by the liver (Cytochrome P450 2B6 (CYP2B6) substrates) interacts with ST. JOHN'S WORT

Voriconazole (Vfend) interacts with ST. JOHN'S WORT

Fentanyl interacts with ST. JOHN'S WORT

Finasteride (Proscar, Propecia) interacts with ST. JOHN'S WORT

Ivabradine (Corlanor) interacts with ST. JOHN'S WORT

Medications used for lowering cholesterol (Statins) interacts with ST. JOHN'S WORT

Clozapine (Clozaril) interacts with ST. JOHN'S WORT

Indinavir (Crixivan) interacts with ST. JOHN'S WORT

Serotonergic drugs interacts with ST. JOHN'S WORT

Minor Interaction

Methylphenidate (Concerta, others) interacts with ST. JOHN'S WORT

Theophylline interacts with ST. JOHN'S WORT

Ambrisentan (Letairis) interacts with ST. JOHN'S WORT

Boceprevir (Victrelis) interacts with ST. JOHN'S WORT

Dosing

You Might Also Like