St. John's Wort
Information about St. John's Wort
St. John’s wort is a popular herbal medication and extract derived from the plant Hypericum perforatum which is purported to be beneficial in depression and anxiety.
Liver safety of St. John's Wort
St. John’s wort has not been implicated convincingly in cases of clinically apparent, acute liver injury, although it may increase the hepatotoxicity of other agents by herb-drug interactions that alter drug metabolism.
Mechanism of action of St. John's Wort
St. John’s wort is an extract prepared from the flowers and leaves of a flowering plant native to Europe commonly known as St. John’s wort, Tipton’s weed or chase-devil (Hypericum perforatum). St. John’s wort is a yellow flowering perennial herb indigenous to Europe that has been introduced elsewhere. Its name refers to the Saint’s day on which it is typically harvested – June 24th. The genus name Hypericum means “above the picture” in reference to its use to ward off evil by hanging the plant over a religious picture or icon. St. John’s wort is an invasive weed in many countries where it has been introduced, where it can be toxic to livestock. St. John’s wort has been used widely as an herbal treatment for depression. It is available as an over-the-counter herbal in the United States, but in other countries is actively prescribed for mild-to-moderate depression. Extracts of St. John’s wort contain many polyphenols, including flavonoids (rutin, hyperoside, isoquercetin, quercitrin, quercetin and others), phenolic acids, naphthodianthrones (hypericin, pseudohypericin, protohypericin and others), and phloroglucinols (hyperforin, adhyperforin). The active principle responsible for the antidepressant effects of St. John’s wort is not known, the most likely candidates being hypericin, pseudohypericin and hyperforin. In controlled trials, St. John’s wort has shown evidence of an antidepressant effect in patients with mild to moderate depression. Side effects can occur with St. John’s wort including gastrointestinal upset, dizziness, confusion, fatigue, anxiety and photosensitivity. Importantly, St. John’s wort has effects on the cytochrome P450 system (induction of CYP 3A4 and 2C9) as well as the major drug transport protein – P-glycoprotein. As a result, St. John’s wort has major drug interactions, particularly with birth control pills, transplant rejection agents, antiretroviral agents, digoxin, platelet inhibitors, anticoagulants and psychotropic agents. Caution should be taken and specific interactions sought when using St. John’s wort with other medications.
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