Botanical Index No. 977

St. John’s-wort

hypericum perforatum

Medicinal Actions

Analgesic, Anticancer, Antibacterial, Antidepressant, Antidote, Antiedemic, Antiherpetic, Antiinflammatory, Antineuralgic, Antiretroviral, Antiseptic, Antispasmodic, Antiulcerogenic, Antiviral, Anxiolytic, Astringent, COMT Inhibitor, Cholagogue, Digestive, Diuretic, Dopaminergic, Emmenagogue, Expectorant, GABA-Reuptake Inhibitor, Hypotensive, Immunostimulant, Melatoninergic, Psychotropic, Sedative, Serotoninergic, Stimulant, Tonic, Uterotonic, Climacteric, Antidepressant activity

Primary Conditions Treated

Aperitif Hemostat MAOI Nervine Resolvent SSRI Tranquilizer Vasoconstrictor Vermifuge Vulnerary Adenopathy Alcoholism Alopecia Anorexia Anuria Anxiety Apoplexy Asthma Bacteria Bite Bladder Stone Bleeding Bronchosis Bruise Bunion Burn Calcification Cancer breast lymph ovary stomach uterus Cardiopathy Catarrh Cerebrosis Chickenpox Childbirth Cholecystosis Cold Cold Sore Concussion Congestion Crohn’s Disease Cough Coxalgia Cramp Cut Cyanosis Cystosis Cytomegalovirus Depression Dermatosis Diarrhea Duodenosis Dysentery Dysmenorrhea Dyspepsia Dysuria Eczema Endometriosis Enterosis Enuresis Epilepsy Epistaxis Fever Fibrososis Flu Gas Gastroduodenosis Gastrosis Gout Headache Hematuria Hemoptysis Hemorrhagia Hemorrhoid Hepatosis Herpes High Blood Pressure HIV Hydrophobia Hysteria Immunodepression Impotence Induration Infection Inflammation Insomnia Jaundice Lumbago Lymphosis Mania Mastosis Melancholy Menopause Menorrhagia Migraine Myalgia Neck Nephrosis Nerve Nervousness Neuralgia Neurasthenia Neurofibromatosis Neurosis Noctambulism OCD Oliguria Otosis Oxyurid Pain Paralysis Parasite Pertussis Phthisis Pulmonosis Rabies Radiation Rheumatism SAD Sciatica Shingles Snakebite Sore Sore Throat Spine Sprain Staphylococcus Sterility Stomatosis Strain Streptococcus Stress Sunburn Swelling Tetanus Tonsilosis Tuberculosis Ulcer Ulcus cruris Uterosis VD Viral Hepatitis Virus Vitiligo Water Retention Worm Wound Enhance mouse immune system against Bordetella pertussis and Staphylococcus aureus Most effective against S. aureus Active against Escherichia Shigella and Staphylococcus Inhibit the flu virus Tranquilizing

General Dosage

2–4 g dry herb/day; 2–5 g dry herb/day; 2–4 ml liquid herb extract; 2–4 g dry shoot, or in tea, 3 ×/day; 1–2 tsp/day; 2–5 g dry herb/day; 2–4 ml liquid herb extract; 2–4 g dry shoot, or in tea, 3 ×/day; 1–2 tsp/cup water 1–2 ×/day for 4–6 wk; 2–4 ml liquid flowering tops extract 3 ×/day; 2–4 ml flowering tops tincture 3 ×/day; 1–2 ml flowering tops tincture 3 ×/day; 1–2.7 mg/day hypericum; 0.2–1.0 mg total hypericin; 500 mg StX; 1 capsule 3 ×/day with a large glass of water. consistent with doses of 900 mg extract in humans. LD50 = >5000 mg/kg. ivn injections of 30–40 mg hypericin.

Safety & Contraindications

Class 2d. May potentiate MAOIs. Active ingredients may be photoactive, especially in fair-skinned people. Reichert takes it even more seriously: Although hypericum is not as strong as synthetic MAOIs, patients should still avoid the things usually avoided: high tyramine foods, alcoholic beverages, amphetamines, cold and hay fever remedies, narcotics, tryptophan, and tyrosine. Do not take during pregnancy or intense sun exposure. Commission E reports adverse effect of photosensitivity. Other sources report flowering top permitted for external use only; not to be used before exposure to sunlight. Foster is moderate, suggesting that St. John’s-Wort should not be mixed with synthetic antidepressants. Because it may inhibit MAO, taking it with SSRIs, such as Prozac, could cause serious health damage. Although side effects have not been reported in clinical studies, range animals eating the plant and then standing in bright sunlight have experienced sunburn or blindness from photosensitization. This treatment option should be discussed with your health care provider. The Herbal PDR state that photodermatosis in animals usually kicks in after high doses, such as 3000 mg per kg body weight. CAN cautions that hypericin is phototoxic. “Mice given 0.2–0.5 mg of the herb were found to develop severe photodynamic effects. Delayed hypersensitivity or photodermatosis has been documented for St. John’s-wort, following the ingestion of a herbal tea made from the leaves”. ESCOP recommends a limited daily intake of 1 mg total hypericin. Because of slight uterine activity in vitro, its use in pregnancy and lactation is to be avoided. No contraindications or drug-drug interactions reported. A recent Internet message cautions about the potential for serotonin syndrome. Symptoms include chills, confusion, fever, myoclonus, hyperactive reflexes, myoclonus, speech difficulties, and sweating. Cannot be mixed with an SSRI. That is likely to produce serotonin syndrome—severe headache, tachycardia, and diaphoresis—which resembles neuroleptic malignant syndrome. Recently found to detoxify all the same drugs that grapefruit potentiates. It induces cytochrome P3A4 450, which speeds up metabolism of several drugs. Nierenberg et al., 1999 kindly remind us that, like synthetic antidepressants, this herbal antidepressant may rarely induce hypomania in manic patients. Poorly designed Loma Linda studies suggest that hypericum may interfere with fertility. But this was based on soaking “skinned human sperm” for 24 hours in hypericum tea as I recall. Phototoxic reactions occur in some patients with AIDS given ivn injections of 30–40 mg hypericin. “Not suitable for use as daily sedatives of sleep aids. Preparations are no more effective than synthetic antidepressants,” but they are extremely well tolerated by the patients. In observational studies or >3000 cases, there is ca. a 3% incidence of minor side effects, cf 10–25% with modern nontricyclic antidepressants.

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