St John’s Wort ( Hypericum perforatum ) - Blackmores · PDF fileSt John’s Wort (...
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St John’s Wort ( Hypericum perforatum ) | Practice points| St John’s wort (SJW) is a popular treatment for mild-moderate depression and appears to be as effective as standard antidepressants with fewer side effects. There is also some evidence for SJW in juvenile depression and menopausal hot flushes. Fair skinned people taking SJW should take extra precautions in the sun. Interactions are possible with some medicines. | Key indications | Depression: A number of systematic reviews and meta-analyses have reported that St John’s wort is as effective as standard antidepressants for the treatment of mild-moderate depression, with fewer side effects 1-3 There is also some evidence that certain extracts may also be useful in moderate-severe depression and for prophylaxis after recovery from an acute episode. 4 Juvenile depression: SJW has been tested in children aged 6 years and over with depression. Although there were some promising preliminary results controlled studies are required to confirm benefits. 5 Menopause: A systematic review and meta-analysis reported potential benefits for menopausal symptoms including hot flushes. 6 | Key actions 7 | Antidepressant Anxiolytic Neuroprotective Antimicrobial | Recommended Doses | Extracts vary in the concentration of various active compounds (e.g. hypericin and hyperforin) so results cannot necessarily be extrapolated from one standardised preparation to another. 8 Extracts and dosage regimens vary from trial to trial but typical doses of extract include: Depression: 500 to 1200 mg daily 2 Juvenile depression: 150-300 mg three times daily 5 Menopause: 900 mg three times daily 6 | Adverse Effects 7 | Adverse effects are infrequent and generally mild. They may include gastrointestinal symptoms and sensitivity to light. Photosensitivity may occur in high doses but this is rare. | Cautions/ Contraindications 7 | Fair skinned people taking SJW with a high hypericin content should be advised to take extra precautions in the sun. Although studies investigating use in pregnancy and lactation have not revealed significant effects, SJW is generally not recommended in pregnancy and use in lactation may cause infant colic, drowsiness or lethargy. | Possible Interactions | CYP450 enzyme substrates (2C19, 3A4): May increase activity of enzyme systems and thereby decrease blood levels of substrates. Studies with oral contraceptives, warfarin, protease inhibitors, reverse transcriptase inhibitors, simvastatin, atorvastatin, verapamil, irinotecan, imatinib, methadone, cyclosporin, tacrolimus, fexofenadine, nifedipine, midazolam, omeprazole and voriconazole. Digoxin: may decrease blood levels and drug effect P-gp substrates: May decrease blood levels and drug effect Prescription antidepressants: may cause serotonergic syndrome with SSRIs; may decrease blood levels of TCAs REFERENCES 1. Ernst E. Review: St John’s wort superior to placebo and similar to antidepressants for major depression but with fewer side effects. Evid Based Ment Health 2009;12(3):78. 2. Linde K, Berner MM, Kriston L. St John’s wort for major depression. Cochrane database of systematic reviews 2008(4):CD000448. 3. Linde K, Kriston L, Rucker G, et al. Efficacy and acceptability of pharmacological treatments for depressive disorders in primary care: systematic review and network meta-analysis. Annals of family medicine 2015;13(1):69-79. 4. Gastpar M. Hypericum extract WS (R) 5570 for depression- -an overview. International journal of psychiatry in clinical practice 2013;17 Suppl 1:1-7. 5. Findling RL, McNamara NK, O’Riordan MA, et al. An open-label pilot study of St. John’s wort in juvenile depression. Journal of the American Academy of Child and Adolescent Psychiatry 2003;42(8):908-14. 6. Liu YR, Jiang YL, Huang RQ, et al. Hypericum perforatum L. preparations for menopause: a meta-analysis of efficacy and safety. Climacteric : the journal of the International Menopause Society 2014;17(4):325-35. 7. Braun L, Cohen M. St John’s Wort. Herbs & natural supplements: an evidence based guide.[Vol. 2]. 4th ed. Australia: Elsevier; 2015. p.933-51. 8. Kasper S, Caraci F, Forti B, et al. Efficacy and tolerability of Hypericum extract for the treatment of mild to moderate depression. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology 2010;20(11):747-65. Contact [email protected] Healthcare Professional Advisory Service 1800 151 493 Website blackmoresinstitute.org
Transcript of St John’s Wort ( Hypericum perforatum ) - Blackmores · PDF fileSt John’s Wort (...
St John’s Wort ( Hypericum perforatum )
| Practice points|
St John’s wort (SJW) is a popular treatment for mild-moderate depression and appears to be as effective as standard antidepressants with fewer side effects.There is also some evidence for SJW in juvenile depression and menopausal hot fl ushes.Fair skinned people taking SJW should take extra precautions in the sun.Interactions are possible with some medicines.
| Key indications |
Depression: A number of systematic reviews and meta-analyses have reported that St John’s wort is as effective as standard antidepressants for the treatment of mild-moderate depression, with fewer side effects1-3 There is also some evidence that certain extracts may also be useful in moderate-severe depression and for prophylaxis after recovery from an acute episode.4
Juvenile depression: SJW has been tested in children aged 6 years and over with depression. Although there were some promising preliminary results controlled studies are required to confi rm benefi ts.5
Menopause: A systematic review and meta-analysis reported potential benefi ts for menopausal symptoms including hot fl ushes.6
| Key actions7 |AntidepressantAnxiolyticNeuroprotectiveAntimicrobial
| Recommended Doses |Extracts vary in the concentration of various active compounds (e.g. hypericin and hyperforin) so results cannot necessarily be extrapolated from one standardised preparation to another.8 Extracts and dosage regimens vary from trial to trial but typical doses of extract include:
Depression: 500 to 1200 mg daily2
Juvenile depression: 150-300 mg three times daily5
Menopause: 900 mg three times daily6
| Adverse Effects7 |Adverse effects are infrequent and generally mild.They may include gastrointestinal symptoms and sensitivity to light.Photosensitivity may occur in high doses but this is rare.
| Cautions/ Contraindications7 |Fair skinned people taking SJW with a high hypericin content should be advised to take extra precautions in the sun.Although studies investigating use in pregnancy and lactation have not revealed signifi cant effects, SJW is generally not recommended in pregnancy and use in lactation may cause infant colic, drowsiness or lethargy.
| Possible Interactions |CYP450 enzyme substrates (2C19, 3A4): May increase activity of enzyme systems and thereby decrease blood levels of substrates. Studies with oral contraceptives, warfarin, protease inhibitors, reverse transcriptase inhibitors, simvastatin, atorvastatin, verapamil, irinotecan, imatinib, methadone, cyclosporin, tacrolimus, fexofenadine, nifedipine, midazolam, omeprazole and voriconazole.
Digoxin: may decrease blood levels and drug effect
P-gp substrates: May decrease blood levels anddrug effect
Prescription antidepressants: may cause serotonergic syndrome with SSRIs; may decrease blood levels of TCAs
REFERENCES 1. Ernst E. Review: St John’s wort superior to placebo and similar to antidepressants for major depression but with fewer side effects. Evid Based Ment Health 2009;12(3):78. 2. Linde K, Berner MM, Kriston L. St John’s wort for major depression. Cochrane database of systematic reviews 2008(4):CD000448. 3. Linde K, Kriston L, Rucker G, et al. Effi cacy and acceptability of pharmacological treatments for depressive disorders in primary care: systematic review and network meta-analysis. Annals of family medicine 2015;13(1):69-79. 4. Gastpar M. Hypericum extract WS (R) 5570 for depression--an overview. International journal of psychiatry in clinical practice 2013;17 Suppl 1:1-7. 5. Findling RL, McNamara NK, O’Riordan MA, et al. An open-label pilot study of St. John’s wort in juvenile depression. Journal of the American Academy of Child and Adolescent Psychiatry 2003;42(8):908-14. 6. Liu YR, Jiang YL, Huang RQ, et al. Hypericum perforatum L. preparations for menopause: a meta-analysis of effi cacy and safety. Climacteric : the journal of the International Menopause Society 2014;17(4):325-35. 7. Braun L, Cohen M. St John’s Wort. Herbs & natural supplements: an evidence based guide.[Vol. 2]. 4th ed. Australia: Elsevier; 2015. p.933-51. 8. Kasper S, Caraci F, Forti B, et al. Effi cacy and tolerability of Hypericum extract for the treatment of mild to moderate depression. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology 2010;20(11):747-65.
Contact [email protected] Healthcare Professional Advisory Service 1800 151 493 Website blackmoresinstitute.org
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