(Hypericum perforatum) - ORAL

J. Iverson Riddle Developmental Center
Patient Education Monograph
IMPORTANT NOTE: THE FOLLOWING INFORMATION IS INTENDED TO SUPPLEMENT, NOT SUBSTITUTE FOR, THE
EXPERTISE AND JUDGEMENT OF YOUR PHYSICIAN, PHARMACIST OR OTHER HEALTHCARE PROFESSIONAL. IT
SHOULD NOT BE CONSTRUED TO INDICATE THAT USE OF THE DRUG IS SAFE, APPROPRIATE, OR EFFECTIVE FOR
YOU. CONSULT YOUR HEALTHCARE PROFESSIONAL BEFORE USING THIS DRUG.
ST. JOHN’S WORT (Hypericum perforatum) - ORAL
USES: St. John’s wort has been used for depression.
• Some herbal/dietary supplement products have been found to contain possibly harmful impurities/additives.
Check with your pharmacist for more details about the brand you use.
• The FDA has not reviewed this product for safety or effectiveness. Consult your doctor or pharmacist
for more details.
HOW TO USE: Take this product by mouth as directed. Follow all directions on the product package. If you are
uncertain about any of the information, consult your doctor or pharmacist. Do not take more than the recommended
amount. It may take about 3 weeks of regular use before you notice the benefits of this product.
• Do not suddenly stop taking this product. Some conditions may become worse when this product is
abruptly stopped. You may need to gradually reduce your dose. Consult your doctor or pharmacist for
details.
• If your condition persists or worsens, or if you think you may have a serious medical problem, seek
immediate medical attention.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the
missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
STORAGE: Refer to storage information printed on the package. If you have any questions about storage, ask your
pharmacist. Keep all medications and herbal products away from children and pets.
• Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly
discard this product when it is expired or no longer needed. Consult your pharmacist or local waste
disposal company for more details about how to safely discard your product.
SIDE EFFECTS: Trouble sleeping, restlessness, upset stomach, dizziness, headache, or numbness/tingling of the
hands/feet may occur. If any of these effects persist or worsen, contact your doctor or pharmacist promptly.
• Tell your doctor immediately if this unlikely but serious side effect occurs: a sunburn-like skin reaction
(increased sun sensitivity).
• Tell your doctor immediately if any of these rare but very serious side effects occur: black/bloody/tarry
stools, vomit that looks like coffee grounds, easy bruising/bleeding.
• This product may rarely cause a very serious condition called serotonin syndrome. The risk increases
when this product is used with certain drugs such as ”triptans” used to treat migraine headaches
(e.g., sumatriptan, eletriptan), certain antidepressants including SSRIs (e.g., citalopram, paroxetine)
and SNRIs (e.g., duloxetine, venlafaxine), lithium, tramadol, tryptophan, or a certain drug to treat obesity
(sibutramine). See also Drug Interactions section. Before taking this product, tell your doctor if you
take any of these medications. Serotonin syndrome may be more likely when you start or increase the
dose of any of these medications. Seek immediate medical attention if you develop any of the following
symptoms: unusual mental/mood changes (e.g., strange thoughts, unusual excitement, extreme anxiety,
confusion), severe dizziness, severe headache, fast heartbeat, unexplained fever, sweating, severe
nausea/vomiting/diarrhea, twitching muscles.
• A very serious allergic reaction to this product is rare. However, seek immediate medical attention if you
notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of
the face/tongue/throat), severe dizziness, trouble breathing.
• This is not a complete list of possible side effects. If you notice other effects not listed above, contact
your doctor or pharmacist.
• In the US -
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• Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-
FDA-1088.
• In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health
Canada at 1-866-234-2345.
PRECAUTIONS: Before taking St. John’s wort, tell your doctor or pharmacist if you are allergic to it; or if you have
any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems.
Talk to your pharmacist for more details.
• If you have any of the following health problems, consult your doctor or pharmacist before using this
product: personal or family history of bipolar/manic-depressive disorder.
• This product may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths,
and sunlamps. Use a sunscreen and wear protective clothing when outdoors.
• Liquid forms of this product may contain sugar and/or alcohol. Caution is advised if you have diabetes,
alcohol dependence, or liver disease. Ask your doctor or pharmacist about using this product safely.
• Before having surgery, tell your doctor or dentist that you are using this product.
• St. John’s wort is not recommended for use during pregnancy. Consult your doctor before using this
product.
• It is not known if St. John’s wort passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide,
phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) within 2 weeks before, during, and after using St.
John’s wort. In some cases a serious (possibly fatal) drug interaction may occur.
• St. John’s wort interacts with many medications and products. The following drugs are just some of
the products that may interact with St. John’s wort.
• Before using this product, tell your doctor or pharmacist of all prescription and nonprescription/herbal
products you may use, especially of: drugs used to prevent organ rejection (e.g., cyclosporine, sirolimus,
tacrolimus), drugs used to treat cancer (e.g., cyclophosphamide, etoposide, irinotecan, paclitaxel, tamoxifen),
heart medications (e.g., digoxin, beta blockers such as metoprolol, calcium channel blockers such
as diltiazem), anti-seizure drugs (e.g., carbamazepine, phenytoin, phenobarbital), tricyclic antidepressants
(e.g., amitriptyline, nortriptyline), sympathomimetic drugs (e.g., albuterol, phenylephrine), drugs
used to treat HIV infection such as protease inhibitors (e.g., indinavir), non-nucleoside reverse transcriptase
inhibitors (NNRTIs such as delavirdine, efavirenz, nevirapine, etravirine), and entry inhibitors (e.g.,
maraviroc), drugs that can cause bleeding/bruising (e.g., antiplatelet drugs such as clopidogrel, ”blood
thinners” such as warfarin and heparin, NSAIDs such as ibuprofen).
• Also tell your doctor if you take any other products/drugs that increase serotonin, such as bromocriptine,
buspirone, dextromethorphan, meperidine, propoxyphene, phentermine, ergots such as dihydroergotamine,
street drugs such as MDMA/”ecstasy,” amphetamine. (See also Side Effects section.)
• Aspirin can increase the risk of bleeding when used with this product. If your doctor has directed you
to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81-325 milligrams
a day), you should continue taking it unless your doctor instructs you otherwise. Discuss the risks and
benefits with your doctor.
• This product may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This
could cause pregnancy. Discuss with your doctor or pharmacist if you should use additional reliable
birth control methods while using this product. Also tell your doctor if you have any new spotting or
breakthrough bleeding, because these may be signs that your birth control is not working well.
• The interactions listed above are not a complete listing of all possible drug interactions. St. John’s wort
may also interact with many other drugs by affecting how they are absorbed by your body or removed
from your body. These effects may change how well these other drugs work. Therefore, before using St.
John’s wort, talk with your doctor or pharmacist about all medications and products you take.
• Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist
first.
• This document does not contain all possible interactions. Therefore, before using this product, tell your
doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share
the list with your doctor and pharmacist.
NOTES: Keep all regular medical and laboratory appointments.
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• Check the product labeling carefully to make sure you have the correct product. St. John’s wort is a
species called Hypericum perforatum and should not be confused with other Hypericum species.
OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US
residents can call the US National Poison Hotline at 1-800-222-1222. Canada residents can call a provincial poison
control center.
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