(Hypericum perforatum) - ORAL

• 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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