The Polypharmacy Network

Polypharmacy Prevention
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What You Should Know About St. John’s Wort (Hypericum perforatum)
By: Joanne Jansen PharmD and Anjanette Dymerski PharmD
Many people consider herbal supplements safe since they are natural. However, even natural things can be bad for you; for example, a bite from a black widow spider is natural and not good. Always discuss any new supplements with your doctor or pharmacist before taking them to make sure they do not interact with your medications or cause worsening of a disease you have.

It is important to remember that natural supplements and vitamins are not regulated by the Food and Drug Administration (FDA). This means that there may be ingredients in the products that are not listed. There is also no guarantee that the ingredients listed on the bottle are accurate.

St. John’s wort is often used as a treatment for mild depression for 1 – 3 months. While this does seem to work in some people, there are many reasons you may not want to take it. St. John’s wort makes the body get rid of some drugs more quickly than it should, and these drugs will not work. For instance, St. Johns wort interacts with all of these drugs and more:
• Warfarin (Coumadin®)
• Antidepressants
     o alprazolam (Xanax®)
     o amitriptyline (Elavil®)
     o paroxetine (Paxil®)
     o sertraline (Zoloft®)
• Drugs for cancer:
     o cyclosporine (Sandimmune®, Neoral®)
     o paclitaxel (Taxol®)
     o etoposide (Toposar®)
     o vinblastine
     o imatinib (Gleevec®)
• Digoxin (Lanoxin®)
• Calcium channel blockers:
     o diltiazem (Tiazac®, Cardizem®, Dilacor®, Cartia®)
     o verapamil (Calan®, Covera HS®, Isoptin®, Verelan®)
     o nicardipine (Cardene®)
• Acid reducers such as omeprazole (Prilosec®)
• Meperidine (Demerol®)
• Narcotics:
     o hydrocodone (Lortab®, Vicodin®)
     o oxycodone (OxyContin®, Roxicodone®, Percocet®)
• Phenytoin (Dilantin®)
• HIV drugs:
     o indinavir (Crixivan®)
     o saquinavir (Invirase®)
     o nevirapine (Viramune®)
     o efavirenz (Sustiva®)
• Reserpine
• Tramadol (Ultram®, Ultracet®)

St. John’s wort can cause problems in people with certain diseases. If you have one of the following, discuss with your doctor or pharmacist whether you should take St. John’s wort:
• Alzheimer’s disease
• Bipolar disorder
• Schizophrenia
• Attention deficit hyperactivity disorder (ADHD)

Other things you should know about St. John’s wort:
• Tell your doctor you are taking this drug before you have surgery. You may need to stop it two weeks before surgery to prevent bleeding or anesthesia problems.
• Tell your doctor or pharmacist you are taking this drug before you start any new medications.
• St. John’s wort may cause you to sunburn more easily than usual, especially if you are taking other medications that also cause you to burn such as tetracycline, Bactrim, hydrochlorothiazide, ciprofloxacin (Cipro) and furosemide (Lasix)
• Some side effects of St. John’s wort can be rash, insomnia, anxiety, diarrhea, hypoglycemia (low blood sugar), dry mouth, dizziness, nausea, irritability and vivid dreams.

More information available at the Natural Products Database of The Pharmacist’s Letter.