goatweed

St. John's wort (Hypericum perforatum)

(saynt jonz wort) stjohnswort,

Amber

(trade name),

Demon chaser

(trade name),

Goatweed

(trade name),

Hardhay

(trade name),

Klamath weed

(trade name),

Rosin rose

(trade name),

Tipton weed

(trade name)

Classification

Therapeutic: antidepressants
Oral: Management of mild to moderate depression and obsessive compulsive disorder (OCD). (Not effective for major depression.) Topical: Inflammation of the skin, blunt injury, wounds and burnsOther uses are for capillary strengthening, decreasing uterine bleeding, and reducing tumor size

Action

Derived from Hypericum perforatum; the active component is hypericin.Oral: Antidepressant action my be due to ability to inhibit reuptake of serotonin and other neurotransmitters.Topical: Anti-inflammatory, antifungal, antiviral, and antibacterial properties.

Therapeutic effects

Oral: Decreased signs and symptoms of depression.Topical: Decreased inflammation of burns or other wounds.

Pharmacokinetics

Absorption: Unknown.Distribution: Unknown.Metabolism and Excretion: Unknown.Half-life: Hypericum constituents—24.8–26.5 hr.

Time/action profile

ROUTE	ONSET	PEAK	DURATION
PO	10–14 days	within 4–6 wk	unknown

Contraindications/Precautions

Contraindicated in: Pregnancy, lactation, or children.Use Cautiously in: History of phototoxicity; Surgery (discontinue 2 weeks prior to surgical procedures); Alzheimer's disease (may induce psychosis); Patients undergoing general anesthesia (may cause cardiovascular collapse); History of suicide attempt, severe depression, schizophrenia or bipolar disorder (can induce hypomania or psychosis).

Adverse Reactions/Side Effects

Central nervous system

dizziness
restlessness
sleep disturbances

Cardiovascular

hypertension

Endocrinologic

hypoglycemia

Gastrointestinal

abdominal pain
bloating
diarrhea
dry mouth
feeling of fullness
flatulence
nausea
vomiting

Neurologic

neuropathy

Dermatologic

allergic skin reactions (hives, itching, skin rash)
phototoxicity

Miscellaneous

serotonin syndrome

Interactions

Concurrent use with alcohol or other antidepressants (including SSRIs and MAO inhibitors ) may ↑ risk of adverse CNS reactions.May ↓ the effectiveness and serum concentrations of digoxinalprazolamamitriptylineimatinibirinotecanwarfarin andprotease inhibitors.Use with MAO Inhibitorstramadolpentazocine and selective serotonin agonists could result in serotonin syndrome.May ↓ effectiveness of oral contraceptives.May ↓ plasma cyclosporine and tacrolimus levels by 30–70% and cause acute transplant rejection.May ↑ metabolism of phenytoin and phenobarbital and cause loss of seizure control.Avoid use of St. John’s Wort and MAO Inhibitors within 2 wk of each other.May ↑ risk of serotonin syndrome when taken with tryptophanand SAM-e.Oral (Adults) Mild Depression—300 mg of St. John’s Wort (standardized to 0.3% hypericin) 3 times daily or 250 mg twice daily of 0.2% hypericin extract. OCD—450 mg twice daily of extended release preparation.Topical (Adults) 0.2–1 mg total hypericin daily.

Availability

Preparations for Oral Use

Dried herb: ^OTCDried (hydroalcoholic) extract: ^OTCOil: ^OTCTincture: ^OTC

Preparations for Topical Application

Liquid: ^OTCSemisolid: ^OTC

Nursing implications

Nursing assessment

Depression: Assess patient for depression periodically during therapy.
Inflammation: Assess skin or skin lesions periodically during therapy.

Potential Nursing Diagnoses

Ineffective coping (Indications)
Anxiety (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

Oral: Tea can be prepared by mixing 2-4 dried herb in 150 mL of boiling water and steeping for 10 min.

Patient/Family Teaching

Instruct patient to take St. John’s wort as directed.
Patients with depression should be evaluated by health care professional. Standard therapy may be of greater benefit for moderate to severe depression.
Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
Caution patients to avoid sun exposure and use protective sunscreen to reduce the risk of photosensitivity reactions.
Inform patient to purchase herbs from a reputable source and that products and their contents vary among different manufacturers.
Caution patient not to use alcohol while taking St. John’s wort.
Warn patients that St. John’s Wort may reduce the therapeutic effectiveness of several drugs.
May potentiate effect of sedatives and side effects of other antidepressants. Do not take within 2 wk of MAO Inhibitor therapy.
Instruct patient to consult healthcare professional before taking otherRx, OTC, or herbal products concurrently with St. John’s wort.
Inform patient that St. John’s wort is usually taken for a period of 4–6 wk. If no improvement is seen, another therapy should be considered.

Evaluation/Desired Outcomes

Decrease in signs and symptoms of depression or anxiety.
Improvement in skin inflammation.

Saint John’s wort

Fringe medicine
An essence which, in the pseudoscience of flower essence therapy, is said to provide a sense of consciousness, self-awareness and inner strength.
Herbal medicine
A perennial herb containing flavonoids, glycosides, mucilage, tannins and volatile oil, which is antibacterial, anti-inflammatory, antimicrobial, astringent, expectorant and sedative; it has been used internally for arthritis, bed-wetting, bronchitis, colds, mental disorders (anxiety, depression, insomnia, nervousness), menstrual cramps, neuralgia, rheumatic pain and sciatica, and topically for burns, cuts and wounds. It was used transiently as a herbal therapy for AIDS.

Toxicity
St John’s wort has been deemed unsafe by the FDA, given its phototoxicity; it causes hypertension, headaches, nausea, and vomiting; it may interact with amphetamines, amino acids (tryptophan, tyrosine), anti-asthmatic inhalants, beer, wine, chocolate, coffee, fava beans, cold and hay fever medication, narcotics, nasal decongestants and smoked or pickled foods.