St. John’s Wort (Hypericum perforatum)

More than 3% of presurgical pts report using St. John’s wort.

Taken mainly for depression, although pts may take it for a variety of reasons including anxiety, viral and bacterial infections, menstrual cramps, HIV, cancer, chest congestion, hemorrhoids, skin wounds, and burns.

Efficacy in treating depression is controversial.

Most integrative medical specialists will use every other alternative first because of drug interactions; this is at best a third-line medication. Others such as S-adenosyl- l -methionine are equally or more effective and without undesirable drug interactions or other side effects.

Drug interactions: May prolong sedative effects of other drugs including anesthetics and sedatives. There are case reports of a severe hypertensive response to vasopressors such as ephedrine or phenylephrine in pts taking St. John’s wort.

Induces cytochrome P450 enzymes; promotes metabolism and decreased blood levels of warfarin, cyclosporine, digoxin, CCBs, and steroids; even renders birth control pills and menopausal drug therapies ineffective. Watch for unplanned and sometimes unwanted pregnancies due to this effect.)

Serotonin-like syndrome (Htn, tachycardia, agitation, restlessness).

Unpredictable effects due to lack of strict regulation.