Avoid combination.Byakika-Kibwika 2012, Coartem April 2013, Huang 2012, Kredo 2011, Lurasidone: St. John's wort may decrease the serum concentration of lurasidone. Consider therapy modification.Invega April 2014, Invega Sustenna November 2014, Invega Trinza May 2015, Ono 2002, Spina 2000, Vermeulen 2007, Yasui-Furukori 2013, Pantoprazole: St. John's wort may decrease the serum concentration of pantoprazole. Monitor therapy.Soma February 2013, Celiprolol: P-gp/ABCB1 inducers may decrease the serum concentration of celiprolol. Consider therapy modification.Russo 2014, Dienogest: St. John's wort may decrease the serum concentration of dienogest. One study reports that tannin content in extracts is influenced by parameters such as temperature of maceration.Rafajlovska 1998 Phenol constituents include caffeic, chlorogenic, and p-coumaric acids, and hyperfolin. Specifically, St John's wort may decrease isavuconazole serum concentrations. Monitor therapy.Albermann 2005, Callaghan 2008, Gurley 2008, Ho 2005, Kim 2002, Kivistö 2004, Leslie 2005, Mueller 2004, Teng 2008, Pimavanserin: St. John's wort may decrease the serum concentration of pimavanserin. Avoid combination.Stivarga September 2012, Reverse transcriptase inhibitors (non-nucleoside): St. John's wort may decrease the serum concentration of reverse transcriptase inhibitors (non-nucleoside). These changes were determined to be clinically insignificant.Jackson 2014, Bortezomib: St. John's wort may decrease the serum concentration of bortezomib. St John's wort may decrease the serum concentration of CYP3A4 substrates. The risk of serotonin syndrome may be increased. Meta-analyses of quality clinical trials support a place for St. John's wort in the treatment of depression as mono- or adjunctive therapy. After 3 months, median severity score had improved significantly from 24 (±5.1) at baseline to 4.1 (±1) (P<0.0001). Origin: The yellow flower, leaves and stem of the St. John’s wort plant, is native to Europe and grows wild in the U.S. Claims: Acts as an antidepressant drug and reduces inflammation and pain. In most countries, St. John’s wort is available OTC, but in some countries, for example, Ireland, a prescription is required. St. John's Wort (Hypericum perforatum) is an herbal anti-depressant and mood enhancer. The most commonly described constituents are naphthodianthrones, flavonoids, phloroglucinols, and essential oils. Topical and internal use of St. John's wort has been reported to provide effective wound healing. Most people take the herb either in tablet or capsule form, but it is also available in teabags. The reddish dianthrone pigment hypericin (Hypericum red) ranges from 0.02% to 2.5%, depending on harvesting period, drying process, and storage.Bombardelli 1995, Newall 1996 Hypericin content varies widely among growing regions, and concentrations are contingent on plant part, with flowers, buds, top leaves, and secondary stems yielding the highest percents.Upton 1997 Microscopic evaluation revealed that hypericin accumulates in secretory cell globules within these plant structures.Liu 1999 Numerous reports concerning high-performance liquid chromatography analysis of hypericin in St. John's wort exist.Balogh 1999, Chi 1999, Fourneron 1999, Michelitsch 2000, Mulinacci 1999, Sirvent 2000, Stochmal 1998, Tateo 1998 Liposoluble pigments from the plant, including hypericin, carotenoids, and chlorophylls, have also been reported.Omarova 1998 A review of the chemistry of phenanthroperylene quinones from hypericin reveals photosensory pigments.Falk 1999, Flavonoid concentrations in St. John's wort occur at less than 12% in flowers and approximately 7% in leaves/stalksUpton 1997 and include kaempferol, quercetin, quercitrin, isoquercitrin, amentoflavone, luteolin, myricetin, hyperin, hyperoside, rutin, miquelianin, and astilbin.Bombardelli 1995, Butterweck 2000, Newall 1996, Upton 1997 The proanthocyanidins (approximately 12% of aerial parts) are certain forms of catechin and epicatechin.Upton 1997, Hyperforin and adhyperforin are in the phloroglucinol class of compounds.Erdelmeier 1998, Hahn 1992, Upton 1997 Hyperforin appears in St. John's wort in concentrations of 2% to 4%, and its isolation, purity, and stability have been studied.Orth 1999 The recovery of hyperforin in plasma has been measured.Chi 1999 The related structure furohyperforin, an oxygenated analog of hyperforin, has been isolated from the plant,Verotta 1999 as have other hyperforin analogs.Verotta 2000 The essential oil component of St. John's wort is between 0.05% and 0.9%.Hahn 1992, Upton 1997 It consists of mono- and sesquiterpenes, mainly 2-methyl-octane (16% to more than 30%), n-nonane, alpha- and beta-pinene, alpha-terpineol, geraniol, and traces of myrecene, limonene, and caryophyllene, as well as others.Bombardelli 1995, Newall 1996, Upton 1997, Other compounds present in St. John's wort include xanthones (1.28 mg per 100 g) and tannins (3% to 16%). In 1633, Gerard's Herbal recorded the plant's use as a balm for burns, and its oil was also popular during this time.Upton 1997 A reddish-colored olive oil extract made from the fresh flowers has been taken internally for the treatment of anxiety but has also been applied externally to relieve inflammation and promote healing.Hahn 1992, St. John's wort has been approved since 1984 by the German Commission E for the treatment of anxiety, depression, and insomnia. Zolpidem: St. John's wort may decrease the serum concentration of zolpidem. St. John’s wort, botanically known as Hypericum perforatum, is a wild plant native to Europe and Asia.It has yellow, star-shaped flowers. Consider therapy modification.De Smet 2000, Izzo 2016, Jiang 2004, Xalkori August 2011, Vorapaxar: St. John's wort may decrease the serum concentration of vorapaxar. However, the Food and Drug Administration reportedly classifies St. John's wort as a strong inducer (80% or greater decrease in area under the curve [AUC]) of CYP3A4 and a weak inducer (20% to 50% decrease in AUC) of CYP2C9.Berry-Bibee 2016, Li 2017, Markert 2015, Russo 2014 The extent of induction of CYP3A4 and P-gp appears to be comparable among ethnic groups (ie, African American, white, Chinese, Hispanic, Indian, Malay).Russo 2014 Organic anion-transporting polypepetides (OATPs) do not appear to be affected.Li 2017, Markert 2015, Afatinib: P-gp/ABCB1 inducers may decrease the serum concentration of afatinib. Nowadays, St. John’s wort is widely used in Europe, especially Germany, as an herbal treatment for depression. Avoid combination.Kosoglou 2013, Zontivity May 2014, Voriconazole: St. John's wort may decrease the serum concentration of voriconazole. Risk of clotting may be increased. Some studies have reported insignificant pharmacokinetic drug interactions with natural products. Scientific Name(s): Hypericum perforatum L.Common Name(s): Amber touch-and-heal, Esbericum, Goatweed, Gol-raei, Hofariqoun, Hyperforat, Hyperiforce, John's wort, Kira, Klamath weed, LI 160, Millepertuis, Neuroplant, Psychotonin, Rosin rose, Sedariston, St John's wort, St. John's wort, STEI 300, WS 5573, Ze 117. trazodone, sertraline, citalopram, Lexapro, Xanax, Zoloft. The popular herbal therapy is often used to ease symptoms of depression. Bioavailability of these constituents after oral administration is low and ranges from approximately 15% to 20%. Avoid combination.Dirix 2016, Lynparza January 2018, Omeprazole: St. John's wort may decrease the serum concentration of omeprazole. The lowest minimum bactericidal concentrations (350 mcg/mL) were observed for S. epidermidis, Bacillus subtilis, and C. albicans, and were fairly comparable between the 2 extracts. 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