Primary Name: St. John’s Wort (Hypericum perforatum)
Other Names: Demon chaser, goat weed, hardhat, Klamath weed, rosin rose, SJW, and Tipton weed.
Dosage: Capsule: 5% hyperforin 300 mg or 300 mg hypericin three times daily; the dose should not exceed 1800 mg/day due to phototoxic skin reactions.
Indications/Homeopathic Use
- Anxiety
- Depression
- Insomnia
- Muscle pain
- Seasonal affective disorder
- Sleep disorders
Perioperative Concerns
Abrupt cessation of St. John’s wort can trigger withdrawal symptoms. Crucially, individuals with Alzheimer’s disease and dementia are advised against using St. John’s wort due to the risk of psychotic delirium. It is recommended to discontinue St. John’s wort at least two weeks prior to surgery to prevent withdrawal symptoms.
St. John’s wort is known to interact with several medications, including benzodiazepines, digoxin, diltiazem, fentanyl, midazolam, naloxone, ondansetron, propofol, steroids, tramadol, and warfarin, necessitating caution in its use (Nagelhout & Plaus, 2023).
Additional Information
St. John’s wort is generally well-received by patients for home use, presenting fewer side effects. Nonetheless, it may lead to symptoms reminiscent of serotonin syndrome, such as hypertension, tachycardia, anxiety, and nausea.
St. John’s wort is thought to exert its effects by acting on neuroreceptors, primarily through inhibiting the reuptake of neurotransmitters such as serotonin, dopamine, and norepinephrine. However, it also adversely affects the opioid system by inhibiting the binding of naloxone to opioid receptors. Additionally, St. John’s wort can induce the activity of hepatic cytochrome CYP450 3A4, potentially accelerating the metabolism of a wide array of medications.
