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Drugs and Health Products

Monograph: St. John's Wort - Oral

This monograph is intended to serve as a guide to industry for the preparation of Product Licence Applications (PLA) and labels for natural health product market authorization. It is not intended to be a comprehensive review of the medicinal ingredient. It is a referenced document to be used as a labelling standard. Note: (i) Text in parentheses is additional optional information which can be included on the PLA and product labels at the applicant's discretion. The solidus (/) indicates that the terms are synonyms or that the statements are synonymous. Either term or statement may be selected by the applicant. (ii) Claims for traditional use must include the term "Herbal Medicine".

Date: 2009-11-12

NHPID Name

Hypericum perforatum (USDA 2008)

Proper Name(s)

Hypericum perforatum L. (Hypericaceae/Clusiaceae) ( USDA 2008 )

Common Name(s)

Source Material

Herb top ( Bradley 2006 , Mills and Bone 2005 , Hoffmann 2003 , Blumenthal et al. 2000 , Felter and Lloyd 1983[1898] , Wren 1907 )

Route Of Administration

Oral

Dosage Form(s)

  • The acceptable pharmaceutical dosage forms include, but are not limited to capsules, chewables (e.g. gummies, tablets), liquids, powders, strips or tablets.
  • This monograph is not intended to include foods or food-like dosage forms such as bars, chewing gums or beverages.

Use(s) or Purpose(s)

Statement(s) to the effect of:

(Traditionally) used in Herbal Medicine to help relieve restlessness and/or nervousness (sedative and/or calmative)  (Mills and Bone 2005, Hoffmann 2003, Blumenthal et al. 2000, Felter and Lloyd 1983[1898], Grieve 1971[1931])

Dose(s)

Adults:

Preparation: All Standardised Extracts

Dose(s): 2 - 4 Grams per day, dried herb tops
Dose(s): 0.2 - 4.2 Grams 3 times per day, dried herb tops
Preparation: Dry, Powder, Decoction & Infusion + All Non-Standardised Extracts

Dose(s): 2 - 4 Grams per day, dried herb tops
Dose(s): 0.2 - 4.2 Grams 3 times per day, dried herb tops

See Appendix 1 for examples of appropriate dosage preparations and frequencies of use, according to cited references. The purpose of Appendix 1 is to provide guidance to industry.

Duration of use

Risk Information

Statement(s) to the effect of:

Caution(s) and Warning(s):

Contraindication(s):
Do not use if you are taking anti-cancer medications, blood thinners, antidepressant medications (e.g. selective serotonin reuptake inhibitors (SSRI)), anti-HIV agents, cardiovascular medications, immunosuppressants, and/or contraceptive medications

Known Adverse Reaction(s):


See Appendix 2 to find the references of the Caution and Contraindication statements about medication use.

Non-medicinal ingredients

Must be chosen from the current Natural Health Products Ingredients Database and must meet the limitations outlined in the database.

Specifications

  • The finished product specifications must be established in accordance with the requirements described in the NHPD Quality of Natural Health Products Guide.
  • The medicinal ingredient must comply with the requirements outlined in the Natural Health Products Ingredient Database (NHPID).
  • The medicinal ingredient may comply with the specifications outlined in one of the following pharmacopoeial monographs: (i) 'St. John's wort' from European Pharmacopoeia (Ph. Eur.) and (ii) 'St. John's wort' or 'Powdered St. John's wort' or 'Powdered St. John's wort extract' in US Pharmacopoeia (USP)

References cited

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Appendix 1: Examples of appropriate dosage preparations, frequencies of use and directions for use

ORAL:

Dried aerial parts:

2-4 g, per day (Blumenthal et al. 2000; BHP 1983)

Infusion:

  • 2-4 g dried flowering tops, per day (Wichtl 2004; ESCOP 2003)
  • 1.8-3.6 g dried herb, 3 times per day (Hoffmann 2003)
  • Directions for use: Pour 250 ml (1 cup) of boiling water over 1 to 2 teaspoons of dried herb (flower) and infuse for 5-15 minutes (Wichtl 2004; Hoffmann 2003). 1 tsp =1.8 g (Wichtl 2004)

Fluid extract:

2-4 g dried equivalent, 3 times per day (1:1, 25% alcohol, 2-4 ml)(BHP 1983)

Tincture:

  • 0.6-0.9 g dried equivalent, per day (1:5, 60 % ethanol, 3-4.5 ml)(ESCOP 2003)
  • 0.4-0.8 g dried equivalent, 3 times per day (1:5, 40 % ethanol, 2-4 ml) (Hoffmann 2003)
  • 0.2-0.4 g dried equivalent, 3 times per day (1:10, 45% ethanol, 2-4 ml) (BHP 1983)

Dry hydroalcoholic extract/solild hydroalcoholic extract:

  • 300-600 mg, 3 times per day (3-7:1) (Anghelescu et al. 2006)
  • 900 mg, per day (Gastpar et al. 2006)
  • 600 mg, per day (3-7:1, 80% methanol) (Kasper et al. 2006)
  • 1,200 mg, per day (3-7:1, 80% methanol) (Kasper et al. 2006)
  • 300 mg, 3 times per day standardized to 0.12%-0.28% hypericin (Fava et al. 2005)
  • 300 mg, 3 times per day (3-7:1) standardized to 3%-6% hyperforin and 0.12%-0.28% hypericin (Szegedi et al. 2005)
  • 600 mg, 3 times per day (3-7:1) standardized to 3%-6% hyperforin and 0.12%-0.28% hypericin (Szegedi et al. 2005)
  • 900 mg, per day (Uebelhack et al. 2004)
  • 300 mg, 3 times per day (4-7:1) standardized to 3%-6% hyperforin and 0.12%-0.28% hypericin. (Lecrubier et al. 2002)
  • 300 mg, 2 times per day (Volz et al. 2002)
  • 300 mg, 3 times per day (2.5-5.0:1) standardized to 5% hyperforin (Kalb et al. 2001)
  • 300 mg, 3 times per day (5-7:1) (Blumenthal et al. 2000)

 

Appendix 2: Examples of classes of medications that can be affected by St. John's wort

  • Anti-cancer agents (Brinker 2008; Sparreboom et al. (2004); Frye et al. 2004; Smith et al. 2004; Hoffmann 2003; Mathijssen et al. 2002; Wang et al. 2001; Roby et al. 2001.);
  • Anticoagulants (blood thinners) (Brinker 2008; Mills and Bone 2005; Jiang et al. 2004; Wichtl 2004; Brinker 2001; Maurer et al. 1999);
  • Anticonvulsants (seizure medications) (Barnes et al. 2007; Burstein et al. 2000);
  • Antidepressants such as SSRIs (selective serotonin reuptake inhibitors) (Brinker 2008; Bradley 2006; Mills and Bone 2005; ESCOP 2003; Brinker 2001);
  • Antihistamines (Mills and Bone 2005; Hoffman 2003; Dresser et al. 2003; Xie et al. 2003; Wang et al. 2002);
  • Anti-HIV agents (Brinker 2008; Barnes et al. 2007; ESCOP 2003; Hoffmann 2003; De Maat et al. 2001; Piscitelli et al. 2000);
  • Anxiolytics (anti-anxiety) (Kawaguchi et al. 2004; Markowitz et al. 2003; Dannawi 2002; Spinella and Eaton 2002; Wang et al. 2001; Parker et al. 2001);
  • Bronchodilators (Mills and Bone 2005; Morimoto et al. 2004; Nebel et al. 1999);
  • Cardiovascular medications (Brinker 2008; Barnes et al. 2007; Bradley 2006; Mills and Bone 2005; Tannergren et al. 2004; Mueller et al. 2004; Sugimoto et al. 2001; Durr et al. 2000; Johne et al. 1999);
  • Immunosuppressants (Brinker 2008; Bradley 2006; Hebert et al. 2004; Alscher and Klotz 2003; Bauer et al. 2003; Dresser et al. 2003; Bolley 2002; Ahmed et al. 2001; Moschella and Jaber 2001; Turton-Weeks 2001; Barone et al. 2000; Karliova et al. 2000; Mai et al. 2000; Ruschitzka et al. 2000; Ernst 1999; Rey and Walter 1998);
  • Muscle relaxants (Gurley et al. 2002);
  • Opiates (Brinker 2008; Mills and Bone 2005; Eich-Höchli et al. 2003; Brinker 2001)