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Drugs and Health Products

Monograph: St. John's Wort - Topical

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

Flower ( Isacchi et al. 2007 , Sosa et al. 2007 , Bradley 2006 , Wichtl 2004 , Hoffmann 2003 , Blumenthal et al. 2000 , Grieve 1971[1931] , Wren 1907 )

Route Of Administration

Topical

Dosage Form(s)

Those suited to the allowable route(s) of administration.

Use(s) or Purpose(s)

Statement(s) to the effect of:

(Traditionally used in Herbal Medicine as an) antiseptic and/or antimicrobial to help treat and heal minor skin wounds, cuts, burns and bruises  (Bradley 2006, Mills and Bone 2005, Hoffmann 2003, Blumenthal et al. 2000, Felter and Lloyd 1983[1898], Wren 1907)

Dose(s)

Adults, adolescents and children:

Preparation: Fresh

Dose(s): flowers infused in vegetable oil

Directions For Use: Apply to affected area(s) as needed (Bove 2001, Blumenthal et al. 2000)


  • Product licence applicants are not required to disclose any extract information (e.g. ratio, method) for topical St. John's wort preparations
  • 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

No statement is required

Risk Information

Statement(s) to the effect of:

Caution(s) and Warning(s):
  • Consult a health care practitioner if symptoms persist.
  • Consult a health care practitioner if symptoms worsen.

Contraindication(s):
No statement is required

Known Adverse Reaction(s):
No statement is required

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).
  • The preparations must meet at least one of the following conditions in order to prevent the growth of the bacterial spores associated with botulism: (i) Products are subjected to a validated treatment, such as heat treatment, with equivalent effect to the 12 D canning process (a thermal process designed to reduce the probability of survival of a single, heat-resistant spore of Clostridium botulinum by a factor of 10 exponent 12) to inactivate spores of C. botulinum (FAO 1985), or (ii) The water activity of the plant material is reduced to 0.94 or less before adding it to the oil, or (iii) Ensure that the pH of the plant material is adjusted to 4.6 or less before adding it to the oil (HC 2007). Note: This information is not to be submitted with the compendial Product Licence Application, although it may be requested at the NHPD's discretion.

References cited

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

TOPICAL:

  • St John's wort oil obtained by macerating the flowering aerial parts with vegetable oil (Sosa et al. 2007)
  • Infused oil from St. John's wort flowers (Bradley 2006)
  • The oil macerate from (Oleum Hyperici), extracted with olive, sunflower or preferably wheatgerm oil (Wichtl 2004)
  • Macerate fresh flowering tops in olive oil or wheat-germ oil for several weeks, stirring often; strain through a cloth and press pulp; for direct application to affected areas (Blumenthal et al. 2000).
  • St John's wort oil is prepared by maceration for several weeks (Maisenbacher and Kovar 1992)
  • The oil is made from the flowers infused in olive oil (Grieve 1971 [1931]).
  • The fresh flowers infused in Olive Oil make the Oil of St. John's Wort (Wren 1907).
  • The Johannis flowering tops (fresh) (250 parts) are crushed and immediately with the help of olive oil (1000 parts) the content is poured into a roomy (large) white glass container. The container is repeatedly shaken and kept for fermentation near a warm place. After completion of fermentation the glass container is sealed (locked) and kept under sunbeams until the oil has acquired a bright red color which normally takes six weeks. Whereupon it is pressed and after a short stand the oil part separated from the aqueous layer and further with the help of dried sodium sulphate (60 parts) dehydrated and filtered (DAB 6 (EB-6) 1941).
  • Directions for use: Apply to the affected area as needed (Bove 2001; 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)