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Doctors' Answers to "Frequently Asked Questions" - St. John's Wort

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 09/24/2000]
Question: I am very sensitive to any of the anitdepressant medications. Taken them all, can't tolerate. Was on imipramine for years and did "OK". Doc wants to put me on Webllutrin but said it wouldn't really help my anxiety, which is the problem. It has gotten so bad that I do not want to get out of the house, but to do so,I have to take the Xanax and it makes me very tired. What about St. John's wort being compared to imiprimine but with less side effects. What are the lesser side effects and what would be a good brand to take since there are so many out there? I feel like I'm not getting anywhere and just getting worse. I hope you can help. Thanks

Answer: Wellbutrin is a stronger drug in general than St. John's Wort. St. John's is like a MAO inhibitor if you have ever tried them. Wellbutrin can help anxiety, just not a FDA indication. I'd try it first, then the St. John's wort. By the way, lots of patients need xanax and some antidepressant in agitated depression.

[posted 03/3/2000]
Question: I would like to know if I can take St. Johns Wart for my post partum depression while I am breast feeding. My doctor said it was ok to take paxil at 20mg at night. That didn't sounf right to me what do you think?

Answer: Wouldn't until you stop breast feeding. There is no data at all on the development of children exposed to these type of drugs.

St. John's Wort With Other Medications [posted 10/13/98]
Question: I am taking mevacor, lotrel, and catapres-3 for my hypertension/ high cholesterol. I am also using St. John's Wort for stress. Should I be concerned about a drug reaction?

Answer: Nothing obvious.

St. John's Wort [posted 8/6/98]
Question: I am a 38 year old female. I take claritin daily for allergies, and an occasional librax for Irritable Bowel Syndrome. I used to take prozac for very severe PMS, and it was the only thing that helped (greatly), but I eventually had to stop due to side affects (fidgety, sexual dysfunction, and weight gain). I would like to try St. John's Wort to see if it helps the PMS, but am concerned because of the claritin. Is there a problem with these three drugs (claritin, librax, St. John's Wort)?

Answer: Shouldn't be a problem. The only obvious interaction is with certain foods - at least theoretically: chicken liver, pickled herring, yogurt, beer, wine (especially red, sherry and chianti), bananas, avocados, raisins, chocolate, sour cream, soy sauce. This is because St. John's Wort is a mild MAO inhibitor.

St. John's Wort and Excedrin [posted 8/4/98]
Question: If I am taking St. John's Wort, can I take Excedrin PM for my muscle pain and sleep? I have been diagnosed with Fibromyalgia.

Answer: Probably, the only risks that are listed are foods such as red wines, sour cream, chicken liver, aged cheeses, bananas, soy sauce, chocolate, raisins, cold medication with decongestants, etc. Having said that I haven't had a patient with any food interaction on the medication. I think judicial use of the foods is ok, but watch decongestants (pseudofed and the like) more closely.

St. John's Wort and Other Medications [posted 7/30/98]
Question: My mother, who is 82 years old, had a triple bypass one year ago and is doing very well physically. I do think that she is suffering from depression and suggested she think about taking St. John's Wort and she is open to trying it assuming it is safe with her medications. Will the following medications she takes for diabetes and high blood pressure cause any problems with the St. John's Wort? Glucophage 500 ml twice a day, Glipizide 10 ml twice a day, Capotril 75 ml twice a day, Metroprolol 50 ml twice a day and Lipitor 10 ml once a day.

Answer: Shouldn't. St. John's Wort is a weak MAO inhibitor according to the drug researchers. There are foods that one is recommended to avoid. I usually tell my patients this list. However, I haven't seen any major reactions in the ER or with my patients so, I'm not sure how aggressive you need to be in avoiding the particular foods. They are: Chocolate, excessive caffeine, soy sauce, bananas, figs (canned), avocados, raisins, yogurt, sour cream, cheese(especially aged, cheddar, blud), beer, wine (especially red), chicken liver and pickled herring.

St. John's Wort
Question: Do you have any information on this natural herb, including drug interactions. I have htn, asthma and a sinus problem. I am interested in starting this medication.

Answer: Hypericum is the name for the chemical derived from St. John's Wort. This is a perennial flower found in many gardens. The drug is usually dispensed in 300 mg pills and usually patients take 300 mg twice a day or 300 mg three times a day. Side effects tend to be minimal, but research on longer side effects is in progress. This drug takes about three weeks to work, but some find it works faster, and should not be taken with prescription antidepressants (lack of research behind this precaution).

St. John's Wort
Question: Do you consider this plant useful in the treatment of depression? Is it excreted through the liver?

Answer: I have some patients who think they are better and the side effects are clearly better. I don't think it is as effective as the SRI class, but there may be patients for which it is superior, especially in decreasing side effects. However, medical research is only in progress and I can't tell you the side effects, metabolism, etc., since I really don't know. Keep tuned, but most drugs are affected by the liver.

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