St. John's Wort Safety

Before taking St. John's wort, safety concerns should be discussed with your healthcare provider. Because the supplement can cause serious problems if taken in combination with certain medications, make sure your healthcare provider is aware of all other medications you are taking. You should also tell your healthcare provider about any medical conditions you have, as St. John's wort can make some of these problems worse.

Is St. John's Wort Safe?

St. John's wort (Hypericum perforatum) is an herbal supplement often used to treat depression, although it is sometimes used for other purposes. St. John's wort should be safe for most people, although you might have a higher risk for problems if you have:
Also, let your healthcare provider know if you are:
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
Make sure to tell your healthcare provider about any other medications you are taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Specific St. John's Wort Warnings and Precautions

Warnings and precautions to be aware of concerning the safety of St. John's wort include the following:
  • St. John's wort supplements can interact with many medications (see St. John's Wort Drug Interactions). If you take any medication, check with your healthcare provider before taking St. John's wort.
  • Taking St. John's wort with other supplements or medications that affect serotonin can increase your risk of a dangerous group of symptoms called serotonin syndrome. The medications that can cause this serious interaction include antidepressants, triptans (migraine medications), and other medications. Contact your healthcare provider immediately if you have any possible symptoms of serotonin syndrome, such as:
    • Confusion
    • Seeing or hearing things that are not really there (hallucinations)
    • A fast heartbeat (tachycardia)
    • Feeling faint
    • Fever
    • Sweating
    • Muscle spasms
    • Difficulty walking
    • Diarrhea
  • Like other antidepressants, St. John's wort may cause mania in people with bipolar disorder. If you have bipolar disorder (or even a family history of this condition), do not take St. John's wort without your healthcare provider's approval and supervision.
  • If you have Alzheimer's disease, check with your healthcare provider before taking St. John's wort. There is some concern that St. John's wort can make dementia worse or may cause psychotic symptoms in people with Alzheimer's.
  • There have been reports of worsening symptoms of attention deficit hyperactivity disorder (ADHD) possibly due to St. John's wort. Check with your healthcare provider before taking St. John's wort if you have ADHD.
  • Laboratory studies indicate that St. John's wort could decrease fertility in men and women. Although this has not yet been confirmed in animals or humans, it may be a good idea to avoid St. John's wort if you are trying to conceive, especially if you are having difficulty getting pregnant.
  • St. John's wort can cause unusual, uncontrollable body movements, such as tremors. If you develop such movements, stop taking St. John's wort and contact your healthcare provider right away.
  • There is some concern that St. John's wort could make schizophrenia worse. If you have this condition, do not take St. John's wort without your healthcare provider's supervision.
  • It is not known if St. John's wort is safe for pregnant or breastfeeding women (see St. John's Wort and Pregnancy and St. John's Wort and Breastfeeding).
  • If you decide to use supplements, what you see on the label may not reflect what is in the bottle. For example, some herbal supplements have been found to be contaminated with heavy metals or prescription drugs, and some have been found to have much more or much less of the featured ingredient than their label states.
Therefore, make sure the manufacturer of your St. John's wort is trusted and reputable. It is a good sign if a manufacturer abides by the rules of Good Manufacturing Practices (GMP) for drugs. It is also a good sign if a product has the United States Pharmacopoeia (USP) seal, which means that the product has been independently tested and shown to contain the correct ingredients in the amounts listed on the label. Your pharmacist is a good resource for information about which manufacturers are most reputable.
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