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NERVOUS SYSTEM › PSYCHOANALEPTICS › ANTIDEPRESSANTS › Other antidepressants
Hyperici herba
N06AX25
Forms & Strengths
- St. John's wort dry extract (standardized to 0.1-0.3% hypericin): 300 mg to 900 mg tablets/capsules
- Liquid extract: 1:1 in 45-60% alcohol
- Herbal tea preparations: 1.5 - 2 g crude herb per cup
Adult Dosing
- Mild to moderate depression: 300 mg to 900 mg daily of standardized extract, divided into 1 to 3 doses
- Maximum therapeutic effect typically observed after 4 to 6 weeks of continuous administration
Pediatric Dosing
- Safety and efficacy in children under 12 years of age have not been established
- Not recommended for pediatric use without specialized clinical supervision
Indications
- Short-term treatment of mild to moderate depressive episodes (ICD-10: F32.0, F32.1)
- Somatic symptoms of mild anxiety and depressive mood states
Mechanism of Action
- Inhibition of synaptosomal reuptake of serotonin (5-HT), norepinephrine, and dopamine
- Down-regulation of cortical beta-adrenergic receptors and up-regulation of 5-HT1 and 5-HT2 receptors
- Weak monoamine oxidase (MAO) inhibition at very high concentrations
Contraindications
- Known hypersensitivity to Hypericum perforatum or other Hypericaceae species
- Severe depressive states
- Concurrent use with immunosuppressants (ciclosporin, tacrolimus)
- Concurrent use with antiretrovirals (protease inhibitors, NNRTIs)
- Concurrent use with antineoplastics (irinotecan, imatinib)
- Concurrent use with direct-acting oral anticoagulants (DOACs) and warfarin
- Concurrent use with other serotonergic antidepressants to avoid serotonin syndrome
Adverse Reactions
- Photosensitivity and cutaneous hypersensitivity reactions, especially in fair-skinned individuals
- Gastrointestinal symptoms (dry mouth, nausea, abdominal discomfort)
- Central nervous system effects (fatigue, anxiety, restlessness, headache)
- Allergic skin reactions (rash, pruritus)
Drug Interactions
- Potent inducer of hepatic cytochrome P450 enzymes (specifically CYP3A4, CYP2C9, CYP2C19) and P-glycoprotein
- Decreases plasma concentrations of oral contraceptives, leading to breakthrough bleeding and loss of efficacy
- Reduces efficacy of statins, anticonvulsants, digoxin, and methadone
- Risk of serotonin syndrome when combined with SSRIs, SNRIs, triptans, or other serotonergic agents
- Enhances sedative effects when combined with central nervous system depressants or alcohol
Curated Content: Needs Vetting Before Put to Clinical Use