720/ST. JOHN'S WORT PDR FOR HERBAL MEDICINESMore recent studies have indicated that the antidepressive
effect may be largely due to the ability of the herb to inhibit
the reuptake of serotonin and other neurotransmitters. The
activity of the herb could be attributable to the combined
contribution of several mechanisms, each one too weak by
itself to account for the overall effect (Bennett, 1998). A
study concluded that hydroalcoholic hypericum extract
inhibits the reuptake of serotonin, norepinephrine and
dopamine with similar affinities, which leads to a significant
down-regulation of cortical beta- adrenoceptors and seroto-
nin (5HT-2) receptors. This data suggested hyperforin is the
active principle of hypericum extracts in biochemical models
of antidepressant activity (Muller, 1998). The antidepressive
action not only results from the effect on adrenergic
transmitter systems (norepinephrine, dopamine, serotonin),
but also from an endocrine effect (melatonin).Oily Hypericum preparations demonstrate an anti-inflamma-
tory action due to their high flavonoid content. Antiviral
(retroviruses) properties of the herb have not been proven.
No antiretroviral activity determined by virologic markers
and CD4 cell count of hypericin was seen in a study of HIV-
infected patients (Gulick, 1999).
v
The antibacterial effect of hyperforin was demonstrated in a
recent study. Hyperforin inhibited the growth of gram
positive bacteria, such as Streptococcus pyogenes and
Streptococcus agalactiae. Hyperforin also demonstrated
efficacy against penicillin-resistant Staphylococcus aureus
(PRSA) and methicillin-resistant Staphylococcus aureus
(MRSA). These data indicate the possible use of the herb for
local treatment of infected wounds and eczematous skin
lesions (Schempp, 1999).CLINICAL TRIALS
A meta-analysis of 23 randomized trials consisting of 1757
outpatients with mild to moderately severe depressive
disorders was conducted to determine the effectiveness of
Hypericum perforatum. Although Hypericum was signifi-
cantly superior to placebo with fewer adverse effects (19.9%
with Hypericum compared to 52.8% with standard antide-
pressants), there was little standardization and a lack of
information with regard to the diagnostic criteria, compli-
ance control, and dosage regimen of Hypericum and standard
antidepressants (Linde K, 1996).The equivalence between St. John's Wort and fluoxetine was
demonstrated in a randomized, double-blind, comparative
trial involving 149 outpatients with mild or moderate
depressive episodes (according to International Statistical
Classification of Diseases and Related Health Problems).
Patients were treated for 6 weeks. A daily dose of 800 mg
St. John's Wort extract LoHyp-57 (dry extract of
St. John's Wort, drug .extract ratio 5-7:1, solvent, ethanol
60% [w/w]) was found to be equivilent in efficacy to 20 mg
fluoxetine (Harrer, 1999).
The effectiveness and tolerance of Hypericum extract LI 160
with a dosage of 300 mg three times daily was compared to
imipramine 25 mg three times daily in a double-blind,
clinical study. The study involved 135 depressed patients
(according to DSM-III-R criteria) treated over a 6-week
period. The analysis demonstrated comparable results be-
tween the treatment groups, with fewer and milder side
effects in the Hypericum group (Vorbach, 1994).INDICATIONS AND USAGE
Approved by Commission E: "' '-- Anxiety
- Depressive moods
- Inflammation of the skin
- Blunt injuries
- Wounds and burns
Internally, the drug is used for psychovegetative distur-
bances, depressive moods, anxiety and nervous unrest.
Externally, the oily Hypericum preparations are used for. treatment and post-therapy of acute and contused injuries
and for first-degree burns.
Unproven uses: The herb has been used for worm infesta-
tion, bronchitis and asthma, gallbladder disease, gastritis
(also diarrhea), nocturnal enuresis, gout and rheumatism.
Oily Hypericum preparations are used internally for dyspep-
tic complaints, and externally for the treatment of myalgia.
Chinese Medicine: In a gargle solution, the herb is used
externally for tonsillitis. The herb is also administered
externally as a lotion for dermatoses.
Homeopathic Uses: The herb has been used for treatment of
peripheral and central nervous system injuries, depressive
moods, asthma and cerebral-vascular calcification.
CONTRAINDICATIONS
Simultaneous use of a MAO inhibitor: St. John's Wort
contains some weak monoamine oxidase inhibitor (MAOI)
properties that may add to the effects of other MAOI drugs,
therefore theoretically increasing the risk for hypertensive
crisis (Hoelzl & Ostrowski, 1986; Muller & Schaefer, 1996;
Suzuki, 1984).
PRECAUTIONS AND ADVERSE REACTIONS
General: No health hazards are known in conjunction with
the proper administration of designated therapeutic dosages.
The tannin content of the drug can lead to digestive
complaints, such as feeling of fullness or constipation.
Patients with a previous history of photosensitization to
various chemicals should be cautious of direct sun exposure
(Wheatley, 1998).