St. John’s Wort / Hypericum perforatum

The Basics

What is St. John’s Wort / Hypericum perforatum?

Naturally found in the yellow flower of Hypericum perforatum with antidepressant, potential antiviral, antineoplastic and immunostimulating activities.

Brand names for St. John’s Wort / Hypericum perforatum

N/A

How St. John’s Wort / Hypericum perforatum is classified

Anti-Anxiety Agents, Antidepressive Agents, Complementary Therapies, Phytotherapy, Plants, Medicinal

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St. John’s Wort / Hypericum perforatum During Pregnancy

St. John’s Wort / Hypericum perforatum pregnancy category

Category N/A
Note that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking St. John’s Wort / Hypericum perforatum while pregnant

Is it safe to take St. John’s Wort while pregnant? Relevant published information pertaining to St. John’s Wort and pregnancy was not found as of the revision date.

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Taking St. John’s Wort / Hypericum perforatum While Breastfeeding

What are recommendations for lactation if you're taking St. John’s Wort / Hypericum perforatum?

St. John’s wort (Hypericum perforatum) contains hypericin and hyperforin as well as flavonoids such as quercetin. It is often recommended by midwives for postpartum depression.[1][2] Both hypericin and hyperforin are poorly excreted into breastmilk; no other components have been measured in milk. One study found a slightly increased frequency of colic, drowsiness and lethargy among breastfed infants whose mothers were taking St. John’s wort, but none of the effects were severe or required treatment. Most reports have related to breastfeeding older infants, rather than during the first 2 months postpartum when infants are more susceptible to adverse reactions. Conflicting information exists on whether St. John’s wort can reduce serum prolactin levels or the maternal milk supply. St. John’s wort adversely interacts with many drugs by increasing their metabolism, and it can occasionally cause phototoxicity. Labeling of commercially available products in the United States is often deficient with respect to these known safety issues.[3] Because there is little published experience with St. John’s wort during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.[3] Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products.

Maternal / infant drug levels

St. John’s wort (Hypericum perforatum) contains hypericin and hyperforin as well as flavonoids such as quercetin. It is often recommended by midwives for postpartum depression.[1][2] Both hypericin and hyperforin are poorly excreted into breastmilk; no other components have been measured in milk. One study found a slightly increased frequency of colic, drowsiness and lethargy among breastfed infants whose mothers were taking St. John’s wort, but none of the effects were severe or required treatment. Most reports have related to breastfeeding older infants, rather than during the first 2 months postpartum when infants are more susceptible to adverse reactions. Conflicting information exists on whether St. John’s wort can reduce serum prolactin levels or the maternal milk supply. St. John’s wort adversely interacts with many drugs by increasing their metabolism, and it can occasionally cause phototoxicity. Labeling of commercially available products in the United States is often deficient with respect to these known safety issues.[3] Because there is little published experience with St. John’s wort during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.[3] Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products.

Possible effects of St. John’s Wort / Hypericum perforatum on milk supply

In a matched cohort study of 33 women who reported that they had taken St. John’s wort during breastfeeding (described in more detail above in Reported Side Effects In Breastfed Infants ), no evidence was found of lower milk production among mothers taking St. John’s wort during breastfeeding.[10]
Thirty-six women with mild premenstrual syndrome received St. John’s wort 450 mg twice daily as coated tablets (Jarsin brand) or placebo for two menstrual cycles. Serum prolactin levels of the women randomized to active treatment (n = 19) were not statistically different from those of the women who received placebo (n = 17) in either the follicular or luteal phase of their menstrual cycles.[11]
Studies in healthy volunteer males (n = 12) given single doses of 2700 mg of St. John’s wort (Jarsin brand) had a drop in serum prolactin that was statistically significant between 150 and 210 minutes after administration.[12]
The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

Possible alternatives to St. John’s Wort / Hypericum perforatum

Nortriptyline, Paroxetine, Sertraline.

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