Should I Take St. John’s Wort? Clinical Considerations

So, what would you say if a patient asked you, “Should I take St. John’s Wort?” My gut screams no! St. John’s Wort is a substantial inducer of many CYP enzymes which can play havoc with many different drugs and their respective levels.  However, we need to take everything into account before blindly saying no.  Here’s a few things I would consider before making a decision on if I would be ok with a patient taking this supplement.

  1. What do they want to take it for?  Figuring out what the indication is for would be step one.  I would initially suspect they would want it for depression, but you don’t know unless you ask.
  2. What’s been tried?  I’m going to assume most patients would ask about it for depression.  Looking back at past medical history and figuring out what medications have been tried may provide you some insight as to why they want to use an herbal supplement with tons of medication interactions.  If they have failed numerous other traditional prescription therapy medications, you could understand that they may be disheartened.
  3. What other drugs are they on?  If this is a patient on 10+ medications or more, you’re asking for more trouble than it is likely worth.
  4. How strongly does the patient feel about it?  If it was merely an idea from a friend or relative, you can likely explain some of the risks associated with St. John’s Wort and why you think an alternative is more appropriate.
  5. Is the patient willing/capable of being their own advocate and telling every healthcare professional they encounter that they are on St. John’s Wort.  This will be incredibly important whenever they are prescribed new medications because herbal supplements are often overlooked or not asked about.

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Written By Eric Christianson

May 31, 2017

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