Last update: Oct. 28, 2014

Hypericum perforatum

Very Low Risk for breastfeeding


Safe. Compatible.
Not risky for breastfeeding or infant.

Herb commonly used from ancient times. Firm evidence is available on its effectiveness for treatment of depression, to the extent that it should be avoided a sudden stop of medication to prevent a rebound effect.

It has been also topically used for the treatment of wounds, burns and eczema due to healing and antiseptical properties.

Constituents are: Hypericin, Hyperforin and Quercetin. Antidepressant properties are attributed to Hypericin but mostly to Hyperforin. Quercetin is a flavonoid which is commonly found in many fruits and eatable vegetables.

Hyperforin is excreted into breast milk in nil or clinically non-significant amount with not side-effects reported among breastfed infants from treated mothers, except for isolated and dubious cases of somnolence and colicky pain with spontaneous resolution with no medical intervention being required. Plasma levels in those infants were undetectable or close to the lower detectable point (0.1μg/L).

Hypericin has not been detected in the breast milk. Quercetin levels found were as low as of few nanomols/L., and related to composition of fruits and vegetables of diet.

It is most important to make sure that composition and amount of Hypericum contained in commercially available products is correct, do not take it without medical surveillance, avoid sudden stop and consider pharmacological interactions with many other medications.

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Hypericum perforatum is also known as St. John´s Wort. Here it is a list of alternative known names::


Pharmacokinetics

Variable Value Unit
Molecular weight 504 daltons
Tmax 2 - 2,6 hours
T1/2 24,8 - 26,5 hours
Theoretical Dose 0,00009 mg/Kg/d
Relative Dose < 1 %

References

  1. Amer MR, Cipriano GC, Venci JV, Gandhi MA. Safety of Popular Herbal Supplements in Lactating Women. J Hum Lact. 2015 Abstract
  2. Sriraman NK, Melvin K, Meltzer-Brody S. ABM Clinical Protocol #18: Use of Antidepressants in Breastfeeding Mothers. Breastfeed Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  3. Dante G, Bellei G, Neri I, Facchinetti F. Herbal therapies in pregnancy: what works? Curr Opin Obstet Gynecol. 2014 Abstract
  4. Romaszko E, Wiczkowski W, Romaszko J, Honke J, Piskula MK. Exposure of breastfed infants to quercetin after consumption of a single meal rich in quercetin by their mothers. Mol Nutr Food Res. 2014 Abstract
  5. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Sep;132(3):e796-809. Abstract Full text (link to original source) Full text (in our servers)
  6. Song BJ, Jouni ZE, Ferruzzi MG. Assessment of phytochemical content in human milk during different stages of lactation. Nutrition. 2013 Abstract Full text (link to original source) Full text (in our servers)
  7. The Royal Women’s Hospital Victoria Australia. Herbal and Traditional Medicines in Breasfeeding. Fact Sheet. 2013 Full text (link to original source) Full text (in our servers)
  8. Budzynska K, Gardner ZE, Dugoua JJ, Low Dog T, Gardiner P. Systematic review of breastfeeding and herbs. Breastfeed Med. 2012 Abstract Full text (link to original source) Full text (in our servers)
  9. Davanzo R, Copertino M, De Cunto A, Minen F, Amaddeo A. Antidepressant drugs and breastfeeding: a review of the literature. Breastfeed Med. 2011 Abstract
  10. Amir LH, Pirotta MV, Raval M. Breastfeeding--evidence based guidelines for the use of medicines. Aust Fam Physician. 2011 Abstract Full text (link to original source) Full text (in our servers)
  11. Howland RH. Update on St. John's Wort. J Psychosoc Nurs Ment Health Serv. 2010 Abstract
  12. Canning S, Waterman M, Orsi N, Ayres J, Simpson N, Dye L. The efficacy of Hypericum perforatum (St John's wort) for the treatment of premenstrual syndrome: a randomized, double-blind, placebo-controlled trial. CNS Drugs. 2010 Abstract
  13. WHO. World Health Organization. WHO monographs on medicinal plants commonly used in the Newly Independent States (NIS). WHO monographs. 2010 Full text (in our servers)
  14. Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #18: use of antidepressants in nursing mothers. Breastfeed Med. 2008 Abstract Full text (link to original source) Full text (in our servers)
  15. Clauson KA, Santamarina ML, Rutledge JC. Clinically relevant safety issues associated with St. John's wort product labels. BMC Complement Altern Med. 2008 Abstract Full text (link to original source) Full text (in our servers)
  16. Kendall-Tackett K. A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. Int Breastfeed J. 2007 Abstract
  17. Klier CM, Schmid-Siegel B, Schäfer MR, Lenz G, Saria A, Lee A, Zernig G. St. John's wort (Hypericum perforatum) and breastfeeding: plasma and breast milk concentrations of hyperforin for 5 mothers and 2 infants. J Clin Psychiatry. 2006 Abstract
  18. Dugoua JJ, Mills E, Perri D, Koren G. Safety and efficacy of St. John's wort (hypericum) during pregnancy and lactation. Can J Clin Pharmacol. 2006 Abstract Full text (in our servers)
  19. Tschudin S, Lapaire O. [Antidepressants and pregnancy]. Ther Umsch. 2005 Abstract
  20. Tesch BJ. Herbs commonly used by women: an evidence-based review. Am J Obstet Gynecol. 2003 Abstract
  21. Lee A, Minhas R, Matsuda N, Lam M, Ito S. The safety of St. John's wort (Hypericum perforatum) during breastfeeding. J Clin Psychiatry. 2003 Abstract
  22. Klier CM, Schäfer MR, Schmid-Siegel B, Lenz G, Mannel M. St. John's wort (Hypericum perforatum)--is it safe during breastfeeding? Pharmacopsychiatry. 2002 Abstract
  23. Wurglics M, Westerhoff K, Kaunzinger A, Wilke A, Baumeister A, Dressman J, Schubert-Zsilavecz M. Comparison of German St. John's wort products according to hyperforin and total hypericin content. J Am Pharm Assoc (Wash). 2001 Abstract
  24. WHO. World Health Organization. Geneva. WHO monographs on selected medicinal plants. Volume 2. WHO monographs. 1999 Full text (link to original source) Full text (in our servers)

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