Last update July 7, 2022
Very Low Risk
St. John's wort or hypericum is a herb commonly used from ancient times. Firm evidence is available on its effectiveness for treatment of depression (Howland 2010), 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 (Klier 2006 & 2002), with not side-effects reported among breastfed infants from treated mothers (Klier 2006 & 2002), except for isolated and dubious cases of somnolence and colicky pain with spontaneous resolution with no medical intervention being required. (Lee 2003)
Hypericin has not been detected in the breast milk (Klier 2002). Quercetin levels found were as low as of few nanomols/L, and related to composition of fruits and vegetables of diet. (Romaszko 2014, Song 2013)
Plasma hypericin and hyperforin levels in these infants were undetectable or at the limit of detection. (Klier 2006 y 2002)
Hypericum does not affect milk production or prolactin levels. (Canning 2010, Lee 2003)
It is 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. (Tesch 2003, Wurglics 2001)
Until more published data is known about this drug in relation to breastfeeding, known safer alternatives may be preferable(Royal W 2013, Sachs 2013, Amir 2011, Dugoua 2006), especially during the neonatal period and in the event of prematurity.
Precautions when taking plant preparations (Anderson 2017, Powers 2015, Posadzki 2013, Efferth 2011, Kopec 1999, Hsu 1995):
Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.
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e-lactancia is a resource recommended by Academy of Breastfeeding Medicine - 2012 of United States of America
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