Last update July 7, 2022

St. John´s Wort

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

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):

  • Make sure they are from a reliable source: poisonings have occurred due to confusion of one plant with another with toxic properties (Hsu 1995), poisonings due to containing heavy metals extracted from the soil, and food poisoning due to contamination with bacteria or fungi. (Anderson 2017)
  • Do not take in excess; follow the recommendations of expert phytotherapy professionals. “Natural” products are not good in any quantity: plants contain active substances from which much of our traditional pharmacopoeia has been obtained and can cause poisoning or act as endocrine disruptors if consumed in quantity or for an exaggerated time because they contain phytoestrogens. (Powers 2015, Zava 1998)

 


See below the information of this related product:

  • Maternal Depression (Moderately safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)

Alternatives

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.

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.

Pharmacokinetics

Variable Value Unit
Molecular weight 504 daltons
Tmax 2 - 2.6 hours
24.8 - 26.5 hours
M/P ratio 0.1 -
Theoretical Dose 0.0009 - 0.005 mg/Kg/d
Relative Dose 0.9 - 2.5 %

References

  1. Anderson PO. Herbal Use During Breastfeeding. Breastfeed Med. 2017 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. Powers CN, Setzer WN. A molecular docking study of phytochemical estrogen mimics from dietary herbal supplements. In Silico Pharmacol. 2015 Mar 22;3:4. Abstract Full text (link to original source) Full text (in our servers)
  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. Posadzki P, Watson L, Ernst E. Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews. Eur J Clin Pharmacol. 2013 Abstract
  6. 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)
  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. 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)
  9. 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)
  10. Amir LH, Pirotta MV, Raval M. Breastfeeding--evidence based guidelines for the use of medicines. Aust Fam Physician. 2011 Sep;40(9):684-90. Review. Abstract Full text (link to original source) Full text (in our servers)
  11. Efferth T, Kaina B. Toxicities by herbal medicines with emphasis to traditional Chinese medicine. Curr Drug Metab. 2011 Abstract
  12. 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)
  13. Howland RH. Update on St. John's Wort. J Psychosoc Nurs Ment Health Serv. 2010 Abstract
  14. 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
  15. 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)
  16. 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
  17. 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)
  18. WHO. World Health Organization. Geneva. WHO monographs on selected medicinal plants. Volume 2. WHO monographs. 2004 Full text (link to original source) Full text (in our servers)
  19. 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
  20. Tesch BJ. Herbs commonly used by women: an evidence-based review. Am J Obstet Gynecol. 2003 Abstract
  21. 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
  22. 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
  23. Kopec K. Herbal medications and breastfeeding. J Hum Lact. 1999 Jun;15(2):157-61. Review. No abstract available. Abstract
  24. Zava DT, Dollbaum CM, Blen M. Estrogen and progestin bioactivity of foods, herbs, and spices. Proc Soc Exp Biol Med. 1998 Abstract
  25. Hsu CK, Leo P, Shastry D, Meggs W, Weisman R, Hoffman RS. Anticholinergic poisoning associated with herbal tea. Arch Intern Med. 1995 Abstract

Total visits

33,546

Help us improve this entry

How to cite this entry

Do you need more information or did not found what you were looking for?

   Write us at elactancia.org@gmail.com

e-lactancia is a resource recommended by AELAMA of Spain

Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM