Education health care providers need to be cautious

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EducationHealth care providers need to be cautious with patients taking St. John’s wort. Most of the research on this herbal supplement was done before 2010, and not a lot of further research has been done [Sap17]. This could cause more problems as so many new medications have been introduced since 2010. Providers should educate patients about the risks of St. John’s wort when taking with other drugs, especially those medications that already have shown evidence of interaction with the herb. References
Saper, R. B. (2017, December 6). Clinical use of St. John's Wort.Retrieved from UpTpDate: -wort?search=St.%20Johns%20Wort&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
Clinical use of St. John's wortAuthor:Robert B Saper, MD, MPHSection Editor:Joann G Elmore, MD, MPHDeputy Editor:Judith A Melin, MA, MD, FACPContributor DisclosuresAll topics are updated as new evidence becomes available and our peer review processis complete.Literature review current through:Aug 2018. | This topic last updated:Dec 06, 2017.INTRODUCTION— St. John's wort (Hypericum perforatum) is a five petal yellow flower (picture1) that has been used medicinally since antiquity [1]. It was commonly referred to as "Fuga Demonum" (the devil's scourge) since it was used to protect against demonic possession and "evil spirits" [2]. One of the earliest references to the name St. John's wort is noted in a Gaelic legend from the sixth century where the missionary St. Columba carried a piece of St. John's wort because of his high regard for St. John [1]. It is believed that the name may have been derived from the fact that the flowers bloom around June 24th, the birthday of St. John the Baptist. Wort represents the old English term for plant.St. John's wort has been utilized mainly for its antidepressant activity, but also for its purported antiinflammatory and wound healing properties [3]. The 2007 National Health Interview Survey found a large decrease in St. John's wort use by adults in the United States [4]. In 2002, St. John's wort was the sixth most popular natural product in the United States, used by 2.2 percentof American adults [5]. In 2007, St. John's wort was not among the 20 most commonly used dietary supplements [4]. This decrease may reflect the public's response to interim news reportsof negative clinical trials [6-8] and potentially harmful interactions with prescription drugs [9-22].Patients considering the use of St. John's wort should be counseled and cautioned regarding evidence of effectiveness and safety, the variability and lack of regulation in St. John's wort products in the United States, and the potential for herb-drug interactions.MECHANISM OF ACTION— A number of compounds isolated from St. John's wort possess pharmacologic activity. Naphthodianthrones (hypericin, pseudohypericin, protohypericin, protopseudohypericin, and cyclopseudohypericin), flavonoids (quercetin, rutin, and luteolin), hyperforin, several amino acids, and tannins have been isolated [23].

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