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Table e4–2 provides an overview of selected botanical medicines.

Table e4–2.Overview of selected botanical medicines (listed in alphabetical order).

A. ST. JOHN'S WORT (Hypericum Perforatum)

St. John's wort is a perennial plant with a yellow flower native to Europe and naturalized to North America. Most preparations are standardized to hypericin or hyperforin. St. John's wort inhibits serotonin, norepinephrine, and dopamine reuptake in the CNS and may modulate autonomic system reactivity. Data from 35 double-blind, randomized, controlled trials (RCTs) show that dropout and adverse event rates in patients receiving Hypericum extracts were less than for tricyclic antidepressants or SSRIs. Side effects include GI upset, photosensitivity, mild headache, and restlessness. Cases of withdrawal symptoms like those that occur with pharmaceutical antidepressants have been described, so gradual tapering of dose is recommended when therapy is terminated. Patients are advised to avoid taking St. John's wort in combination with prescription antidepressants because there have been case reports of the serotonin syndrome. Importantly, St. John's wort also potently induces the cytochrome P450 system (isozyme CYP3A4), which may ...

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