For practitioner dispensing and professionally guided use.
Always read the label and follow the directions for use.
St John’s Wort can interact with many prescription, over-the-counter and complementary medicines.
Do not use it with medication unless the complete combination has been checked by a doctor or pharmacist who knows all medicines and supplements being taken.
St John’s Wort may affect drug-metabolising enzymes and transport proteins. This can reduce the effectiveness of some medicines or alter their blood concentrations.
Clinically important interactions may occur with hormonal contraceptives, anticoagulants, antiplatelet medicines, transplant medicines, HIV medicines, antiviral medicines, cancer treatments, heart medicines, seizure medicines, statins, sedatives, opioids and many other prescriptions.
St John’s Wort may reduce the effectiveness of oral contraceptive pills, implants and other forms of hormonal contraception.
Breakthrough bleeding may indicate altered contraceptive hormone exposure but does not reliably confirm whether contraception remains effective.
People using hormonal contraception require medical or pharmacist advice about suitability and appropriate additional contraceptive protection.
Do not combine St John’s Wort casually with antidepressants or other serotonin-affecting medicines and supplements.
This includes monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, serotonin-noradrenaline reuptake inhibitors, tricyclic antidepressants, migraine triptans, tramadol, dextromethorphan, buspirone, 5-HTP, tryptophan and SAMe.
Combining several serotonin-affecting products may contribute to excessive serotonergic effects.
Seek urgent medical attention for severe agitation, confusion, fever, heavy sweating, diarrhoea, tremor, muscle rigidity, overactive reflexes or a rapidly racing heartbeat.
Do not use without specialist approval if you take cyclosporine, tacrolimus, sirolimus or another medicine used to prevent organ rejection.
Reduced transplant-medicine concentrations can result in loss of treatment effectiveness and organ rejection.
Do not use alongside cancer treatment, HIV treatment, antiviral medicine, warfarin or another medicine requiring precise blood-level control unless specifically approved and monitored by the treating specialist.
Do not start, stop or alter St John’s Wort around prescribed medication without professional guidance. Medicine concentrations may change when the herb is introduced and may rise again when it is discontinued.
Do not use St John’s Wort as a substitute for antidepressant medication, counselling, psychotherapy or professional mental-health care.
Do not suddenly stop antidepressant or other mental-health medication to begin St John’s Wort.
This product is not suitable for serious depression or severe mental-health symptoms.
People with bipolar disorder, a history of mania, psychosis, schizophrenia or significant mood instability should not use St John’s Wort without specialist medical supervision.
St John’s Wort may contribute to agitation, mood elevation, mania or worsening psychotic symptoms in susceptible people.
Seek urgent assistance for suicidal thoughts, self-harm thoughts, hallucinations, severe agitation, rapidly escalating behaviour or an inability to remain safe.
St John’s Wort may increase sensitivity to sunlight and artificial ultraviolet radiation.
The risk may be more relevant with higher doses or higher-strength preparations.
Avoid excessive sunlight, tanning beds and intense ultraviolet exposure while using the product.
Use protective clothing and broad-spectrum sunscreen when outdoors.
Stop use and seek professional advice if unusual sunburn, marked skin redness, blistering, eye discomfort or another photosensitivity reaction develops.
Use cautiously if you have an existing photosensitivity condition or take medication known to increase sensitivity to sunlight.
Possible side effects may include digestive discomfort, dry mouth, headache, dizziness, fatigue, restlessness, anxiety, insomnia, confusion, sexual dysfunction or increased sensitivity to sunlight.
Use during pregnancy only under the supervision of an appropriately qualified healthcare practitioner.
Use cautiously while breastfeeding and only with professional guidance.
Adequate safety information has not been established for routine unsupervised use during pregnancy or breastfeeding.
Use in children and adolescents under 18 years of age is not recommended unless specifically prescribed and medically supervised.
The High Grade preparation contains 60% ethanol.
Do not apply the undiluted liquid directly to wounds, inflamed skin, psoriasis plaques, the eyes or mucous membranes.
Where a practitioner specifically recommends topical use, 5 mL may be incorporated into 45 g of vitamin E cream. The finished preparation should be correctly compounded, labelled and used only as directed.
A professionally prepared topical cream is not equivalent to applying the concentrated liquid extract directly to the skin.
Discontinue use at least seven days before general anaesthesia, surgery, dental surgery or an invasive procedure unless otherwise directed by the treating medical team.
Tell the surgeon, anaesthetist, dentist and pharmacist that St John’s Wort has been used.
Contains ethanol.
Keep out of reach of children.
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