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What is St. John's wort?
The use of St. John's wort in cultural and traditional settings may differ from concepts accepted by current Western medicine. When considering the use of herbal supplements, consultation with a primary health care professional is advisable. Additionally, consultation with a practitioner trained in the uses of herbal/health supplements may be beneficial, and coordination of treatment among all health care providers involved may be advantageous. St. John's wort is also known as Hypericum perforatum, klamath weed, John's wort, amber touch-and-heal, goatweed, rosin rose, and milleperituis.

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What are the possible side effects of St. John's wort?

Although uncommon, allergic reactions to St. John's wort have been reported. Stop taking St. John's wort and seek emergency medical attention if you experience symptoms of a serious allergic reaction including difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives.

Other less serious side effects have been more frequently reported. Talk to your doctor or pharmacist if you experience

• increased skin sensitivity to sunlight,

• a rash,

• a feeling of fullness in your stomach, or

• constipation.

Side effects other than those listed here may also occur. Talk to your doctor, pharmacist, or health care provider about any side effect that seems unusual or that is especially bothersome.

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How should I take St. John's wort?
The use of St. John's wort in cultural and traditional settings may differ from concepts accepted by current Western medicine. When considering the use of herbal supplements, consultation with a primary health care professional is advisable. Additionally, consultation with a practitioner trained in the uses of herbal/health supplements may be beneficial and coordination of treatment among all health care providers involved may be advantageous. If you choose to take St. John's wort, use it as directed on the package or as directed by your doctor, pharmacist, or other health care provider.

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What is the most important information I should know about St. John's wort?
Avoid prolonged exposure to sunlight. St. John's wort may increase the sensitivity of your skin to the sun. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable. St. John's wort has not been evaluated by the FDA for safety, effectiveness, or purity. All potential risks and/or advantages of St. John's wort may not be known. Additionally, there are no regulated manufacturing standards in place for these compounds. There have been instances where herbal/health supplements have been sold which were contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

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What happens if I miss a dose?
No information is available regarding a missed dose of St. John's wort. Consult your doctor, pharmacist, or health care professional if you require further information.

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What other drugs will affect St. John's wort?
St. John's wort may interact with many other medicines, possibly increasing side effects or resulting in decreased therapeutic effects. Do not take St. John's wort without first talking to your doctor if you are taking any other medicines, especially any of the following: a monoamine oxidase inhibitor such as tranylcypromine (Nardil), phenelzine (Parnate), or isocarboxazid (Marplan); a selective serotonin reuptake inhibitor such as citalopram (Celexa), fluvoxamine (Luvox), fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft);

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Can I take this if I am pregnant or trying to get pregnant or if I am breastfeeding?

Do not take St. John's wort without first talking to your doctor if you are pregnant or could become pregnant. It is not known whether St. John's wort will be harmful to an unborn baby.

Do not take St. John's wort without first talking to your doctor if you are breast-feeding a baby. It is also not known whether St. John's wort will be harmful to a nursing infant.

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What happens if I overdose?
Seek emergency medical attention. Symptoms of a St. John's wort overdose are not known.

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Who should not take St. John's wort?
Before taking St. John's wort, talk to your doctor, pharmacist, or health care professional if you have any other medical conditions, allergies (especially to plants), or if you take other medicines or other herbal/health supplements. St. John's wort may not be recommended in some situations. Do not take St. John's wort without first talking to your doctor if you are pregnant or could become pregnant. It is not known whether St. John's wort will be harmful to an unborn baby. Do not take St. John's wort without first talking to your doctor if you are breast-feeding a baby. It is also not known whether St. John's wort will be harmful to a nursing infant.

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Can I stop taking the medication if I feel better?
As a general rule, you should always take your medications exactly as prescribed and do not change the dosage or stop taking the medication without first discussing it with your healthcare provider.

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I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.

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