Johanniskraut H&s (Hyperici Herba)

Johanniskraut H&s, a herbal antidepressant, acts on neurotransmitter pathways associated with mood regulation.

• Mild depression: helps improve mood and reduce depressive symptoms.
• Moderate depression: supports alleviation of depressive signs when used as an adjunct therapy.
• Seasonal affective disorder: may lessen mood swings during seasonal changes.

• Hyperici Herba exerts its effect by inhibiting the reuptake of serotonin, norepinephrine, and dopamine, thereby increasing their synaptic availability. It also modulates inflammatory pathways and influences neurotrophic factors, contributing to its antidepressant and mood‑stabilising properties without direct receptor agonism.

Adverse reactions have been reported with oral Hyperici Herba preparations.

Common Side Effects

• Gastrointestinal upset: nausea, stomach discomfort, or diarrhoea.
• Photosensitivity: increased skin sensitivity to sunlight.
• Dizziness or light‑headedness.
• Fatigue or mild drowsiness.
• Headache.
• Dry mouth.

Serious or Rare Side Effects

• Serotonin syndrome: risk when combined with other serotonergic agents.
• Severe allergic reactions: rash, itching, or swelling.
• Hepatotoxicity: rare liver enzyme elevations.
• Mania or hypomania in susceptible individuals.
• Severe phototoxic skin reactions.
• Emergence of suicidal thoughts or behaviours.

When considering Johanniskraut H&s, several safety measures are recommended.

• Pregnancy: safety not established; avoid unless specifically prescribed.
• Breastfeeding: unknown safety profile; consider alternative therapies.
• Drug interactions: review all concomitant serotonergic or CYP‑inducing medications.
• Photosensitivity: advise patients to use sun protection and avoid prolonged UV exposure.
• Psychiatric monitoring: watch for mood switching, especially in bipolar disorder.
• Store at ambient temperature: keep in the original pack, protect from moisture and light.

Hyperici Herba can affect the pharmacokinetics and pharmacodynamics of several medicines.

Major Interactions (Avoid)

• SSRIs (e.g., fluoxetine, sertraline): risk of serotonin syndrome.
• MAO inhibitors (e.g., phenelzine): potential severe hypertensive crisis.
• Tricyclic antidepressants (e.g., amitriptyline): increased plasma concentrations.

Moderate Interactions (Monitor Closely)

• Warfarin: may enhance anticoagulant effect, requiring INR monitoring.
• Oral contraceptives: may reduce hormonal efficacy, increasing risk of breakthrough bleeding.
• Antiepileptics (e.g., carbamazepine, phenytoin): may lower Hyperici levels, reducing therapeutic benefit.