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Since May 10th 2008


Initial H



Hamamelis virginiana

Hypericum perforatum
Harpagophytum procumbens
Humulus lupulus
Hydrastis canadensis


 

 

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Hypericum perforatum L. (Clusiaceae/Guttiferae/Hypericaceae)

Synonyms
Hypericum officinarum Crantz, Hypericum officinale Gater ex. Steud., Hypericum vulgare Lam

Local names
Balsana, bassan, bossant, common St John’s Wort, corazoncillo, dendlu, devil’s scourge, echtes Johanniskraut, Eisenblut, erba di San Giovanni, flor de sao joao, fuga daemonum, hardhay, Hartheu, herbe à mille trous, herbe de millepertuis, Herrgottsblut, Hexenkraut, hierba de San Juan, hiperico, hipericon, houfarighoun, iperico, Jageteufel, Johannisblut, Johanniskraut, John’s wort, Jottannesort, klamath weed, Konradskraut, Liebeskraut, Lord God’s wonder plant, Mannskraft, millepertuis, pelicao, perforata, perforate St John’s wort, pinillo de oro, quian-ceng lou, St Jan’s kraut, St John’s Wort, seiyouotogiri, sint janskruid, tenturotou, Teufelsflucht, Tüpfelhartheu, witches’s herb, zwieroboij

Description
A herbaceous, aromatic perennial plant, up to 1m high; glabrous throughout, green or sometimes glaucous. Stems rounded, 2-winged, erect and branched at top. Leaves oval, linear-oblong, broadly elliptic, subcordate, flat or more or less revolute-marginated with pellucid glands and sometimes a number of brown-black glandular dots. Flowers numerous, forming a broadly paniculate, compound cymose inflorescence. Petals oblong to oblong-elliptic, inequilateral with numerous glandular dots. Seed 1mm long, cylindrical, brown, minutely pitted longitudinally

Plant material used
dried flowering tops or aerial parts

Chemical assays
Contains not less than 0.08% hypericins calculated as hypericin, as determined by spectrophotometry. Quantitation can also be obtained by highperformance liquid chromatography

Major chemical constituents
The major characteristic constituents includ 0.05–0.30% naphthodianthrones (hypericin, pseudohypericin, hyperforin, adhyperforin); 2–4% flavonoids (hyperoside, quercitrin, isoquercitrin, rutin); and 7–15% catechin tannins

Medicinal uses
Uses supported by clinical data
Symptomatic treatment of mild and moderate depressive episodes (classified as F32.0 and F32.1, respectively, in the International statistical classification of diseases and related health problems, Tenth revision (ICD-10).

Uses described in pharmacopoeias and well established documents
Externally for the treatment of minor cuts, burns and skin ulcers. Topically for viral infections

Uses described in traditional medicine
As an antiphlogistic agent in the treatment of inflammation of the bronchi and urogenital tract; treatment of biliary disorders, bladder irritation, the common cold, diabetes mellitus, dyspepsia, haemorrhoids, neuralgia, migraine headaches, sciatica and ulcers. Also used as a diuretic, an emmenagogue and an antimalarial agent

Proven pharmacological activity
Animal studies
Antidepressant, Smooth muscle relaxant, Antibacterial and antiviral, Wound healing

Human studies
Antidepressant, Photodynamic for skin disorder

Contraindications
Herba Hyperici is contraindicated in cases of known allergy to plants of the Clusiaceae family.

Warnings
As with other antidepressant drugs, observation of the therapeutic effects of Herba Hyperici may require 2–4 weeks of therapy. If a significant antidepressant effect is not observed after 6 weeks of treatment, a physician should be consulted.

Precautions
General
Ultraviolet treatments or prolonged exposure to direct sunlight should be avoided when Herba Hyperici is used, as photosensitization may occur in lightsensitive individuals. (See Adverse reactions.)

Drug interactions
Although the ingestion of foods containing high concentrations of tyramine such as pickled or smoked foods and cheese, and selective serotonin reuptake inhibitors such as fluoxetine are contraindicated with MAO inhibitors, in vivo data linking Herba Hyperici to MAO inhibition are lacking. The com-bination of Herba Hyperici with other standard antidepressant drugs, such as tricyclic antidepressants or fluoxetine, is not recommended, unless under medical supervision. There are now numerous reports in the medical literature indicating that Herba Hyperici extracts induce hepatic enzymes that are responsible for drug metabolism and may reduce the serum levels and therapeutic efficacy of drugs. Coadministration of theophylline with a Herba Hyperici extract lowered the serum level of theophylline in a patient previously stabilized, requiring an increase in the theophylline dose. Coadministration of Herba Hyperici and digoxin reduced serum digoxin concentrations after 10 days of treatment. A decrease in serum cyclosporin, warfarin and phenprocoumon concentrations was seen in patients after they had additionally taken Herba Hyperici extracts. Concomitant use of Herba Hyperici in five patients previously stabilized on serotonin-reuptake inhibitors resulted in symptoms of central serotonin excess. The United States Food and Drug Administration has publicized a report concerning a significant drug interaction between Herba Hyperici and indinavir, a protease inhibitor used to treat HIV infections. Herba Hyperici substantially reduced indinavir plasma concentrations, due to induction of the cytochrome P450 metabolic pathway. As a consequence, the concomitant use of Herba Hyperici and protease inhibitors or non-nucleoside reverse transcriptase inhibitors is not recommended and may result in suboptimal antiretroviral drug concentrations, leading to a loss of virucidal activity and the development of resistance

Carcinogenesis, mutagenesis, impairment of fertility
The mutagenicity of hydroalcoholic extracts of Herba Hyperici containing 0.2–0.3% hypericin and 0.35mg/g quercetin has been studied in various in vitro and in vivo systems. The in vitro studies were performed using the Salmonella/microsome assay, hypoxanthine guanidine phosphoribosyl transferase test (up to 4ml/ml), unscheduled DNA synthesis test (up to 1.37ml/ml), cell transformation test in Syrian hamster embryo cells (up to 10ml/ml) and spot test in mice (up to 10ml/ml). The in vivo tests included the chromosome aberration test with bone marrow cells of Chinese hamsters (10ml/kg body weight, gastric lavage) and the micronucleus test in rodent bone marrow (2g/kg body weight, gastric lavage). Although some positive results were observed in vitro in the Salmonella/microsome assay, all the in vivo tests were negative, indicating that the hydroalcoholic extract was not mutagenic in animals. In a 26-week study, intragastric administration of the hydroalcoholic extract to rats and dogs (900 and 2700mg/kg body weight) had no effect on fertility, development of the embryo, or pre- or postnatal development.

Other precautions
No information available on precautions concerning drug and laboratory test interactions; teratogenic and non-teratogenic effects in pregnancy; nursingmothers; or paediatric use. Therefore, Herba Hyperici should not be administered during pregnancy or lactation or to children without medical supervision.

Adverse reactions
Phototoxicity has been reported in cattle after ingestion of H. perforatum during grazing. However, the doses were estimated to be approximately 30–50 times higher than normal therapeutic doses. Photosensitization in lightsensitive individuals has been demonstrated in a controlled clinical trial involving metered doses of hypericin and exposure to ultraviolet A and B irradiation. Patients were treated with 600 mg of a hydroalcoholic extract of the herb (containing 0.24–0.32% total hypericin) three times daily for 15 days. A measurable increase in erythema in light-sensitive individuals was observed after ultraviolet A irradiation. The plasma concentration of hypericin and pseudohypericin in these subjects was double that seen during normal therapeutic treatment of depression. A single case of reversible erythema after exposure to ultraviolet B has been reported in one patient who had been taking the herb for 3 years. A single case of acute neuropathy after exposure to sunlight has been repor ed in one patient taking the herb. Drug-monitoring studies indicate that side-effects of the herb are rare and mild, and include minor gastrointestinal irritations, allergic reactions, tiredness and restlessness. However, these studies did not last longer than 8 weeks. Clinical studies have suggested that the use of the herb does not affect general performance or the ability to drive.

Dosage forms
Dried crude drug for decoction, powdered drug or extracts in capsules, tablets, tinctures and drops. Topical preparations include the oil, infusions, compresses, gels and ointments. Store in a well-closed container, protected from light.

Posology
(Unless otherwise indicated)
Daily dosage: 2–4g crude drug. Internal use: standardized tinctures or fluidextracts, or standardized hydroethanolic or dried hydromethanolic extracts, up to a daily dose of 900mg extract (equivalent to 0.2– 2.7 mg total hypericin)

 

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