العرن المثقوب او عشبة القديس يوحنا او عشبة القديسين أو نبتة سانت جونز أو نبتة سيدي يحيى Hypericum, St John's wort (Hypericum perforatum) Part used: dried flowering tops (better) or with leaves or aerial parts. Constituents: 1- Naphthodianthrones (usually 0.3% total hypericins), including hypericin and pseudohypericin. 2- Prenylated phloroglucinol derivatives including hyperforin and adhyperforin; standardise for hyperforin (usually 2% to 5%). 3- xanthones (dibenzo-γ-pirone) 4- Flavonoids (such as biapigenin, quercetrin and rutin) and procyanidins 5- essential oil.

1. HERBAL MEDICINE
ST JOHN'S WORT
DR. MOSTAFA MAHMOUD HEGAZY PH.D

2. Herbal medicine Dr. Mostafa Hegazy
‫او‬ ‫المثقوب‬ ‫العرن‬
‫عشبة‬
‫او‬ ‫يوحنا‬ ‫القديس‬
‫عشبة‬
‫سان‬ ‫نبتة‬ ‫أو‬ ‫القديسين‬
‫أو‬ ‫جونز‬ ‫ت‬
‫يحيى‬ ‫سيدي‬ ‫نبتة‬
Hypericum, St John's wort
(Hypericum perforatum)
 Part used: dried flowering tops (better) or with leaves or aerial
parts.
 Constituents:
1- Naphthodianthrones (usually 0.3% total hypericins), including
hypericin and pseudohypericin.
2- Prenylated phloroglucinol derivatives including hyperforin and
adhyperforin; standardise for hyperforin (usually 2% to 5%).
3- xanthones (dibenzo-γ-pirone)
4- Flavonoids (such as biapigenin, quercetrin and rutin) and procyanidins
5- essential oil.

3. Herbal medicine Dr. Mostafa Hegazy
 Main Actions
1- Moderate antidepressant activity.
2- Useful for wound healing.
3- Antiseptic: antibacterial, antifungal activity and Antiviral
activity with potential applicability to disorders caused by
enveloped viruses (cold sores, herpes genitalis, chicken pox,
CMV and viral hepatitis) and retroviruses.
4- Anti-inflammatory activity
 Other actions
5- Anticancer activity: Hypericin a photosensitiser in
photodynamic therapy (PDT).

4. Herbal medicine Dr. Mostafa Hegazy
 Indications supported by clinical trials
 I- nervous system
1- Treatment of mild-to-moderate depression (high level evidence).
hypericum standard dose as effective as lower dose of tricyclic and
standard dose of SSRIs and better tolerated.
2- treatment of anxiety
3- adjunct to light therapy for seasonal affective disorder (SAD)
4- obsessive-compulsive disorder and social phobia.
 II- Skin
1- orofacial and genital herpes.
2- topically for wound healing and reducing scar formation.
3- topical treatment of subacute mild-to-moderate atopic dermatitis
(eczema) and psoriasis.

5. Herbal medicine Dr. Mostafa Hegazy
 Indications supported by clinical trials (cont.)
 III- Men and women
1- Premature ejaculation.
2- Psychological symptoms of menopause.
3- Premenstrual syndrome.
 IV - Oil of hypericum
Internally (dyspepsia)
Externally (wounds, bruises, myalgia , burns)..

6. Herbal medicine Dr. Mostafa Hegazy
Mechanism of action
I- Antidepressant activity :
1- Neurotransmitter (Like Selective serotonin reuptake
inhibitor but not selective): restores serotonin levels in
synapses by preventing its reuptake by the presynaptic neuron
after impulse and subsequent degradation by COMT and MAO
(Weak Inhibition).
2- suppression of interleukin-6 releases which may assist in
deactivating the Hypothalamic-Pituitary-Adrenal axis.
3- Receptors: Significant receptor binding affinity for
adenosine (non-specific), GABA-A, GABAB, benzodiazepine,
inositol triphosphate (extract and hypericin) and Upregulation
of central serotonergic receptors from cerebral tissue.

7. Herbal medicine Dr. Mostafa Hegazy
II- Delayed ejaculation
Dose-dependent inhibition of contractions in human vas deferens
for the whole extract, and for hyperforin.
III- Wound healing/anti-inflammatory activities (topically
and orally)
1- antibacterial and/or anti-inflammatory activities.
2- Collagen
A- increase the stimulation of fibroblast collagen production
B- facilitation of the collagen maturation phase of wound
healing,
3- activation of fibroblast cells that play a role in wound repair
by closing the damaged area
4-enhanced new skin growth and an influence on epithelial cell
proliferation and migration.

8. Herbal medicine Dr. Mostafa Hegazy
Dose generally and Preparation method
Dried herb: 2 to 5 g/day of dried herb or the equivalent of 1.0 to
2.7 mg/day of total hypericin (TH) for 4- 6 weeks
Tablets or capsules: 350 to 1800 mg daily (equivalent to 0.4 to
2.7 mg hypericin daily).
No restriction of use duration, but at least 4 weeks of treatment
is required to assess the antidepressant effect.
For premature ejaculation: 1.5 g infusion or 1 tab. About
(about 250 mg) 3 hours before
Preparation may vary in potency different doses may be
required if switching brand.
Practical part for special preparation : ?????????

9. Herbal medicine Dr. Mostafa Hegazy
Interactions (if any) with other drugs or herbs or food
1- Metabolic or pharmacokinetic interactions (potent inducer
of the cytochrome P450
irinotecan, amitriptyline, phenprocoumon and warfarin,
fexofenadine, alprazolam and midazolam, protease
inhibitors, “ antiviral drugs against viruses such as flus and
HIV” cyclosporin, digoxin, statin drugs, methadone and
several oral contraceptives (additional contraceptive measure
e.g. condom), theophylline, carbamazepine and phenytoin.
2- Pharmacodynamic interactions, Hypericum augments
SSRI and MAO inhibitors, leading to excess serotonin
availability in the CNS which may lead to Serotonin syndrome.
3- Tyramine in foods (e.g. cheeses, red wine, etc).

10. Herbal medicine Dr. Mostafa Hegazy
Egyptian pharmaceutical products (if any).
Sekem mood® herbs 10 filter bags, Anti Dep® 150 Cap, Nobur®
cream (moisturizing), Momentum® 300 Cap, safamood® 250 f.c.
tablet, safamood fort® 600 f.c. tablet, Hyperoil® 50 ml oil dropping
bottle, Hyperoil® 3ml gel, sedanurin® tab, Acnora® cream
Adverse effects (if any)
Dry mouth, constipation, dizziness, photosensitivity (rare only with
high doses and long period of exposure to tropical and subtropical
sun) and serotonin syndrome with SSRI.
Contraindications (if any)
It is not suited for the treatment of serious depression with
psychotic symptoms, suicidal risk or signs and symptoms that
are so severe that they do not allow the patient’s family or work
involvements to continue.

11. Herbal medicine Dr. Mostafa Hegazy

12. Herbal medicine Dr. Mostafa Hegazy
Precautions (if any)
1- Avoidance of excessive exposure to sunlight.
2- Avoidance of tyramine-containing foods (cheeses,
beer and wine) and drugs such as L-dopa is not
necessary.
3- If no significant response after 4 to 6 weeks, the
treatment should be discontinued,.
4- Use cautiously in patients with a history of mania or
hypomania (as in bipolar disorder) due to the possibility
of Hypericum-induced manic episodes.
5- should be discontinued at least 1 week prior to
surgery
6- avoided in patients with known sensitivity to St John’s
wort or any of its constituents.

13. Herbal medicine Dr. Mostafa Hegazy
Use in pregnancy and lactation
In view of the lack of toxicity data, St John's wort preparations should not be used
during pregnancy and lactation.
Effects on ability to drive and use of machines
No negative influence is expected.
References
Mills, Simon, and Kerry Bone. Principles and practice of phytotherapy. Modern herbal medicine. Churchill Livingstone, 2000.
Barnes, J., and L. A. Anderson. "Phillipson JD Herbal Medicines." (2007). (No. Ed. 3). pharmaceutical press.
William Charles Evans BPharm BSc PhD DSc FIBiol FLS FRPharmS, ... Daphne Evans BA MA, in Trease and Evans' Pharmacognosy (Sixteenth Edition), 2009
R1- Maher, A. R., Hempel, S., Apaydin, E., Shanman, R. M., Booth, M., Miles, J. N., & Sorbero, M. E. (2016). St. John's Wort for major depressive disorder: a
systematic review. Rand health quarterly, 5(4).
R2- Ting, E. Y. C., Yang, A. C., & Tsai, S. J. (2020). Role of interleukin-6 in depressive disorder. International journal of molecular sciences, 21(6), 2194.
R3- Wölfle, U., Seelinger, G., & Schempp, C. M. (2014). Topical application of St. Johnʼs wort (Hypericum perforatum). Planta medica, 80(02/03), 109-120.

14. Herbal medicine Dr. Mostafa Hegazy