Re: Tremors + St 's Wort.

[Guest guest]

Hi Gretchen,

Thanks for your email. Yes, I do know Elavil (Amitriptyline is the salt) and

also know Propanolol (beta blocker) another drug for tremors but I do not take

anyhting because it is not so bad. I can manage that quite well now.

St. 's Wort... I did take long time ago...did not feel much

difference. You have to take care with St 's wort if you like to take

sunbath and also see drug interaction.

Well, I decided to send you this info. Take care and Thanks a lot!!!

Joana

ST JOHN'S WORT - a patient's guide

Gauld - Pharmacy Educator

Use: mild to moderate depression

St. 's Wort is a herbal remedy, also known as hypericum. It has

been used for centuries for depression and anxiety. It is commonly

used in Germany and other parts of the world.

The flowers and leaves of the St. 's Wort plant (Hypericum

perforatum) are used to make the herbal remedies. These flowers and

leaves contain many different compounds including hypericin, which

is thought to be one of the compounds that makes St. 's Wort

helpful for depression and anxiety. These compounds are extracted

from the plant matter using alcohol.

Some of the products available are " standardised " for hypericin.

This means that the amount of hypericin is measured and should be

the same in every single tablet. Therefore, standardised products

are more consistent than products that are not standardised. Because

there are many different compounds in the plant, it is thought that

other ingredients will have an effect on depression also, but

because they are not " standardised " they may vary from tablet to

tablet. Different brands will have different amounts of hypericin

and other ingredients, so it pays to stay with one reputable brand

rather than switching from one to another.

St. 's Wort looks very promising as a treatment for mild to

moderate depression. There have been comparisons of St. 's Wort

with other medicines for depression such as imipramine and

amitriptyline (tricyclic antidepressants) in tests. These studies

have been fairly positive for St. 's Wort, indicating that St.

's Wort helps with depression and does not have many side

effects. Unfortunately the trials have been only for short periods

of time (e.g. 4 or 8 weeks), so it is not certain how well St. 's

Wort will work or whether there will be more side effects over a

longer period of use. These studies have usually been carried out

with only small numbers of patients, which is also a disadvantage.

St. 's Wort has been compared with older tricyclic

antidepressants (e.g. imipramine and amitriptyline), and has

generally shown fewer side effects than the tricyclic

antidepressants. It would be useful to compare St. 's Wort with

newer antidepressants such as fluoxetine (Prozac) and paroxetine

(Aropax) to see if St. 's Wort works as well and if St. 's

Wort has as few or less side effects, as these medicines are used so

commonly now.

It is not known how St. 's Wort works. It is thought that St.

's Wort may affect serotonin, noradrenaline and dopamine uptake.

Cautions:

Do not use if pregnant or breastfeeding without talking to your

doctor first.

If you are on other medicines check with your doctor or pharmacist

before taking St. 's Wort.

If you have liver or kidney problems, or other serious medical

conditions it is very important to check with your doctor before

taking any herbal remedies.

If you think you are depressed it is important to talk to your

doctor about how you are feeling. More severe and persisting

depression may not be responsive to St. 's Wort, and it is

important to talk to your doctor to discuss if your feelings are due

to depression.

Side effects:

This remedy does not seem to have many problems with side effects,

however possible side effects are listed below:

Allergy.

Increased skin sensitivity to the sun is extremely rare.

St. 's Wort generally does not seem to cause drowsiness and

affect the ability to drive, however a very small percentage of

people taking it may feel tired.

Increased sensitivity to touch, temperature and pain is a

possibility.

There may be other side effects, so if you have any unexpected

symptoms while taking this medicine, tell your doctor or pharmacist.

Interactions:

There is a potential with any herbal product or medicine for

interactions - even grapefruit juice can affect medicines, so it is

very important to check with your doctor or pharmacist if you are

taking any medicines, before starting St. 's Wort.

Likely interactions include (but are not limited to):

Certain antidepressants including fluoxetine (Prozac), paroxetine

(Aropax), other SSRI antidepressants.

Warfarin/coumarins/anti-coagulants (for thinning the blood).

Digoxin (for the heart).

Cyclosporin (for transplants and some diseases such as psoriasis and

arthritis).

Theophylline (for asthma).

Migraine medicines called triptans, e.g. Imigran (sumatriptan).

Some medicines used to treat HIV.

Oral Contraceptives ( " the pill " ).

It is also thought possible that there could be an interaction with

some epilepsy medicines that sometimes are also used for pain, or

bipolar disorder (manic depression), e.g. carbamazepine, phenytoin,

and phenobarbitone.

It is very likely that there are other interactions that are not yet

known.

If there is an interaction with your medicines and St. 's Wort,

difficulties may show up when you are taking the St 's Wort and

also may occur at the point in time when you stop taking St. 's

Wort. Some of these interactions may be very severe, so it is

extremely important that you talk to your doctor if you are on St.

's Wort as well as other medicine or if you are considering

using St. 's Wort.

Patient information:

Follow the instructions on the label of the medicine or as directed

by your doctor.

Talk to your doctor before taking St. 's Wort if you have serious

medical conditions or are on other medicine.

It is advisable to talk to your doctor about depression. You may be

suffering from more severe depression and St. 's Wort will not

help and may delay getting other treatment.

In addition, other help such as counselling may be more appropriate.

It is unwise to suddenly stop your prescribed medicines for

depression without discussing it with your doctor first.

The Medic8® Family Health Guide