Problems associated with 

Herbals 

• Lack information on active ingredients.

• Lack safety and efficacy data.

• Lack of quality control-- Changing

• Undeclared ingredients– Changing ??

• Intentional adulteration -

• Source unknown and questionable.

• Confusing literature.

• Toxicities  some innocuous others not.

• Drug interactions with allopathic drugs.

Sedative and hypnotic

– Contains valepotriates--  shown to have CNS 

depressant activity with less adverse effect than 

diazepam

It alters immune 

cells but does it alter the outcome of the 

cold

Heterogeneity of preparations

– Need standardized preps –bioassay?

• Some evidence that the aerial parts of 

E.purpurea may have some effect.

• Methodologies of trials vary.

• Bias towards positive results- negative 

results not published.

Contains hypericin 

– High concentrations inhibit uptake of 

serotonin and norepinephrine and dopamine 

in CNS – As do other antidepressants.

– Clinical trials – 55% versus placebo

– Toxicities as with other antidepressants. 

Treatment of Minor depression with St john’s wort or Citalopram: 

(2011)

St.John’s Wort not different from placebo

– Citalopram not different from placebo.

St. John’s Wort extract LI160 for the treatment of depression.

mild depression

not effective

St. John’s Wort extract LI160 for the treatment of depression.

HAM-D17

St. John’s Wort extract LI160 for the treatment of depression.

CGI-S

Contains Kava Lactones  -- anti-anxiety

• Uses

– Anxiolytics – supported by clinical trials 

– Mild sedative

Potentiates other CNS drugs –alcohol

– Scaly skin condition

– Not for pregnant women

– Several warnings from Health Canada. Do not use.

Becoming a problem

• Additive response  St john’s Wort and 

antidepressants

• Valerian and alcohol

• Warfarin with ginseng and echinacea