Care St John's Wort Low Mood Relief Tablets

A traditional herbal medicinal product used to relieve the symptoms of slightly low mood and mild anxiety, based on traditional use only.

For oral short term use only.

For adults and the elderly, take 2 tablets once daily. The tablets should be swallowed whole with a little liquid. The tablets should not be chewed

This product is not recommended for use in children or adolescents under 18 years (See section 4.4 'Special warnings and precautions for use')

A doctor or qualified healthcare practitioner should be consulted if symptoms worsen or do not improve after 6 weeks.

Hypersensitivity to the active ingredient or any of the excipients.

Patients with known dermal photosensitivity or patients undergoing phototherapy or any photodiagnostic procedures.

Concomitant use with ciclosporin, tacrolimus for systemic use, amprenavir, indinavir and other protease inhibitors, irinotecan and warfarin (see section 4.5 'Interactions with other medicinal products and other forms of interaction'). This is because St John's Wort (Hypericum perforatum) has been shown to induce the cytochrome P450 isoenzymes CYP1A2, CYP2C19, CYP2C9 and CYP3A4 as well as transport protein P-glycoprotein. This results in pharmacokinetic interactions with a large number of medicines including leading to a possible decrease in the effectiveness of those medicines.

In addition, pharmacodynamic interactions have also been identified with antidepressants, particularly the SSRI antidepressants and with the triptan group of medicines.

Do not exceed the stated dose.

If the condition worsens, or if symptoms persist for more than six weeks medical advice should be sought.

The use of this product in children or adolescents under 18 years of age is not recommended because data are not sufficient and medical advice should be sought.

This product is intended for relief of symptoms of slightly low mood and mild anxiety. Patients with signs and symptoms of depression should seek medical advice for appropriate treatment.

In very rare cases, particularly in fair-skinned persons, sun burn type reactions on skin areas exposed to strong sunlight may occur due to photosensitisation by St John's Wort. Persons using this product should avoid excessive sunbathing or the use of sun-beds or solariums.

This product should be discontinued at least 10 days prior to elective surgery due to the potential for interactions with medicinal products used during general and regional anaesthesia (see section 4.5).

Substances in St John's Wort (Hypericum perforatum) have been shown to induce the cytochrome P450 isoenzymes CYP1A2, CYP2C19, CYP2C9 and CYP3A4 as well as transport protein P-glycoprotein. This results in pharmacokinetic interactions with a large number of medicines leading to a potential decrease in the effectiveness of those medicines.

The concomitant use of ciclosporin, tacrolimus for systemic use, amprenavir, indinavir and other protease inhibitors, irinotecan and warfarin is contraindicated.

Special care should be taken in case of concomitant use of all drug substances the metabolism of which is influenced by CYP1A2, CYP3A4, CYP2C9, CYP2C19 or P-glycoprotein (e.g. amitriptyline, fexofenadine, benzodiazepines, methadone, simvastatin, digoxin, finasteride), because a reduction of plasma concentration is possible

Users of oral contraceptives taking St John's Wort (Hypericum perforatum) may experience intracyclic menstrual bleeding and risk of contraception failure is increased.

Clinically significant pharmacodynamic interactions have also been identified with SSRI antidepressants, and the triptan group of medicines used to treat migraines. Due to increased risk of undesirable effects associated with these interactions this product should not be used concomitantly with these types of medicines.

Therefore this product should not be taken concomitantly with the medicines included in the table below.

Safety of the product during pregnancy and lactation has not been established. In the absence of sufficient data, the use during pregnancy and lactation is not recommended.

No studies on the effects on fertility have been performed.

No studies on the ability to drive and use machines have been performed.

Gastrointestinal disorders including dyspepsia, anorexia, nausea, diarrhoea or constipation; allergic skin reactions such as rash, urticaria, pruritis; fatigue and restlessness have been reported. The frequency is not known.

Fair-skinned individuals may react with intensified sunburn-like symptoms under intense sunlight or strong ultra-violet (UV) irradiation.

Other adverse reactions that have been reported include headaches, neuropathy, anxiety, dizziness and mania.

If other adverse reactions not mentioned above occur a doctor or qualified healthcare practitioner should be consulted.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard or search for 'MHRA Yellow Card' in the Google Play or Apple App Store.

Symptomatic and supportive measures should be taken as appropriate.

After intake or up to 4.5g dry extract per day for 2 weeks and additionally 15g dry extract just before hospitalisation, seizures and confusion have been reported. After ingestion of massive overdoses, the patient should be protected from sunlight and other UV-light sources for 1 -2 weeks. Outdoor activities should be restricted and clothes and/or sun block preparations used to protect the skin from sunlight.

Pharmacotherapeutic group: Other antidepressants

ATC code: N06AX

The absorption of hypericin is delayed and starts about 2 hours after administration. The elimination half-life is about 20 hours, the mean residence time about 30 hours. Maximum hyperforin levels are reached about 3 – 4 hours after administration: no accumulation could be detected. Hyperforin and the flavonoid miquelianin can cross the blood brain barrier Hyperforin induces the activity of the metabolic enzymes CYP3A4, CYP2C9, CYP2C19, and PGP dose-dependently via activation of the PXR system Therefore the elimination of other drug substances may be accelerated, resulting in decreased plasma concentrations.

The active ingredients in St John's Wort, like other type SRI or SRRI medicinal agents with an antidepressant action, can raise the concentration of serotonin in certain parts of the central nervous system so that this neurotransmitter can sometimes reach toxic levels, particularly when drugs containing St John's Wort are combined with other antidepressants.

Studies on acute toxicity and repeated dose toxicity did not show signs of toxic effects.

The weak positive results of an ethanolic extract in the AMES-test (salmonella typhimurium TA 98 and TA 100, with and without metabolic activation) could be assigned to quercetin and are irrelevant to human safety. No signs of mutagenicity could be detected in further in-vitro and in-vivo test systems.

Tests on reproductive toxicity revealed equivocal results.

Tests on carcinogenic potential have not been performed.

Phototoxicity:

After oral application of dosages of 1800mg per day for 15 days, the skin sensitivity against UVA was increased and the minimum dose for pigmentation was significantly reduced. In the recommended dosage, no signs of phototoxicity are reported.

Not applicable

3 years.

Do not store above 25° C.

Store in the original packaging to protect from light and moisture.

Amber glass bottle with polypropylene cap incorporating induction heat seal closure. Printed outer carton containing Patient Information Leaflet.

Pack sizes of 30, 60, 90 and 120 tablets. Not all pack sizes may be marketed.

No special requirements.