Sandra76 asked
I am wondering if it is safe to take St. John's wort with ibuprofen?
At a glance
- Although studies show that St. John's Wort could potentially affect the metabolism of ibuprofen, there have been no clinically significant drug interactions reported, even in studies in which both were given together.
- While it may work to help you fall asleep for a few days, long-term use of Benadryl as a sleep-aid likely isn't effective and is associated with several side effects like next-day drowsiness. Additionally, the long-term use of drugs like Benadryl in those 65 years old and over is linked with an increased risk of dementia.
Answer
St. John's Wort and ibuprofen (brand names Advil, Motrin) are considered safe to take together. There are no known drug interactions.
While it can often be difficult to assess potential drug interactions with herbal products due to the lack of available information, St. John's Wort is one of the most studied in regard to efficacy, side effects and potential drug interactions.
There have even been several studies that have specifically evaluated the effects of combined use of ibuprofen and St. John's Wort.
One such study, 'Effects of St. John's Wort Supplementation on Ibuprofen Pharmacokinetics' concluded the following:
St. John's wort administration for 21 days had no apparent clinically important impact on the single-dose pharmacokinetic parameters of S(+)- and R(-)-ibuprofen.
There are other studies that indicate St. John's Wort can inhibit the activity of a variety of CYP metabolizing enzymes, particularly CYP 2C9. This has been shown to lead to potentially serious interactions with drugs metabolized by this enzyme, notably warfarin, an anticoagulant.
I mention this because ibuprofen is metabolized by CYP 2C9 as well. Nevertheless, the studies that have evaluated St. John's Wort effect on ibuprofen have not shown any clinically significant interactions or need for dose adjustment.
The next sections provide additional information regarding St. John's Wort and ibuprofen.
About St. John's Wort
St. John's wort is a flowering plant and is among the most popular, and well studied, herbal products used for medicinal purposes. It is used for a range of indications including:
It has many active constituents, notably hypericin, which is thought to be primarily responsible for its effects. Other related compounds found in the plant are medicinally active as well. These include:
- Hyperforin
- Adhyperforin
Although St. John's wort has been well studied and has a large body of evidence purporting its effects, it must be used cautiously due to the high number of potentially serious drug interactions as it can inhibit a variety of metabolizing enzymes in the body.
Just a small sampling of known drug interactions include:
Prior to starting therapy with St. John's wort, it is extremely important to consult your doctor or pharmacist regarding potential drug interactions.
Drug interactions aside, St. John's wort is generally well tolerated. The most commonly reported side effects include:
- Insomnia
- Vivid dreams
- Restlessness
- Irritability
- Nausea
- Dry mouth
- Headache
In fact, several studies report that St. John's wort in many cases is better tolerated than conventional antidepressants.
About Ibuprofen
Ibuprofen is an NSAID (non-steroidal anti-inflammatory drug) that is available both over the counter (200 mg), or via prescription (400 mg, 600 mg, 800 mg). It is also available in liquid dosage forms.
The onset of action of ibuprofen is generally 15 to 30 minutes, with peak effects occurring within 1 to 2 hours. It has a duration of action around 4 to 6 hours per dose.
It should be taken with food to minimize GI discomfort. Long term use of ibuprofen should only be done under the supervision of your doctor due to the risk of gastrointestinal and cardiovascular side effects.
References
- ^ Effects of St. John's wort supplementation on ibuprofen pharmacokinetics. PubMed
- ^ St John's wort (Hypericum perforatum): drug interactions and clinical outcomes. PubMed
- ^ Clinical pharmacokinetics of ibuprofen. The first 30 years. PubMed
- ^ Controlled clinical trials of hypericum extracts in depressed patients--an overview. PubMed
