Is the use of St John´s Wort (hypericum perforatum) compatible with breast-feeding?/nBackground: A

Fråga: Is the use of St John´s Wort (hypericum perforatum) compatible with breast-feeding?

Background: A nursing mother suffers from a mild depressive disorder, and has previously noticed some benefits of trying St John´s Wort. There is no other current medication, and no treatment under consideration.

Sammanfattning: The use of herbal drugs, including St John´s Wort, is not recommended while breast-feeding. Products are usually poorly characterised in terms of passage of pharmacologically active and potentially toxic compounds to breast milk.

Svar: The documentation about the use of St John´s Wort during lactation is very poor and limited to case reports. There are no reports of toxic effects in the child (1). However, one of the main general concerns about using herbal remedies during lactation, is the uncertainties about the manufacturing process resulting in probably different amounts of contaminating chemicals with unknown effects. This has contributed to the general recommendation that breast-feeding mothers should avoid intake of herbal remedies (2, 3).

Concerning the possible transfer of St John´s Wort-derived substances into breast milk, a thorough literature search revealed only one case report (4). The amounts of hypericin and hyperforin, believed to be active compoints, were analysed in plasma and breast milk from a mother taking standard doses of St John´s Wort three times daily for eight weeks. Peak plasma concentrations of these compounds were detected about 5h after drug intake, corresponding to roughly 10 and 150 ng/mL, respectively. While hypericin could not be detected in breast milk, low levels of hyperforin was found (around 20 ng/mL) in hind-milk (4). Neither hypericin nor hyperforin was detectable in the infant´s plasma, but the authors concluded that long-term studies on safety are required before the above-mentioned restrictions would need reconsideration. 1 Schaefer C, editor. Drugs during pregnancy and lactation. Handbook of prescription drugs and comparative risk assessment. Amsterdam: Elsevier; 2001. 2 Briggs GB, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 6th ed. Baltimore: Williams & Wilkins; 2002. p. 1276-7. 3 Barnes J. Herbal therapeutics (2) Depression. Pharm J 2002;268:908-10. 4 Klier CM, Schäfer MR, Schmid-Siegel B, Lenz G, Mannel M. St John´s Wort (hypericum perforatum) - is it safe during breastfeeding? Pharmacopsychiatry 2002;35:29-30.