ABSTRACT
Botanical use is prevalent throughout the world with between 10% and 30% of individuals residing in the United States using complementary and alternative medicines routinely. Of particular concern is the finding that up to 30% of individuals taking prescription medicines have also used botanical remedies concurrently within the past year (1-3). The number of individuals consuming St. John’s wort on a daily basis has been estimated at more than 11 million and approximately one-third of these are using St. John’s wort to treat self-diagnosed depression. In the United States, St. John’s wort is one of the top-selling botanical preparations with sales ranking second in 1999 and seventh in 2002 (4,5). Although botanical preparations are widely considered by the public to be without adverse effect or a source of drug interactions, this is not the case. The report of Ruschitzka et al. (6) clearly illustrates the danger of coadministering botanical products (i.e., St. John’s wort) with prescription products and demonstrates that, despite popular belief, the indiscriminant use of botanical products does involve risk. This chapter will review the historical indications, formulations, pharmacology, and interactions between St. John’s wort, echinacea, and other medicines.
