St. John's Wort Side Effects — Complete Guide & What to Do
Most St. John's Wort side effects, when they occur, are mild and resolve in 1-2 weeks as your body adjusts. A smaller group are serious and need prompt medical attention. Here's how to tell them apart, what to do, and how dose or generic switches can change your experience.
St. John's Wort: common vs serious side effects
Common (usually manageable)
- •Nausea or stomach upset
- •Headache
- •Dizziness
- •Fatigue
- •Allergic reactions (rash, itching)
Serious (call prescriber / 911)
- •Severe allergic reaction or anaphylaxis
- •Organ toxicity (liver, kidney) — varies by medication class
- •Drug interactions — check with your pharmacist before starting any new medication
Patient-tested tips for St. John's Wort (Herbal Supplements)
- Take at the same time daily for consistency
- Never stop prescription medications abruptly without consulting your doctor
- Report any unusual symptoms to your healthcare provider
- Bring a complete medication list to every appointment
When to call your doctor — 5 red flags
- Trouble breathing, swelling of face / tongue / throat, severe rash — call 911
- Severe chest pain, fainting, or sudden severe headache — call 911
- New or worsening suicidal thoughts — call 988 (Suicide & Crisis Lifeline)
- Dark urine + muscle pain + fever — same-day medical review
- Persistent vomiting, dehydration, or inability to keep medication down — call your prescriber today
St. John's Wort side effects vs cost — a real tradeoff
All FDA-approved generic versions of Hypericum perforatum extract contain the same active ingredient at the same strength. However, inactive ingredients (binders, fillers, dyes) differ between manufacturers — and a minority of patients are sensitive to those differences.
If you switch from brand St. John's Wort to a generic (or between two generics) and notice new side effects, here\u2019s what to do:
- Ask your pharmacist to identify the generic manufacturer of your current fill.
- Request the previous manufacturer at your next fill (pharmacies can usually accommodate).
- If brand St. John's Wort is the only formulation that works for you, ask your prescriber about a manufacturer savings card to offset the higher cost.
Does dose affect St. John's Wort side effects?
Yes — most St. John's Wort side effects are dose-related. The standard prescriber playbook when side effects appear:
- Wait 1-2 weeks at the same dose — many side effects resolve as your body adjusts.
- If still bothersome, drop to a lower dose (typically half) for 1-2 weeks, then re-titrate.
- Consider an extended-release or alternative formulation that smooths blood-level peaks.
- If side effects persist at the lowest effective dose, switch to a related medication in the same class.
Never adjust your own St. John's Wort dose. Your prescriber or pharmacist can help you find the right path.
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St. John's Wort side effects: FAQs
What are common side effects of St. John's Wort?
St. John's Wort can cause various side effects depending on the medication. Most are mild and resolve in the first 1–2 weeks. Check the patient information leaflet for the full list, and contact your prescriber or pharmacist about any side effect that's severe, persistent, or unexpected.
When should I call the doctor about St. John's Wort side effects?
Call your prescriber for severe side effects, side effects that worsen over time, signs of an allergic reaction (rash, swelling, difficulty breathing), or any reaction that feels unusual. Call your pharmacist for mild side effects you want to discuss.
Do St. John's Wort side effects go away?
Many St. John's Wort side effects, if they occur, resolve within the first 1–2 weeks as your body adjusts. Some persist longer — discuss persistent side effects with your prescriber rather than stopping the medication on your own.
Can I stop St. John's Wort if I'm having side effects?
Don't stop St. John's Wort on your own — some medications require tapering to avoid rebound or withdrawal effects. Talk to your prescriber first; they may adjust the dose, recommend timing changes, or switch you to an alternative.
Where can I find the lowest cash price for St. John's Wort?
ScriptUnlock compares cash prices across participating pharmacies for St. John's Wort in real time.