Dr. Kathleen Kendall-Tackett on St. John’s Wort-4

Part 4, St. John’s Wort and BreastfeedingSt. John’s Wort and Breastfeeding
St. John’s wort is generally safe to take while breastfeeding (Dugoua et al., 2006; Hale, 2006; Humphrey, 2007). In a case study, Klier and colleagues (2002) examined the pharmacokinetics of St. John’s wort in four breast milk samples (including both fore and hind milk) from a mother taking the standard dose of St. John’s wort (300 mg/three times per day). They tested the samples for both hypericin and hyperforin and found that only hyperforin was excreted into breast milk, at a low level. Both hyperforin and hypericin were below the level of quantification in the infant’s plasma.

More recently, Klier and colleagues (2006) tested 36 breast milk samples from five mothers taking 300 mg of St. John’s wort, three times a day. They also tested the plasma of the five mothers and two infants. As with their earlier case study, they found that only hyperforin was excreted into breast milk, at low levels. Hyperforin was at the limit of quantification in the infants’ plasma, with the relative infant dose being 0.9% to 2.5% of the mother’s dose. This level of infant exposure is comparable to that of antidepressants. No side effects were noted in either mothers or babies.

A recent review found that there is good evidence to support use of St. John’s wort while breastfeeding (Dugoua et al., 2006). The authors found that St. John’s wort neither affects milk supply nor infant weight. They noted that it could cause infant colic, drowsiness, or lethargy, although only a few cases have been reported. The authors concluded that common and traditional use of St. John’s wort caused minimal risk for breastfeeding women and their babies. They did express some concern about use of St. John’s wort during pregnancy, however.

Be sure to read tomorrow:

Part 5, Summary and references


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