A Randomized Clinical Trial of St. John's Wort for Smoking Cessation

Abstract

Introduction: St. John's wort (SJW) is a widely used herbal supplement. The predominant mechanism(s) accounting for the activity of SJW in vivo are, however, unclear. The purpose of this study was to investigate the efficacy of SJW for smoking cessation. Methods: We conducted a randomized, blinded, placebo-controlled, three-arm, dose-ranging clinical trial. A total of 118 subjects were randomly allocated to receive SJW 300 mg, 600 mg, or a matching placebo tablet 3 times a day combined with a behavioral intervention for 12 weeks. Self-reported smoking abstinence was biochemically confirmed with expired air carbon monoxide. Results: Mean age of the study participants was 37.6 AE 12.4 years; they smoked an average of 20.0 AE 6.6 cigarettes per day for 20 AE 12.1 years. The study dropout rate was high (43%). By intention-to-treat analysis, no significant differences were observed in abstinence rates at 12 and 24 weeks between SJW dose groups and placebo. SJW did not attenuate withdrawal symptoms among abstinent subjects. Abstinence rates did not differ by study group among subjects who took at least 75% of their study medication. No significant side-effects were noted with SJW. Conclusions: In this randomized trial, SJW did not increase smoking abstinence rates. Our data, in combination with data from other studies, suggest that SJW has little role in the treatment of tobacco dependence.

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“…The small sample size and relatively high proportion of treatment noncompleters limit our interpretation of the results; however, it is notable that our experiences with the proportion of individuals telephone screened who enrolled in studies, as well as the percent of treatment non-completers, are consistent with those of other recent studies of treatments for cannabis dependence and nicotine dependence. [29][30][31][32][33] Other limitations of this study included duration of follow-up and heterogeneity of the sample with respect to baseline cigarette smoking. Previous studies utilizing CBT for substance use disorders suggest that the benefits of CBT may emerge months after treatment ends.…”

Toward Enhancing Treatment for Pregnant Smokers: Laying the Groundwork for the Use of Complementary and Alternative Medicine Approaches

“…One randomized, blinded, placebo-controlled trial of 118 smokers found that St. John's Wort did not promote smoking abstinence or attenuate withdrawal symptoms (Sood et al, 2010). These results indicate that St. John's Wort is not indicated for smoking cessation.…”

New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline?

“…Two small trials of St John's wort have failed to detect a significant effect on quit rates or withdrawal symptoms [330,331]; although there may be some worthwhile benefits for preventing weight gain [330]. One trial of SAMe did not find significantly increased tobacco abstinence rates nor decreased nicotine withdrawal symptoms compared to placebo [332], and evidence is lacking for a dose response [86].…”

“…St John's Wort is not associated with adverse events, but is contraindicated for concurrent contraceptive use, and has mild side-effects including anxiety, dizziness, abdominal bloating and dry mouth [331,334].…”

“…SAMe in clinical trials has been used in 400-mg four tablets a day formulations and St John's wort in 300-mg three tablets a day formulations [331,332]. This may adversely affected treatment adherence relative to the first-line treatments which require one oral dose per day.…”