Plant Comparison
Perforate St John’s-wort vs Ribwort Plantain
A side-by-side comparison of two medicinal plants — every documented constituent, action, use, safety note and cited source, assembled automatically from the Omnia Sana database.
At a glance
Perforate St John’s-wort and Ribwort Plantain: they share 7 indicated uses (arthritis / joint pain, bruising, cold & flu, …); 3 pharmacological actions in common.
Evidence face-off — shared uses
| Condition | Perforate St John’s-wort | Ribwort Plantain | Verdict |
|---|---|---|---|
| Arthritis / joint pain | 1/10 | 1/10 | Comparable evidence |
| Bruising | 1/10 | 1/10 | Comparable evidence |
| Cold & flu | 1/10 | 1/10 | Comparable evidence |
| Infection (general) | 1/10 | 2/10 | Comparable evidence |
| Inflammation (general) | 1/10 | 1/10 | Comparable evidence |
| Skin irritation | 1/10 | 1/10 | Comparable evidence |
| Wounds | 1/10 | 2/10 | Comparable evidence |
Evidence scores (1–10) are computed from the tier of each cited source. “Comparable” means the two scores are within one point. Follow a score to its detailed sources.
Key Constituents
Red pigments historically used to standardise extracts; contribute to antiviral activity and are the compounds responsible for photosensitivity risk.
Considered the principal compound behind the antidepressant activity and the main driver of the herb's potent CYP3A4/P-glycoprotein induction and drug-interaction profile.
Antioxidant flavonoids contributing to overall activity.
Anti-inflammatory and antimicrobial constituents.
Coat and protect inflamed mucous membranes and reduce cough-receptor sensitivity.
Antioxidant and anti-inflammatory constituents.
Pharmacological Actions
Anti-inflammatory for temporary mild inflammation of the mouth and throat (sore throat); in vitro the extract inhibits nitric oxide production and inducible NOS in macrophages, supporting its traditional respiratory anti-inflammatory use
Demulcent for catarrh of the respiratory tract and dry, irritating cough / bronchitis (mucilage soothes and protects irritated airways)
Traditional & Indicated Uses
inferred from anti-inflammatory action
inferred from antiviral action
inferred from anti-inflammatory action
inferred from sedative action
inferred from anti-inflammatory action
inferred from anti-inflammatory action
Demulcent for catarrh of the respiratory tract and dry, irritating cough / bronchitis (mucilage soothes and protects irritated airways)
inferred from immunomodulator action
Demulcent for catarrh of the respiratory tract and dry, irritating cough / bronchitis (mucilage soothes and protects irritated airways)
inferred from immunomodulator action
inferred from antimicrobial action
Anti-inflammatory for temporary mild inflammation of the mouth and throat (sore throat); in vitro the extract inhibits nitric oxide production and inducible NOS in macrophages, supporting its traditional respiratory anti-inflammatory use
inferred from demulcent action
Anti-inflammatory for temporary mild inflammation of the mouth and throat (sore throat); in vitro the extract inhibits nitric oxide production and inducible NOS in macrophages, supporting its traditional respiratory anti-inflammatory use
Safety, Cautions & Contraindications
Significant drug interactions: strongly induces CYP3A4 and P-glycoprotein, reducing plasma levels of many drugs including oral contraceptives, antiretrovirals, cyclosporine, warfarin, and digoxin. May cause photosensitivity (fair-skinned individuals). Do not combine with SSRIs, SNRIs, or MAOIs (serotonin syndrome risk). Avoid in bipolar disorder.
Duke (2002) rates St. John's wort as ++ (raised from earlier editions) and notes antidepressant, antiviral, antibacterial, and wound-healing activities at experimental and clinical levels. Hypericin and hyperforin are identified as key active constituents. Clinical evidence (score 2) confirms antidepressant efficacy in mild-to-moderate depression, and WHO/Commission E provide approval for this indication. Dose: 300 mg standardized extract (0.3% hypericin, 3–5% hyperforin) three times daily. Duke emphasizes the critical drug interaction: St. John's wort is a potent CYP3A4 inducer and can significantly reduce blood levels of many medications including oral contraceptives, cyclosporine, antiretrovirals, and warfarin. Avoid combined use with SSRIs (serotonin syndrome risk) and pharmaceutical antidepressants (Duke, 2002).
External Ids
Botanical Description
Erect, branching perennial herb with paired, oval leaves dotted with tiny translucent oil glands that look like pinpricks when held to the light (giving the species name 'perforatum'). Bright yellow, five-petalled flowers with numerous stamens and black dots along the petal edges are borne in flat-topped clusters, and release a reddish pigment when crushed.[4]
Perennial herb (Plantaginaceae) forming a low rosette of narrow, lance-shaped leaves with prominent parallel ribs (hence 'ribwort'). Slender, furrowed, leafless flowering stalks rise from the rosette bearing a dense, short, dark brown-black ovoid to cylindrical flower spike ringed by a 'collar' of protruding cream-white stamens.[11]
Habitat
Grows in grassland, roadsides, woodland clearings and waste ground on well-drained soils; native to Europe, Western Asia and North Africa and widely naturalised elsewhere, including North America and Australia.[4]
Native throughout Europe and temperate Asia and naturalised worldwide; common in grassland, meadows, lawns, roadsides and waste ground, tolerating trampling and a wide range of soils.[11]
Harvesting
The flowering tops (flower and upper leaf) are cut in summer as the flowers open, around the traditional St John's Day period, and dried quickly in a warm, shaded, airy place to preserve the hypericin and hyperforin content.[4]
Leaves and aerial parts are gathered during the growing season, ideally before or during flowering, and dried quickly.[11]
Traditional Uses
St John's wort has a centuries-long European folk reputation as a wound-healing and nerve tonic herb, traditionally used for mild wounds, burns and nerve pain and to lift low mood; this traditional mood-supporting use is now one of the most extensively clinically studied applications of any herbal medicine, with standardised extracts shown comparable to conventional antidepressants for mild-to-moderate depression.[1, 4]
Ribwort plantain has an official European herbal-monograph tradition for the temporary relief of dry cough and irritation of the mouth and throat, and for minor skin wounds, reflecting its long folk use as a demulcent respiratory remedy and wound herb. Modern research confirms mucilage-driven demulcent action alongside antimicrobial and anti-inflammatory activity.[11, 12]
Preparations
Flowering-top extract standardised to hypericin and/or hyperforin content, taken as tablets or capsules; the best-studied clinical form for mood support.
Dosage
Clinical trials for mild-to-moderate depression commonly use around 300 mg of standardised extract three times daily (900 mg/day total); given extensive drug interactions, use should be discussed with a healthcare provider, especially alongside other medicines. Educational reference only, not a prescription.
Drug Class Interactions
Not documented
References
Pairings
St John's wort raises serotonin activity and can cause serotonin syndrome when combined with other serotonin-boosting agents; pairing it with another mood-active, serotonergic herb such as saffron may add to this risk.[30]
St John's wort is a strong enzyme inducer and increases serotonin activity; combining it with another antidepressant-type herb such as rhodiola may add to serotonergic effects and unpredictably change how each is handled by the body.[30]
St John's wort speeds up the breakdown of many substances and also raises serotonin activity; pairing it with a sedative herb such as valerian may add to drowsiness and can unpredictably change how each is handled by the body.[30, 31]
St John's wort is a strong enzyme inducer and kava is a liver-metabolised sedative; combining them may add to central-nervous-system effects and alter how kava is processed, so combined use warrants caution.[30, 31]
Not documented
Lookalikes Review
References & Sources
- Ng, Q.X., Venkatanarayanan, N. and Ho, C.Y.X (2017) 'Clinical use of Hypericum perforatum (St John's wort) in depression: A meta-analysis', Journal of Affective Disorders, 210, pp. 211-221. doi:10.1016/j.jad.2016.12.048 Meta-analysis / review
https://doi.org/10.1016/j.jad.2016.12.048 - Kholghi, G., Arjmandi-Rad, S., Zarrindast, M.R. and Vaseghi, S (2022) 'St. John's wort (Hypericum perforatum) and depression: what happens to the neurotransmitter systems?', Naunyn-Schmiedeberg's Archives of Pharmacology, 395(6), pp. 629-642. doi:10.1007/s00210-022-02229-z Traditional / reference
https://doi.org/10.1007/s00210-022-02229-z - Fugh-Berman, A (2000) 'Herb-drug interactions', Lancet, 355(9198), pp. 134-138. doi:10.1016/S0140-6736(99)06457-0 Traditional / reference
https://doi.org/10.1016/S0140-6736(99)06457-0 - Nobakht, S.Z., Akaberi, M., Mohammadpour, A.H., Tafazoli Moghadam, A. and Emami, S.A (2022) 'Hypericum perforatum: Traditional uses, clinical trials, and drug interactions', Iranian Journal of Basic Medical Sciences, 25(9), pp. 1045-1058. doi:10.22038/IJBMS.2022.65112.14338 Meta-analysis / review
https://doi.org/10.22038/IJBMS.2022.65112.14338 - Jiang, Z., Wang, F., Zhao, Y., Lu, L., Jiang, X., Huang, T., Lin, Y., Guo, L., Weng, Z. and Liu, E (2024) 'Hypericum perforatum L. attenuates depression by regulating Akkermansia muciniphila, tryptophan metabolism and NFkB-NLRP2-Caspase1-IL1beta pathway', Phytomedicine, 132, pp. 155847. doi:10.1016/j.phymed.2024.155847 Preclinical
https://doi.org/10.1016/j.phymed.2024.155847 - Oliveira, A.I., Pinho, C., Sarmento, B. and Dias, A.C.P (2016) 'Neuroprotective Activity of Hypericum perforatum and Its Major Components', Frontiers in Plant Science, 7, pp. 1004. doi:10.3389/fpls.2016.01004 Meta-analysis / review
https://doi.org/10.3389/fpls.2016.01004 - Russo, E., Scicchitano, F., Whalley, B.J., Mazzitello, C., Ciriaco, M., Esposito, S., Patane, M., Upton, R., Pugliese, M., Chimirri, S., Mammi, M., Palleria, C. and De Sarro, G (2013) 'Hypericum perforatum: pharmacokinetic, mechanism of action, tolerability, and clinical drug-drug interactions', Phytotherapy Research, 28(5), pp. 643-655. doi:10.1002/ptr.5050 Meta-analysis / review
https://doi.org/10.1002/ptr.5050 - Saddiqe, Z., Naeem, I. and Maimoona, A (2010) 'A review of the antibacterial activity of Hypericum perforatum L', Journal of Ethnopharmacology, 131(3), pp. 511-521. doi:10.1016/j.jep.2010.07.034 Meta-analysis / review
https://doi.org/10.1016/j.jep.2010.07.034 - Mennini, T. and Gobbi, M (2004) 'The antidepressant mechanism of Hypericum perforatum', Life Sciences, 75(9), pp. 1021-1027. doi:10.1016/j.lfs.2004.04.005 Meta-analysis / review
https://doi.org/10.1016/j.lfs.2004.04.005 - Liu, Y., Jiang, Y., Huang, R., Yang, J., Xiao, B. and Dong, J (2013) 'Hypericum perforatum L. preparations for menopause: a meta-analysis of efficacy and safety', Climacteric, 17(4), pp. 325-335. doi:10.3109/13697137.2013.861814 Meta-analysis / review
https://doi.org/10.3109/13697137.2013.861814 - Wurglics, M. and Schubert-Zsilavecz, M (2006) 'Hypericum perforatum: a 'modern' herbal antidepressant: pharmacokinetics of active ingredients', Clinical Pharmacokinetics, 45(5), pp. 449-468. doi:10.2165/00003088-200645050-00002 Meta-analysis / review
https://doi.org/10.2165/00003088-200645050-00002 - Kasper, S (2001) 'Hypericum perforatum - a review of clinical studies', Pharmacopsychiatry, 34(Suppl 1), pp. S51-S55. doi:10.1055/s-2001-15467 Meta-analysis / review
https://doi.org/10.1055/s-2001-15467 - Nathan, P (1999) 'The experimental and clinical pharmacology of St John's Wort (Hypericum perforatum L.)', Molecular Psychiatry, 4(4), pp. 333-338. doi:10.1038/sj.mp.4000557 Meta-analysis / review
https://doi.org/10.1038/sj.mp.4000557 - Verotta, L (2003) 'Hypericum perforatum, a source of neuroactive lead structures', Current Topics in Medicinal Chemistry, 3(2), pp. 187-201. doi:10.2174/1568026033392589 Meta-analysis / review
https://doi.org/10.2174/1568026033392589 - Linde, K. et al (2008) 'St John'. Traditional / reference
https://scholar.google.com/scholar?q=St%20John - Natural Standard (2013) 'Hypericum perforatum (St'. Traditional / reference
https://scholar.google.com/scholar?q=Hypericum%20perforatum%20%28St - Duke, J.A (2002) 'Handbook of Medicinal Herbs, Second Edition'. Traditional / reference
https://scholar.google.com/scholar?q=Handbook%20of%20Medicinal%20Herbs%2C%20Second%20Edition - Zhou, S., Chan, E., Pan, S.Q., Huang, M. and Lee, E.J.D (2004) 'Pharmacokinetic interactions of drugs with St John's wort', Journal of Psychopharmacology, 18(2), pp. 262-276. doi:10.1177/0269881104042632 Meta-analysis / review
https://doi.org/10.1177/0269881104042632 - Izzo, A.A. and Ernst, E (2009) 'Interactions between herbal medicines and prescribed drugs: an updated systematic review', Drugs, 69(13), pp. 1777-1798. doi:10.2165/11317010-000000000-00000 Meta-analysis / review
https://doi.org/10.2165/11317010-000000000-00000 - Borrelli, F. and Izzo, A.A (2009) 'Herb-drug interactions with St John's wort (Hypericum perforatum): an update on clinical observations', The AAPS Journal, 11(4), pp. 710-727. doi:10.1208/s12248-009-9146-8 Meta-analysis / review
https://doi.org/10.1208/s12248-009-9146-8 - Nicolussi, S., Drewe, J., Butterweck, V. and Meyer zu Schwabedissen, H.E (2020) 'Clinical relevance of St. John's wort drug interactions revisited', British Journal of Pharmacology, 177(6), pp. 1212-1226. doi:10.1111/bph.14936 Meta-analysis / review
https://doi.org/10.1111/bph.14936 - Piscitelli, S.C., Burstein, A.H., Chaitt, D., Alfaro, R.M. and Falloon, J (2000) 'Indinavir concentrations and St John's wort', Lancet, 355(9203), pp. 547-548. doi:10.1016/S0140-6736(99)05712-8 Clinical study
https://doi.org/10.1016/S0140-6736(99)05712-8 - Barone, G.W., Gurley, B.J., Ketel, B.L., Lightfoot, M.L. and Abul-Ezz, S.R (2000) 'Drug interaction between St. John's wort and cyclosporine', Annals of Pharmacotherapy, 34(9), pp. 1013-1016. doi:10.1345/aph.10088 Clinical study
https://doi.org/10.1345/aph.10088 - Murphy, P.A., Kern, S.E., Stanczyk, F.Z. and Westhoff, C.L (2005) 'Interaction of St. John's Wort with oral contraceptives: effects on the pharmacokinetics of norethindrone and ethinyl estradiol, ovarian activity and breakthrough bleeding', Contraception, 71(6), pp. 402-408. doi:10.1016/j.contraception.2004.11.004 Clinical study
https://doi.org/10.1016/j.contraception.2004.11.004 - Murphy, P.A., Kern, S.E., Stanczyk, F.Z. and Westhoff, C.L (2005) 'Interaction of St. John's Wort with oral contraceptives: effects on the pharmacokinetics of norethindrone and ethinyl estradiol, ovarian activity and breakthrough bleeding', Contraception, 71(6), pp. 402-408. doi:10.1016/j.contraception.2004.11.004 Clinical study
https://doi.org/10.1016/j.contraception.2004.11.004 - Pfrunder, A., Schiesser, M., Gerber, S., Haschke, M., Bitzer, J. and Drewe, J (2003) 'Interaction of St John's wort with low-dose oral contraceptive therapy: a randomized controlled trial', British Journal of Clinical Pharmacology, 56(6), pp. 683-690. doi:10.1046/j.1365-2125.2003.02005.x Randomized trial
https://doi.org/10.1046/j.1365-2125.2003.02005.x - Johne, A., Brockmoller, J., Bauer, S., Maurer, A., Langheinrich, M. and Roots, I (1999) 'Pharmacokinetic interaction of digoxin with an herbal extract from St John's wort (Hypericum perforatum)', Clinical Pharmacology and Therapeutics, 66(4), pp. 338-345. doi:10.1053/cp.1999.v66.a101944 Clinical study
https://doi.org/10.1053/cp.1999.v66.a101944 - Mathijssen, R.H.J., Verweij, J., de Bruijn, P., Loos, W.J. and Sparreboom, A (2002) 'Effects of St. John's wort on irinotecan metabolism', Journal of the National Cancer Institute, 94(16), pp. 1247-1249. doi:10.1093/jnci/94.16.1247 Randomized trial
https://doi.org/10.1093/jnci/94.16.1247 - Smith, P., Bullock, J.M., Booker, B.M., Haas, C.E., Berenson, C.S. and Jusko, W.J (2004) 'The influence of St. John's wort on the pharmacokinetics and protein binding of imatinib mesylate', Pharmacotherapy, 24(11), pp. 1508-1514. doi:10.1592/phco.24.16.1508.50958 Clinical study
https://doi.org/10.1592/phco.24.16.1508.50958 - Izzo, A.A (2004) 'Drug interactions with St. John's Wort (Hypericum perforatum): a review of the clinical evidence', International Journal of Clinical Pharmacology and Therapeutics, 42(3), pp. 139-148. doi:10.5414/cpp42139 Meta-analysis / review
https://doi.org/10.5414/cpp42139 - Caus, M.N., Lupoae, M. and Chitescu, C.L (2026) 'Efficacy and Safety of Herbal Supplements with Anxiolytic, Antidepressant, and Sedative Action: A Review of Clinical Data and Toxicological Risks', Pharmaceuticals, 19(3), pp. 399. doi:10.3390/ph19030399 Meta-analysis / review
https://doi.org/10.3390/ph19030399
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https://doi.org/10.3390/ijms25137112 - Budzianowska, A. and Budzianowski, J (2022) 'A new flavonoid, a new phenylethanoid glycoside and related compounds isolated from the inflorescences of Plantago lanceolata L', Natural Product Research, 36(15), pp. 3813-3824. doi:10.1080/14786419.2021.1888289 Preclinical
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https://doi.org/10.1016/j.jaci.2014.02.016 - Sousa, R., Osorio, H., Duque, L., Ribeiro, H., Cruz, A. and Abreu, I (2014) 'Identification of Plantago lanceolata pollen allergens using an immunoproteomic approach', Journal of Investigational Allergology and Clinical Immunology, 24(3), pp. 177-183. Available at: https://pubmed.ncbi.nlm.nih.gov/25011355/ Preclinical
https://pubmed.ncbi.nlm.nih.gov/25011355/ - Reza, M.M., Redoy, M.R.A., Rahman, M.A., Ety, S. and others (2021) 'Response of plantain (Plantago lanceolata L.) supplementation on nutritional, endo-parasitic, and endocrine status in lambs', Tropical Animal Health and Production, 53(1), pp. 82. doi:10.1007/s11250-020-02514-0 Preclinical
https://doi.org/10.1007/s11250-020-02514-0 - Rahamouz-Haghighi, S., Bagheri, K., Mohsen-Pour, N. and Sharafi, A (2022) 'Evaluation of Cytotoxicity and Antibacterial Activities of Ribwort Plantain (Plantago lanceolata L.) Root Fractions and Phytochemical Analysis by Gas Chromatography-Mass Spectrometry', Archives of Razi Institute, 77(6), pp. 2131-2143. doi:10.22092/ARI.2022.358045.2143 Preclinical
https://doi.org/10.22092/ARI.2022.358045.2143 - Kovac, I., Durkac, J., Holly, M., Jakubcova, K. and others (2015) 'Plantago lanceolata L. water extract induces transition of fibroblasts into myofibroblasts and increases tensile strength of healing skin wounds', Journal of Pharmacy and Pharmacology, 67(1), pp. 117-125. doi:10.1111/jphp.12316 Preclinical
https://doi.org/10.1111/jphp.12316 - Jaric, S., Kostic, O., Mataruga, Z., Pavlovic, D. and others (2017) 'Traditional wound-healing plants used in the Balkan region (Southeast Europe)', Journal of Ethnopharmacology, 211, pp. 311-328. doi:10.1016/j.jep.2017.09.018 Traditional / reference
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https://doi.org/10.1016/j.fitote.2019.104443 - Drava, G., Cornara, L., Giordani, P. and Minganti, V (2019) 'Trace elements in Plantago lanceolata L., a plant used for herbal and food preparations: new data and literature review', Environmental Science and Pollution Research International, 26(3), pp. 2305-2313. doi:10.1007/s11356-018-3740-1 Preclinical
https://doi.org/10.1007/s11356-018-3740-1 - European Medicines Agency (HMPC) (n.d.) 'European Union herbal monograph on Plantago lanceolata L., folium (Plantaginis lanceolatae folium)'. Available at: https://www.ema.europa.eu/en/medicines/herbal/plantaginis-lanceolatae-folium Traditional / reference
https://www.ema.europa.eu/en/medicines/herbal/plantaginis-lanceolatae-folium - ESCOP (European Scientific Cooperative on Phytotherapy) (n.d.) 'Plantaginis lanceolatae folium-herba (Ribwort Plantain Leaf/Herb) monograph', pp. com. Available at: https://www.escop.com/downloads/ribwort-plantain-leaf-herb/ Traditional / reference
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Generated automatically from the Omnia Sana plant database and its cited sources. For educational purposes only — not medical advice. Always consult a qualified practitioner before using medicinal plants.