Plant Comparison
Perforate St John’s-wort vs Cowslip
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 Cowslip: they share 4 indicated uses (arthritis / joint pain, inflammation (general), insomnia / sleeplessness, …); 3 pharmacological actions in common.
Evidence face-off — shared uses
| Condition | Perforate St John’s-wort | Cowslip | Verdict |
|---|---|---|---|
| Arthritis / joint pain | 1/10 | 1/10 | Comparable evidence |
| Inflammation (general) | 1/10 | 1/10 | Comparable evidence |
| Insomnia / sleeplessness | 1/10 | 1/10 | Comparable evidence |
| Skin irritation | 1/10 | 1/10 | 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.
Pharmacological Actions
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
inferred from anti-inflammatory action
inferred from sedative action
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).
Allergy risk: avoid if you’re allergic to cowslip/other Primula species (European Medicines Agency, 2012). Stomach sensitivity: use caution if you have gastritis or a stomach ulcer—cowslip can upset the stomach in some people (European Medicines Agency, 2012). Possible side effects (especially high dose): nausea, vomiting, diarrhea; allergic reactions can happen (European Medicines Agency, 2012). Pregnancy/breastfeeding: not recommended due to lack of good safety data (European Medicines Agency, 2012). Kids: many preparations are not recommended under 12 (and some root extracts under 4) unless a labeled product specifically allows it (European Medicines Agency, 2012).
Duke (2002) provides clinical evidence (score 2) for cowslip's expectorant and secretolytic activities, consistent with Commission E approval for bronchitis and cough with mucus. Dose: 0.5–1 g root or 1–2 g herb as tea three times daily. Saponins in the root are responsible for the expectorant action. Duke warns that the plant may cause hemolysis in large doses due to saponin content, and caution is warranted in individuals with aspirin sensitivity due to phenolic acid content (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]
Low perennial herb (Primulaceae) forming a basal rosette of wrinkled, oval, softly hairy leaves that taper abruptly to a winged stalk. A single leafless flowering stem rises from the rosette bearing a one-sided umbel of small, fragrant, deep yellow, funnel-shaped flowers with orange spots at the throat, nodding on slender pedicels.[10]
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 across Europe and western Asia, growing in unimproved, species-rich grassland, meadows, pastures, open woodland and hedge banks on calcareous or well-drained soils.[10]
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]
Flowers are picked in spring as they open; the root/rhizome is dug in autumn.
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]
Cowslip has a long European folk tradition as an expectorant remedy for coughs and bronchial catarrh, and the flowers have traditionally been used as a mild sedative and for headache. Modern research on its saponin-rich root supports secretolytic (mucus-thinning) expectorant activity, and its flowers are rich in antioxidant phenolics.[1, 6]
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
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
- Veldman, J., Bordewijk, E., Lloyd, A.R., Vlieger, A.M. and others (2023) 'Mechanistic Evidence of Andrographis paniculata, Pelargonium sidoides, Echinacea Species and a Combination of Hedera helix, Primula veris/elatior and Thymus vulgaris/zygis in the Treatment of Acute, Uncomplicated Respiratory Tract Infections: A Systematic Literature Review and Expert Interviews', Pharmaceuticals (Basel), 16(9), pp. 1206. doi:10.3390/ph16091206 Meta-analysis / review
https://doi.org/10.3390/ph16091206 - Baczek, K.B., Kosakowska, O., Przybyl, J.L., Pioro-Jabrucka, E. and others (2017) 'Phenolics in Primula veris L. and Primula elatior (L.) Hill Raw Materials', International Journal of Analytical Chemistry, 2017, pp. 2871579. doi:10.1155/2017/2871579 Preclinical
https://doi.org/10.1155/2017/2871579 - Prokofiev, A.B., Latypova, G.M., Bondarenko, T.A., Romanenko, E.B. and others (2023) 'Solid herbal extract of Primula veris L. improves morphofunctional condition of rats' myocardium in chronic alcohol intoxication', Journal of Traditional and Complementary Medicine, 13(3), pp. 306-314. doi:10.1016/j.jtcme.2023.02.006 Preclinical
https://doi.org/10.1016/j.jtcme.2023.02.006 - Tarapatskyy, M., Gumienna, A., Sowa, P., Kapusta, I. and Puchalski, C (2021) 'Bioactive Phenolic Compounds from Primula veris L.: Influence of the Extraction Conditions and Purification', Molecules, 26(4), pp. 997. doi:10.3390/molecules26040997 Preclinical
https://doi.org/10.3390/molecules26040997 - Trendafilova, A., Ivanova, V., Todorova, M., Aneva, I. and others (2025) 'Phytochemical Characterization and Anti-Biofilm Activity of Primula veris L. Roots', Molecules, 30(8), pp. 1702. doi:10.3390/molecules30081702 Preclinical
https://doi.org/10.3390/molecules30081702 - Colombo, P.S., Flamini, G., Rodondi, G., Giuliani, C. and others (2017) 'Phytochemistry of European Primula species', Phytochemistry, 143, pp. 132-144. doi:10.1016/j.phytochem.2017.07.005 Traditional / reference
https://doi.org/10.1016/j.phytochem.2017.07.005 - Latypova, G.M., Bondarenko, T.A., Katayev, V.A., Romanenko, E.B. and others (2019) 'Composition and cardioprotective effects of Primula veris L. solid herbal extract in experimental chronic heart failure', Phytomedicine, 54, pp. 17-26. doi:10.1016/j.phymed.2018.09.015 Preclinical
https://doi.org/10.1016/j.phymed.2018.09.015 - Brys, R. and Jacquemyn, H (2015) 'Disruption of the distylous syndrome in Primula veris', Annals of Botany, 115(1), pp. 27-39. doi:10.1093/aob/mcu211 Preclinical
https://doi.org/10.1093/aob/mcu211 - Muller, A., Ganzera, M. and Stuppner, H (2006) 'Analysis of phenolic glycosides and saponins in Primula elatior and Primula veris (primula root) by liquid chromatography, evaporative light scattering detection and mass spectrometry', Journal of Chromatography A, 1112(1-2), pp. 218-223. doi:10.1016/j.chroma.2005.10.067 Preclinical
https://doi.org/10.1016/j.chroma.2005.10.067 - Graikou, K., Damianakos, H., Ganos, C., Syklowska-Baranek, K. and others (2023) 'Comparative Phytochemical Analyses of Flowers from Primula veris subsp. veris Growing Wild and from Ex Situ Cultivation in Greece', Foods, 12(13), pp. 2623. doi:10.3390/foods12132623 Preclinical
https://doi.org/10.3390/foods12132623 - European Medicines Agency (2012) 'European Union herbal monograph on Primula veris L'. Traditional / reference
https://scholar.google.com/scholar?q=European%20Union%20herbal%20monograph%20on%20Primula%20veris%20L - Royal Botanic Gardens, Kew (n.d.). Available at: https://powo.science.kew.org Traditional / reference
https://powo.science.kew.org - Wicke, L (2007) 'Primula veris in the treatment of upper respiratory infections', pp. 109--116. Traditional / reference
https://scholar.google.com/scholar?q=Primula%20veris%20in%20the%20treatment%20of%20upper%20respiratory%20infections - 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 - Ghasemzadeh Rahbardar, M. and Hosseinzadeh, H (2024) 'Therapeutic potential of hypnotic herbal medicines: A comprehensive review', Phytotherapy Research, 38(6), pp. 3037-3059. doi:10.1002/ptr.8201 Meta-analysis / review
https://doi.org/10.1002/ptr.8201 - Block, K.I., Gyllenhaal, C. and Mead, M.N (2004) 'Safety and efficacy of herbal sedatives in cancer care', Integrative Cancer Therapies, 3(2), pp. 128-148. doi:10.1177/1534735404265003 Meta-analysis / review
https://doi.org/10.1177/1534735404265003
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.