Herb–Drug Interactions with St John’s Wort (Hypericum perforatum): an Update on Clinical Observations
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TLDR
St John’s wort extracts, prepared from the aerial parts of Hypericum perforatum, contain numerous pharmacologically active ingredients, including naphthodianthrones, which are widely used for the treatment of mild-to-moderate depression.Abstract:
St John’s wort (SJW) extracts, prepared from the aerial parts of Hypericum perforatum, contain numerous pharmacologically active ingredients, including naphthodianthrones (e.g., hypericin and its derivatives), phloroglucinols derivatives (e.g., hyperforin, which inhibits the reuptake of a number of neurotransmitters, including serotonin), and flavonoids. Such extracts are widely used for the treatment of mild-to-moderate depression. As a monotherapy, SJW has an encouraging safety profile. However, relevant and, in some case, life-threatening interactions have been reported, particularly with drugs which are substrate of cytochrome P450 and/or P-glycoprotein. Well-documented SJW interactions include (1) reduced blood cyclosporin concentration, as suggested by multiple case reports as well as by clinical trials, (2) serotonin syndrome or lethargy when SJW was given with serotonin reuptake inhibitors, (3) unwanted pregnancies in women while using oral contraceptives and SJW, and (4) reduced plasma drug concentration of antiretroviral (e.g., indinavir, nevirapine) and anticancer (i.e., irinotecan, imatinib) drugs. Hyperforin, which is believed to contribute to the antidepressant action of St John’s wort, is also strongly suspected to be responsible of most of the described interactions.read more
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References
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Herb-drug interactions
TL;DR: Patients should caution patients against mixing herbs and pharmaceutical drugs, as many reports of herb-drug interactions are sketchy and lack laboratory analysis of suspect preparations.
Journal ArticleDOI
St. John's wort induces hepatic drug metabolism through activation of the pregnane X receptor
Linda B. Moore,Bryan Goodwin,Stacey A. Jones,G. Bruce Wisely,Cosette J. Serabjit-Singh,Timothy M. Willson,Jon L. Collins,Steven A. Kliewer +7 more
TL;DR: It is shown that hyperforin, a constituent of St. John's wort with antidepressant activity, is a potent ligand for the pregnane X receptor, an orphan nuclear receptor that regulates expression of the cytochrome P450 (CYP) 3A4 monooxygenase.
Journal ArticleDOI
Indinavir concentrations and St John's wort
TL;DR: St John's wort reduced the area under the curve of the HIV-1 protease inhibitor indinavir by a mean of 57% (SD 19) and decreased the extrapolated 8-hindinavir trough by 81% in healthy volunteers, which could lead to the development of drug resistance and treatment failure.
Journal ArticleDOI
Herbal Medicines and Perioperative Care
TL;DR: During the preoperative evaluation, physicians should explicitly elicit and document a history of herbal medication use to prevent, recognize, and treat potentially serious problems associated with their use and discontinuation.
Journal ArticleDOI
Acute heart transplant rejection due to Saint John's wort
TL;DR: An acute rejection in two transplant patients due to a metabolic interaction of St John's wort and cyclosporin is reported.
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