A St John’s wort

Greeson, J.M., Sanford, B., and Monti, D.A. St. John s wort (Hypericum perforatum) a review of the current pharmacological, toxicological, and clinical literature, Psychopharmacology, 153, 402-414, 2001. 

Despite the controversy over whether these products should be held to the same safety and efficacy standards as "conventional medicines," the DSHEA currently allows herbal labeling to carry claims about the product s ability to affect the structure or function of the human body or to promote general wellbeing (Kurtzweil, 1999). For example, a St. John s wort label may state, "Helps enhance general mental well-being," but it cannot state, "Cures depression." Likewise, a claim such as, "Improves memory and concentration" would be allowed on a ginkgo biloba product, but "Cures Alzheimer s disease" would not be allowed. For consumers, some structure/function claims may be difficult to distinguish from claims of disease treatment/prevention. For example, would most consumers understand that "Supports cardiovascular health" is not synonymous with "Prevents coronary artery disease" More study is needed in this area. 

She is in your pharmacy now, carrying a bottle of Kaopectate and trying to select a St. John s wort product. 

Cyclosporin A St. John s wort Decrease in whole-blood trough concentration (mean dose-... 

In a study using tolbutamide as a prohe drug for CYP2C9 aetivity, St John s wort 900 mg daily had no effeet on the metaholism of a single dose of tolhutamide either after one day or after 2 weeks of use. Similarly, in another study, a St John s wort preparation with low hyperforin eontent (Esbericum) at a dose of 240 mg daily had no effeet on tolhutamide metaholism. ... 

John s wort the decreases were only 8.6% and 4.3%, respectively. In this study, irinotecan was given as a single 350-mg/ni intravenous dose every 3 weeks, and during one cycle a St John s wort preparation was given three times daily, heginning 14 days before and stopping 4 days after the irinotecan. ... 

Potassium Competitive Acid Blockers The pregnane X receptor (PXR) is a promiscuous nuclear receptor, that has evolved to protect the body from toxic chemicals. It is activated by a wide variety of xenobiotics including several diugs like rifampicin, hyperforin ( the active ingredient of St. John s wort), clotrimazole and others. PXR heterodimerizes with the... 

Another successful adaptation of the fully extended DFG S19 approach is the determination of, e.g., fenpyroximate in all type of berries by LC/MS/MS with APCI monitoring of positive ions directly in the S19 raw extract, and further the determination of trifluralin by LC/MS/MS with APCI monitoring of negative ions after performing a short SPE cleanup on an ion-exchange material. Similar approaches have used CC/MS/MS for, e.g., fenpropimorph and kresoxim methyl in St. John s Wort and peppermint. 

It is being recognized increasingly that regulation can have a positive impact on laboratory productivity.36 System suitability testing has been proposed as superior to and supplemental to calibration in the UV-VIS detector.37 Large variations in both response factor and in relative response factors were observed on different instruments. Even on the same instrument, UV-VIS spectra can be extremely dependent on solution conditions, as was observed in a separation of hypericin, the antidepressant extract of St. John s wort.38... 

CYP3A4 is highly inducible by a large variety of commonly prescribed and utilized synthetic drugs (e.g., carbamazepine) and plant products (e.g., St. John s wort) (Roby, Anderson et al, 2000), and at the same time also is potently inhibited by various other medications (e.g., terfenadine and ketoconazole) (Jurima-Romet, Crawford etal, 1994) as well as common foodstuffs (e.g., grapefruit juice) (Oesterheld 8c Kallepalli, 1997). Since individual and ethnic/cultural groups vary dramatically in their exposure to these inducers and inhibitors, it stands to reason that... 

Lecrubier, Y., Clerc, G., Didi, R. Kieser, M. (2002). Efficacy of St. John s Wort extract WS 5570 in major depression a double-blind, placebo-controlled trial. Am. J. Psychiatry, 159, 1361-6. 

Schrader, E. (2000). Equivalence of St John s Wort extract (Ze 117) and fluoxetine a randomized, controlled study in mild-moderate depression. Int. Clin. Psychopharmacol., 15, 61-8. 

A. Johne, J. Brockmoller, S. Bauer, A. Maurer, M. Langheinrich, and I. Root, Pharmacokinetic interaction of digoxin with an herbal extract from St. John s wort (Hypericum perforatum). Clin. Pharmacol. Ther., 66, 338-345 (1999). 

Some herbs are standardized for several active constituents, while others are standardized to a single active ingredient. St. John s wort is standardized to contain 0.3% hypericin, whereas ginkgo is standardized to contain 24% flavone glycosides and 6% ter-pene lactones. However, standardizing an herb product to one or more plant component(s) that are identifiable by assay may be incorrect. Many herbalists believe that the whole plant contributes to the efficacy and that there are many unknown active compounds in each plant [6]. 

Some products available on the market contain a combination of Ma Huang and St. John s wort and are referred to as herbal phen-fen. Phen-fen received its name when the combination of phentermine and fenfluramine were used for weight loss. Herbal phen-fen is touted as a natural and effective weight loss agent that does not contain phentermine or fenfluramine. However, herbal phen-fen carries the same warnings that apply to Ma Huang and St. John s wort when each is used alone. Furthermore, there are no clinical studies to support the use of herbal phen-fen. ... 

G. Harrer, U. Schmidt, U. Kuhn, and A. Biller, Comparison of equivalence between St. John s wort extract and LoHyp-57 and fluoxetine, Arzneimittelforschung, 49, 289 (1999). 

St John s wort is a yellow flowering plant that was first used medicinally by the ancient Greeks as a diuretic and a treatment for wounds and menstrual disorders. This herbal remedy is widely prescribed in Germany, where it has been studied extensively in clinical trials as a treatment for depression. In most countries, including the UK, it is available over the counter. In Ireland it is available only by prescription. Recently, a team of German scientists led by Klaus Linde at the University of Munich published a comprehensive review of 29 clinical trials of St John s wort, involving more than 5,000 depressed patients. They concluded that it is more effective than placebos and as effective as standard antidepressants in the treatment of major depression. 

I am not a great fan of St John s wort. For lasting control of depression, psychological treatment produces the best results, and medication does not add much - if anything - to it. Nevertheless, if a depressed patient wants medication, or if available alternative treatments are not sufficiently effective, this herbal remedy, taken under medical guidance, may be worth considering. 

Hudson, Christopher G., Socioeconomic Status and Mental Illness Tests of the Social Causation and Selection Hypotheses , American Journal of Orthopsychiatry 75, no. 1 (2005) 3-18 The Humble Humbug , The Lancet 2 (1954) 321 Hunter, Aimee M., Andrew F. Leuchter, Melinda L. Morgan and Ian A. Cook, Changes in Brain Function (Quantitative EEG Cordance) During Placebo Lead-in and Treatment Outcomes in Clinical Trials for Major Depression , American Journal of Psychiatry 163, no. 8 (2006) 1426-32 Hyland, Michael E., Do Person Variables Exist in Different Ways , American Psychologist 40 (1985) 1003-10 Hypericum Depression Trial Study Group, Effect of Hypericum Perforatum (St John s Wort) in Major Depressive Disorder A Randomized Controlled Trial , Journal of the American Medical Association 287 (2002) 1807-14... 

Hyperforin, the major constituent in Hypericum perforatum (St. John s Wort), inhibits the enzymatic activity of 5-lipoxygenase and COX-1 in platelets, acts as a dual inhibitor of 5-lipoxygenase and COX-1, and might have some potential in inflammatory and allergic diseases connected to eicosanoids (32), Several Hypericum species are of medicinal value in Asia and the Pacific. One of these is Hypericum erectum Thunb., the potential of which as a source of 5-lipoxygenase is given here. 

In addition to this serious diet-drug interaction, irreversible MAOIs also potentiate the effects of sympathomimetic drugs like ephedrine found in over-the-counter cold remedies and recreational stimulants like amphetamine. The MAOIs also interact with drugs that increase synaptic concentrations of 5-HT, such as the tricyclic antidepressant clomipramine and the herbal SSRI antidepressant St John s wort (Hypericum spp.). The resulting serotonin syndrome is characterised by hyperthermia and muscle rigidity. While devoid of these side effects the reversible MAO-A inhibitor moclobemide has yet to establish itself as a first-line alternative to the SSRIs. 

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