Antidepressants St. John’s wort

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. 

Ernst E, Rand JI, Barnes J, Stevinson C. (1998). Adverse effects profile of the herbal antidepressant St. John s wort (Hypericum perforatum L.). EurJ Clin Pharmacol. 54(8) 589-94. 

Herbal antidepressants - St John s Wort (Hypericum officinalis)... 

STATINS ANTIDEPRESSANTS-ST JOHN S WORT St John s wort may lower simvastatin levels Uncertain at present Monitor lipid profile closely look for poor response to simvastatin... 

NERVOUS SYSTEM DRUGS ANTIDEPRESSANTS St John s wort... 

MODAFINIL 1. ANTIBIOTICS-rifabutin 2. ANTICANCER AND IMMUNOMODULATING DRUGS - corticosteroids 3. ANTIDEPRESSANTS-St John s wort 4. ANTIEPILEPTICS -phenytoin 5. ANTIDIABETIC DRUGS-pioglitazone 6. ANTIVIRALS - efavirenz, nevirapine May 1 modafinil levels Induction of CYP3A4, which has a partial role in the metabolism of modafinil Be aware... 

IMATINIB 1. ANTIBIOTICS-rifampicin 2. ANTICANCER AND IMMUNOMODULATING DRUGS - dexamethasone 3. ANTIDEPRESSANTS-St John s wort 4. ANTI EPILEPTICS - carbarn azepine, phenobarbital, phenytoin 1 imatinib levels Due to induction of CYP3A4-mediated metabolism of imatinib Monitor for clinical efficacy and adjust dose as required. Avoid co-administration of imatinib and rifampicin... 

PACLITAXEL 1. ANTIBIOTICS-rifampicin 2. ANTIDEPRESSANTS-St John s wort 3. ANTIEPILEPTICS -carbamazepine, phenobarbital, phenytoin 1 plasma concentration of paclitaxel and 1 efficacy of paclitaxel Due to induction of hepatic metabolism of paclitaxel by the CYP isoenzymes Monitor for clinical efficacy and need to T dose if inadequate response is due to interaction... 

VINCA ALKALOIDS - VINBLASTINE, VINCRISTINE 1. ANTIBIOTICS-rifampicin 2. ANTICANCER AND IMMUNOMODULATING DRUGS - dexamethasone 3. ANTIDEPRESSANTS-St John s wort 4. ANTI EPILEPTICS -carbamazepine, phenobarbital, phenytoin 1 of plasma concentrations of vinblastine and vincristine, with risk of inadequate therapeutic response. Reports of 1 AUC by 40% and elimination half life by 35%, and t clearance by 63%, in patients with brain tumours taking vincristine, which could lead to dangerously inadequate therapeutic responses Due to induction of CYP3A4-mediated metabolism Monitor for clinical efficacy, and t dose of vinblastine and vincristine as clinically indicated in the latter case, monitor clinically and radiologically for clinical efficacy in patients with brain tumours and t dose to obtain desired response... 

TAMOXIFEN ANTIDEPRESSANTS -ST JOHN S WORT i plasma concentrations of tamoxifen and risk of inadequate therapeutic response Due to induction of metabolism of tamoxifen by the CYP3A isoenzymes by St John s wort Avoid concurrent use... 

CORTICOSTEROIDS ANTIDEPRESSANTS -ST JOHN S WORT 1 plasma concentrations of corticosteroids and risk of poor or inadequate therapeutic response, which would be undesirable if used for e.g. cerebral oedema Due to induction of the hepatic metabolism by the CYP3A4 isoenzymes Closely monitor therapeutic response - clinically, by ophthalmoscopy and radiologically - and t dose of corticosteroids for desired therapeutic effect... 

TACROLIMUS ANTIDEPRESSANTS-ST JOHN S WORT J tacrolimus levels Induction of CYP3A4-mediated metabolism of tacrolimus Avoid co-administration... 

Taher MM, Lammering GM, Hershey CM, Valerie KC. Mood-enhancing antidepressant St. John s Wort inhibits the activation of human immunodeficiency virus gene expression by ultraviolet light. Life 2002 54 357-364. 

Figure 6.1 St. John s wort, shown here, is a plant that has been used as an herbal antidepressant. St. John s wort has been used to cure ailments such as pain, fever, and stomachache and its use can be documented as far back as the ancient Greeks. Today, it is available in the form of pills, teas, and foods, although it is not FDA-regulated. 

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