Hyperforin drug interactions

Mai I, Bauer S, Perloff ES, Johne A, Uehleke B, Frank B, Budde K, Roots I. Hyperforin content determines the magnitude of St. John s wort-cyclosporine drug interactions. Clin Pharmacol Ther 2004 76 330-340. 

Mai, L, Bauer, S., Perloff, E., Johne, A., Uehleke, B., Frank, B., et al. (2004). Hyperforin content determines the magnitude of the St John s wort-cyclosporine drug interaction. Clinical Pharmacology and Therapeutics, 76, 330—340. 

Madabushi R, Frank B, Drewelow B, et al. Hyperforin in St. John s wort drug interactions. Eur J Clin Pharmacol 2006 62 225-233. 

Mai, 1., S. Bauer, E.S. Perloff, et al. 2004. Hyperforin content determines the magnitude of the St. John s wort-cyclospxjiine drug interaction. Clin. Pharmacol. Ther. 76(4) 330-340. 

A commoniy reported drug-dietary suppiement interaction is between St. John s Wort and FiiV protease inhibitors, ieading to drug resistance and treatment faiiure. St. John s wort is a popuiar dietary suppiement often used for depression. Of the two substances found in St. John s wort, hypericin and hyperforin, hyperforin appears to be the main constituent, with in vitro seieotive serotonin reuptake inhibitor (SSRi) activity (see Chapter 21). Hyperforin aiso appears to be the more potent inducer of CYP3A enzymes based on in vitro and in vivo studies. 

Information seems to be limited to these reports, but the interaction would appear to be established. The extent of the interaction may depend on the St John s wort preparation involved and dose used and seems to be correlated with the dose of hyperforin. See also Drug-herb interactions , (p.lO). Reductions in serum digoxin levels of the size seen with LI 160 could diminish the control of arrhythmias or heart failure. Digoxin serum levels should therefore be well monitored if St John s wort is either started or stopped and appropriate dosage adjustments made if necessary. The recommendation of the CSM in the UK is that St John s wort should not be used by patients taking digoxin. ... 

Low-hyperforin and hyperforin-free extracts are commercially available and are believed to be less likely to interact with drugs than extracts with standard amounts of hyperforin (Madabushi et al. 2006). 

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