St. John’s wort, drug interactions

Although many patients believe that dietary supplements will not interact with medications, recent literature suggests otherwise. Recently, many St. John s wort-drug interactions have been reported in the literature. Cases of patients developing symptoms of serotonin syndrome have been reported with St. John s wort alone and in concomitant therapy with other antidepressants such as monoamine oxidase inhibitors, serotonin reuptake inhibitors, and venlafaxine. St. John s wort may exacerbate the sedative effects of benzodiazepines, alcohol, narcotics, and other sedatives. St. John s wort may decrease the levels of protease inhibitors, cyclosporine, digoxin, and theophylline. 

AUC, area under the plasma concentration cuive BZ, benzodiazepine Cl, clearance t, elimination half-life Vd, volume of distribution. Data from Benzodiazepines. Fads and Comparisons 4.0 Online. Wolters Kluwer Health, Inc. 2005, http //online.factsandcomparisons.com and Madabushi R, Frank B, DrewelowB, etal. Hyperforinin St. John s wort drug interactions. Fur J Gin Pharmacol 2006 62 225-233. 

Table 3B St. John s Wort-Drug Interactions in Labeling of St. John s Wort Products...

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

There have been reports of a serious drug interaction between cyclosporine and the herbal dietary supplement, St. John s wort . This interaction has been reported to produce a marked reduction in the blood concentrations of cyclosporine, resulting in subtherapeutic levels, rejection of transplanted organs, and graft loss ... 

St. John s wort (SJW) interactions with prescribed drugs, leading to loss of efficacy... 

St. John s wort This herbal remedy may induce CYP3A4 the certainty of an interaction probably rests on the specific preparation being used, but caution would dictate that this herbal product should be avoided in those receiving methadone treatment withdrawal symptoms have been noted in patients taking methadone maintenance who have added St. John s wort to their drug regimen. 

Drug interactions Metabolized by CYP450 3A4 (e.g., cyclosporine, erythromycin, itraconazole, phenytoin, 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. 

St. John s wort, an herbal nonprescription medication containing hyperi-cum, may be effective for mild to moderate depression, but it is associated with several drug-drug interactions. Its potency, purity, and manufacture are not regulated by the FDA. As depression is a potentially life-threatening disease, all antidepressant treatments should be overseen by a trained healthcare professional. 

NA /D, abd pain, bleeding, fevCT, T QT Interactions t Effects W7 atazanavir, clarithromycin, CT5rthromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfi-navir, ritonavir, saquinavir, telithromycin X effects W7 antacids, carbamazqjine, dexamethasone, phenobarbital, phenytoin, rifampicin, St. John s wort EMS Drug contains lactose, may cause D/abd discomfort in pts w/ lactose intolerance OD Sxs unknown symptomatic and supportive... 

---