St. John’s wort drugs

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. 

Drugs that may affect epierenone include ACE inhibitors, angiotensin II antagonists, CYP3A4 inhibitors, NSAIDs, and St. John s wort. Drugs that may be affected by epierenone include lithium. 

Drugs that may affect nelfinavir include anticonvulsants, azithromycin, azole antifungals, efavirenz, delavirdine, HMG-CoA reductase inhibitors, indinavir, interleukins, nevirapine, rifabutin, rifampin, ritonavir, saquinavir, St. John s wort. Drugs that may be affected by nelfinavir include amiodarone, antiarrhythmics (amiodarone, quinidine), azithromycin, benzodiazepines, efavirenz, ergot alkaloids, delavirdine, didanosine, fentanyl, indinavir, lamivudine methadone, nonsedating antihistamines, oral contraceptives, phenytoin, pimozide, quinidine, rifabutin, saquinavir, sildenafil, sirolimus, tacrolimus, zidovudine. 

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. 

Si02 St. John s wort (drug) Apple sauce Al203-powder... 

Traditional herbal and homeopathic remedies that are supplied as natural treatments for medical conditions or diseases are subject to regulation as drugs, for example St. John s wort. 

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. 

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... 

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. 

Moore, L.B., Goodwin, B., Jones, S.A., Wisely, G.B., Serabjit-Singh, C.J., Willson, T.M., Collins, J.L. and Kliewer, S. A. (2000) St. John s wort induces hepatic drug metabolism through activation of the pregnane X receptor. Proceedings of the National Academy of Sciences of the United States of America, 97, 7500-7502. 

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