St. John’s Wort extract

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. 

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). 

Bilia, A. R., Bergonzi, M. C., Mazzi, G., and Vincieri, F. F. (2001). Analysis of plant complex matrices by use of nuclear magnetic resonance spectroscopy St. John s wort extract. /. Agric. Food Chem. 49, 2115-2124. 

Schmidt U, Sommer H. (1993). [St. John s wort extract in the ambulatory therapy of depression. Attention and reaction ability are preserved]. Fortschr Med. 111(19) 339-42. 

Vorbach EU, Arnoldt KH, Hubner WD. (1997). Efficacy and tolerability of St. John s wort extract LI 160 versus imipramine in patients with severe depressive episodes according to ICD-10. Pharmacopsychiatry. 30(suppl 2) 81-85. 

Whitten DL, Myers SP, Hawrelak JA, Wohlmuth H. The effect of St John s wort extracts on CYP3A a systematic review of prospective clinical trials. Br J Clin Pharmacol 2006 62 512-26. 

A multicenter trial comparing more appropriate doses of imipramine (75 mg twice daily, N = 167) and St. John s wort extract (250 mg twice daily standardized to 0.2% hypericin, N = 157) showed no difference in efficacy after 6 weeks of treatment. However, St. John s wort seemed to reduce anxiety symptoms more often than imipramine and was better tolerated (Woelk, 2000). A study including 240 participants compared St. John s wort with fluoxetine in mild to moderate depression and also concluded that efficacy of both treatments was comparable (Schrader, 2000). These results have been replicated in a smaller trial us-... 

Hypericum extracts can have clinically significant interactions with prescribed medications (Rey and Walter, 1998 Ernst, 1999b Piscitelli et ah, 2000 Walter et ah, 2000). The more important interactions known are presented in Table 29.2. There is limited information about the mechanisms involved. The more common view is that St. John s wort extracts activate the... 

Rager, I. et al., Rapid quantification of constituents in St. John s wort extracts by NIR spectroscopy, J. Pharm. Biomed. Appl, 28, 439, 2002. 

Golsch S, Vocks E, Rakoski J, et al. Reversible increase in photosensitivity to UV-B caused by St. John s wort extract. Hautarzi 1997 48 249-252. 

In modern European medicine, St. John s wort extracts are included in many over-the-counter and prescription drugs for management of mild depression, and have clinical implications for bed-wetting and nightmares in children. The extracts are included in diuretic preparations and the oil is taken orally using a teaspoon to help heal gastritis, gastric ulcers, and inflammatory conditions of the colon. The oil is also used extensively externally in burn and wound remedies. 

Schulz V. Safety of St. John s Wort extract compared to synthetic antidepressants. Phytomedicine. 2006 13 199-204. 

Kasper, S., Anghelescu, I. G., Szegedi, A., Dienel, A., Kieser, M. 2006, Superior efficacy of St John s wort extract WS 5570 compared to placebo in patients with major depression a randomized, double-blind, placebo-controlled, multicenter trial [ISRCTN77277298], BMC.Med., vol. 4, p. 14. 

Hypericum extract LI 160 (=standardized preparation) Hypericum extract (= St John s Wort extract)... 

A 36-year-old woman became pregnant whilst taking an oral contraceptive, ethinylestradiol/dienogest (doses not stated) (33). She had also taken St. John s wort extract. 

Karyekar CS, Eddington ND, Dowling TC. Effect of St. John s wort extract on intestinal expression of cytochrome P4501A2 studies in LS180 cells. J Postgrad Med 2002 48(2) 97-100. 

Fiebich BL, Hollig A, Lieb K. Inhibition of substance P-induced cytokine synthesis by St. John s Wort extracts. Pharmacopsychiatry 2001 34(Suppl 1) S26-S28. 

Volz HP, Murck H, Kasper S, Moller HJ. St. John s wort extract (LI 160) in somatoform disorders results of a placebo-controlled trial. Psychopharmacology 2002 164 294-300. 

PS1 / mice receiving St. John s Wort extract showed significant reductions of parenchymal Afh o and APi 42 accumulation, and moderate increases in cerebrovascular P-glycoprotein expression. According to these data reported by Brenn et al. [286], the induction of cerebrovascular P-glycoprotein may be a novel therapeutic strategy to protect the brain from p-amyloid accumulation. 

Harrer G, Schimidt U, Kuhn U, Biller A. Comparison of equivalent between the St. John s wort extract LoH)q)-57 and fluoxetine. Arzneimittel-Forschung/Drug Res 1999 49 289 - 296. 

Analysis of St John s wort extract with other analytical techniques... 

Grube B, Walper A, Wheatley D. St John s wort extract Efficacy for menopausal symptoms of psychological origin. Adv Ther 1999 16 177-186. 

St. John s wort extract may help to enhance sleep quality. In a study of 12 volunteers, hypericum extract LI 160 (Jarsin ) 300 mg, three times daily, did not improve sleep onset, intermittent wakenings, or total sleep duration. However, EEG analysis showed an increase in the mean percentage of time spent in deep (stages 3 and 4 slow wave) sleep (Schulz and Jobert, 1994). Human and animal studies suggest these EEG effects may be due to hyperforin (Schellenberg et al., 1998). These effects on sleep are not consistent with the effects observed with the use of traditional antidepressants, and are striking because a deficit in slow-wave sleep has been associated with affective disorders (Schulz and Jobert, 1994). 

Phototoxicity manifested as elevated, itching, erythematous lesions has been described (Golsch et al., 1997). Phototoxicty may also present as neuropathy, presumably caused by demyelination of cutaneous axons by photoactivated hypericins (Bove, 1998). After taking ground St. John s wort extract for 4 wk, a 35-yr-old woman complained of stinging pain on sun-exposed areas, worsened by cold, minimal mechanical stimuli, and sun exposure. The neuropathy improved over 2 mo after she discontinued the product (Bove, 1998). 

Lecrubier, Y., G. Clerc, R. Didi, and M. Kieser. Efficacy of St. John s Wort Extract WS 5570 in Major Depression A Double-Blind, Placebo-Controlled Trial. Am. /. Psychiatry 159 (2002) 1361-1366. 

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