St. Johns wort s. Hypericum perforatum

A. Johne, J. Brockmoller, S. Bauer, A. Maurer, M. Langheinrich, and I. Root, Pharmacokinetic interaction of digoxin with an herbal extract from St. John s wort (Hypericum perforatum). Clin. Pharmacol. Ther., 66, 338-345 (1999). 

Dimpfel W, Schober F, Mannel M. (1998). Effects of a methanolic extract and a hyperforin-enriched C02 extract of St. John s Wort (Hypericum perforatum) on intracerebral field potentials in the freely moving rat (Tele-Stereo-EEG). Pharmacopsychiatry. 31(suppl 1) 30-5. 

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. 

St. John s wort (Hypericum perforatum) Relieves anxiety and depression prevents insomnia relieves some skin disorders... 

St John s Wort (Hypericum perforatum, S JW) has been on the herbal pharmacopeia for many years. It is a traditional remedy for depression which has been validated in recent randomized clinical trials. Like many herbal preparations levels of active constituents vary from one preparation to another. As a consequence of its validation as an active preparation it has been widely promoted. Recently it has been shown to interact with a variety of other substances probably through the process of drug interaction. 

Table 9. The effect of St John s wort Hypericum perforatum) on some conventional drugs ...

Markowitz, J.S., DeVane, C.L., Boulton, D.W, Carson, S.W, Nahas, Z., and Risch, S.C. (2000) Effect of St. John s wort (Hypericum perforatum) on cytochrome P-450 2D6 and 3A4 activity in healthy volunteers. Life Sci 66 PL133-PL139. 

Nathan P. The experimental and clinical pharmacology of St. John s wort (hypericum perforatum L). Mol Psychiatry 1999 4 333-338. 

Wang Z, Gorski JC, Hamman MA, Huang SM, Lesko LJ, Hall SD. The effects of St. John s wort (Hypericum perforatum) on human cytochrome P450 activity. Clin Pharmacol Ther 2001 70 317-326. 

Barnes J, Anderson LA, Phillipson JD. St John s wort Hypericum perforatum L.) a review of its chemistry, pharmacology and clinical properties. J Pharm Pharmacol 2001 53 583-600. 

St. John s wort (Hypericum perforatum) is a perennial wildflower indigenous to Europe, North Africa, and western Asia (Fig. 1) and has been used for medicinal purposes for over two millennia. As far back as the early 16th century, St. John s wort was used primarily to treat anxiety, depression, and sleep disorders. In the late 20th and early 21st century, St. John s wort has been recommended for the treatment of mild to moderate depression (7). In support of its use for the treatment of mild to moderate depression, a number of clinical trials have demonstrated that St. John s wort has comparable efficacy to the tricyclic antidepressants (i.e., imipramine) and selective serotonin reuptake inhibitors (e.g., fluoxetine and paroxetine) (8-13). 

Breidenbach T, Kliem V, Burg M, Radermacher J, Hoffmann MW, Klempnauer J. Profound drop of cyclosporin A whole blood trough levels caused by St. John s wort (Hypericum perforatum). Transplantation 2000 69(10) 2229-2230. 

Hebert MF, Park JM, Chen YL, Akhtar S, Larson AM. Effects of St. John s Wort (Hypericum perforatum) on tacrolimus pharmacokinetics in healthy volunteers. J Clin Pharmacol 2004 44(l) 89-94. 

Izzo AA. Drug interactions with St. John s Wort (Hypericum perforatum) a review of the clinical evidence. Int J Clin Pharmacol Ther 2004 42(3) 139-148. 

St. John s Wort Hypericum perforatum L.) A Review. Christopher Hobbs-Health World Online, 1996. 

Herbal preparations St. John s Wort (hypericum perforatum) could result in reduced sirolimus levels. 

Stevia Stevia rebaudiana) Uses Natural sweetener, hypoglycemic and hypotensive properties Actions Multiple chemical components sweetness d/t glycoside, stevioside hypotensive effect may be d/t diuretic action or vasodilation action Available forms Liq extract, powder, caps Notes/SE HA, dizziness, bloating Interactions T Hypotensive effects W/ antihypertensives esp CCB, diuretics EMS Monitor BP does not encourage dental caries may -1-glucose St. John s Wort (Hypericum perforatum) Uses Mild-mod depression, anxiety, anti-inflammatory, immune stimulant/anti-HIV/antiviral, gastritis, insomnia, vitiligo Action MAOI in vitro, not in vivo bacteriostatic bactericidal, T capillary blood flow, uterotonic activity in animals Efficacy Variable benefit w/ mild-mod depression in several trials, but not always seen in clinical practice Available forms Teas, tabs, caps, tine, oil ext for topical use Dose 2-4 g of herb or 0.2-1 mg of total hypericin (standardized extract) daily Notes/SE Photosensitivity (use sunscreen) rash, dizziness, dry mouth, GI distress Interactions Enhance MAOI activity, EtOH, narcotics, sympathomimetics EMS T Risk of photosensitivity Rxns t effects of opioids and sympathomimetics... 

Synaptic serotonin (5-hydroxytryptamine) transporters are inhibited by amphetamines, the tropane alkaloids cocaine and ecgonine [194] and by the indole alkaloid ibogaine (12-methoxyibogamine) and its demethylation product ibogamine [191, 195]. Hyperforin is a major antidepressant constituent of St. John s Wort (Hypericum perforatum) and inhibits serotonin uptake by elevating cytosolic Na+ [196]. The additional... 

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