Pharmacokinetic Interactions of Drugs with St John’s Wort
- 1 June 2004
- journal article
- review article
- Published by SAGE Publications in Journal of Psychopharmacology
- Vol. 18 (2), 262-276
- https://doi.org/10.1177/0269881104042632
Abstract
There is a worldwide increasing use of herbs which are often administered in combination with therapeutic drugs, raising the potential for herb-drug interactions. St John’s wort ( Hypericum perforatum) is one of the most commonly used herbal antidepressants. A literature search was performed using Medline (via Pubmed), Biological Abstracts, Cochrane Library, AMED, PsycINFO and Embase (all from their inception to September 2003) to identify known drug interaction with St John’s wort. The available data indicate that St John’s wort is a potent inducer of CYP 3A4 and P-glycoprotein (PgP), although it may inhibit or induce other CYPs, depending on the dose, route and duration of administration. Data from human studies and case reports indicate that St John’s wort decreased the blood concentrations of amitriptyline, cyclosporine, digoxin, fexofenadine, indinavir, methadone, midazolam, nevirapine, phenprocoumon, simvastatin, tacrolimus, theophylline and warfarin, whereas it did not alter the pharmacokinetics of carbamazepine, dextromethorphan, mycophenolic acid and pravastatin. St John’s wort decreased the plasma concentration of the active metabolite SN-38 in cancer patients receiving irinotecan treatment. St John’s wort did not alter the pharmacokinetics of tolbutamide, but increased the incidence of hypoglycaemia. Several cases have been reported that St John’s wort decreased cyclosporine blood concentration leading to organ rejection. St John’s wort caused breakthrough bleeding and unplanned pregnancies when used concomitantly with oral contraceptives. It also caused serotonin syndrome when coadministered with selective serotonin-reuptake inhibitors (e.g. sertaline and paroxetine). Both pharmacokinetic and pharmacodynamic components may play a role in these interactions. Because the potential interaction of St John’s wort with other drugs is a major safety concern, additional systematic research on herb-drug interactions and appropriate regulation in herbal safety and efficacy is needed.Keywords
This publication has 99 references indexed in Scilit:
- St. John's wort and depressionLife Sciences, 2002
- St John's Wort increases expression of P‐glycoprotein: Implications for drug interactionsBritish Journal of Clinical Pharmacology, 2002
- Relative Contribution of CYP3A to Amitriptyline Clearance in Humans: In Vitro and In Vivo StudiesThe Journal of Clinical Pharmacology, 2001
- Five Distinct Human Cytochromes Mediate Amitriptyline N‐Demethylation In Vitro: Dominance of CYP 2C19 and 3A4The Journal of Clinical Pharmacology, 1998
- Characterisation and Clinical Management of CPT-11 (Irinotecan)-induced Adverse Events: The European PerspectiveEuropean Journal Of Cancer, 1996
- P450 superfamily: update on new sequences, gene mapping, accession numbers and nomenclaturePharmacogenetics, 1996
- Absence of the mdr1a P-Glycoprotein in mice affects tissue distribution and pharmacokinetics of dexamethasone, digoxin, and cyclosporin A.JCI Insight, 1995
- BIOCHEMISTRY OF MULTIDRUG RESISTANCE MEDIATED BY THE MULTIDRUG TRANSPORTERAnnual Review of Biochemistry, 1993
- Metabolism of digoxin, digoxigenin digitoxosides and digoxigenin in human hepatocytes and liver microsomesFundamental & Clinical Pharmacology, 1991
- Toxic delirium possibly caused by loperamideThe Journal of Pediatrics, 1991