Hyperforin in St. John’s wort drug interactions
- 14 February 2006
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Journal of Clinical Pharmacology
- Vol. 62 (3), 225-233
- https://doi.org/10.1007/s00228-006-0096-0
Abstract
Recently, interactions of herbal medicines with synthetic drugs came into focus of particular interest. In the past 3 years, more than 50 papers were published regarding interactions between St. John’s wort (Hypericum perforatum L.; SJW) and prescription drugs. Co-medication with SJW resulted in decreased plasma concentrations of a number of drugs including amitriptyline, cyclosporine, digoxin, indinavir, irinotecan, warfarin, phenprocoumon, alprazolam, dextrometorphane, simvastatin, and oral contraceptives. Sufficient evidence from interaction studies and case reports indicate that SJW is a potent inducer of cytochrome P450 enzymes (particularly CYP3A4) and/or P-glycoprotein. Recent studies could show that the degree of enzyme induction by SJW correlates strongly with the amount of hyperforin found in the product. Products that do not contain substantial amounts of hyperforin (<1%) have not been shown to produce clinically relevant enzyme induction. On the other hand, some evidence suggests that hyperforin may also contribute to the antidepressant activity of SJW. However, clinical studies using SJW preparations with a low hyperforin amount (<1%) clearly demonstrated the superiority of this plant extract over placebo and its equivalence to imipramine and fluoxetine in the treatment of mild to moderate forms of depression. In the present paper clinical significant SJW interactions are critically evaluated against the background of hyperforin.Keywords
This publication has 63 references indexed in Scilit:
- Interaction of St John's wort with conventional drugs: systematic review of clinical trialsBMJ, 2004
- Pharmacokinetic Interactions of Drugs with St John’s WortJournal of Psychopharmacology, 2004
- Drug Interactions with St John???s WortDrug Safety, 2004
- The interaction between St John's wort and an oral contraceptiveClinical Pharmacology & Therapeutics, 2003
- Interaction of St John's wort with low‐dose oral contraceptive therapy: a randomized controlled trialBritish Journal of Clinical Pharmacology, 2003
- St John's wort (Hypericum perforatum): drug interactions and clinical outcomesBritish Journal of Clinical Pharmacology, 2002
- St. John's wort and depression: Efficacy, safety and tolerability-an updateLife Sciences, 2002
- St John's Wort increases expression of P‐glycoprotein: Implications for drug interactionsBritish Journal of Clinical Pharmacology, 2002
- Interactions Between Herbal Medicines and Prescribed DrugsDrugs, 2001
- Metabolism of 17 α-ethynylestradiol in humansLife Sciences, 1990