the therapeutic goods administration (tga) wishes to alert doctors, pharmacists and complementary health practitioners to emerging evidence of important interactions between st john’s wort (hypericum perforatum) preparations and some prescribed medicines. the content of st john’s wort varies from one product to another. it appears that preparations of st john’s wort may be inducers of various drug metabolising enzymes. because amounts of active ingredients can vary from one preparation of st john’s wort to another, and patients may switch between preparations, the degree of induction is likely to vary.
in addition, st john’s wort products may affect neurotransmitters in the brain and, through this different mechanism, interact with psychotropic medicines including the reuptake inhibitor nefazodone and the selective serotonin reuptake inhibitors (ssris) citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline. specific advice on dealing with patients who are already taking st john’s wort and one of the medicines listed above is given in the information sheet. the actions of many other drugs depend on their route and rate of metabolism and thus other drugs may also interact with st john’s wort preparations. practitioners are encouraged to report suspected interactions with st john’s wort preparations to the adverse drug reactions advisory committee using the postage pre-paid blue cards, distributed with the schedule of pharmaceutical benefits booklet and the australian adverse drug reactions bulletin.
the degree of induction is unpredictable due to factors such as the variable quality and quantity of constituent(s) in sjw preparations. however, the increased usage has also brought to light a number of problems associated with these apparently safe herbal preparations such as interactions and adverse reactions. sjw extract has been shown to inhibit the uptake of serotonin, noradrenaline and dopamine [4, 7]. it is therefore likely that different preparations vary in their content of substances contributing to the antidepressant effects of sjw . this may be especially important as the use of sjw in mild to moderate depression is consistent with long-term use.
after sjw was stopped, cyclosporin concentrations increased by a mean of 187% (range 84–292%) and the dose of cyclosporin had to be decreased to the levels given before sjw was taken . as of december 2001, 7 cases of unplanned pregnancies possibly due to interactions with sjw have been reported through the yellow card scheme in the uk and two cases have been reported in sweden. the excess serotonin is believed to be due to common pharmacological mechanisms of action on serotonin, particularly in the brain, of both sjw and conventional antidepressants [7, 43, 44]. therefore the safety profile of combining these agents with sjw is not fully known and in the interests of patient safety these combinations should be avoided. a general warning has been added to the packaging of sjw products in sweden and the uk. data at present are insufficient to indicate to what extent the use of different sjw products and dosages may produce different outcomes in terms of adverse reactions.
st. john’s wort can be effective for treating mild to moderate depression. however, the supplement interacts with many medications and can cause serious side john’s wort may interact with medications used to treat depression or other mood disorders, including tricyclic antidepressants, ssris, and monoamine oxidase it appears that preparations of st john’s wort may be inducers of various drug metabolising enzymes. this may result in a reduction in the plasma concentrations, st john s wort side effects, st john s wort side effects, st john’s wort contraindications, st john’s wort uses, st john’s wort child dosage.
avoid taking st. john’s wort with other medicines that can make you more sensitive to sunlight, especially antibiotic medicine or a sulfa drug. a number of clinically significant interactions have been identified with prescribed medicines including warfarin, phenprocoumon, cyclosporin, hiv protease of its active constituents, the naphthodianthrone hypericin and phloroglucinol hyperforin are effective antibacterial compounds against various it appears that st john’s wort preparations may interact with medicines either by increasing the rate of their metabolism or increasing levels of, st john’s wort drug interactions list, how long does st john’s wort stay in your system.
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