Clinical risks of St John’s Wort (Hypericum perforatum) co-administration

Abstract

St. John's wort (SJW) is a common medicinal herb used for the treatment of mild to moderate depression. Hyperforin, one of the chief components of SJW, plays an important role in the induction of cytochrome P450 enzymes (CYP) and P-glycoprotein transporter (P-gp), and therefore, affects the pharmacokinetics of various drugs. There are several clinical studies demonstrating the interaction of SJW with the metabolism of conventional drugs which may cause life-threatening events. Areas covered: This review focuses on human studies that have evaluated pharmacokinetic alterations of conventional drugs in concomitant use with different SJW preparations. Expert opinion: SJW preparations have demonstrated clinically important interactions with several classes of conventional drugs such as immunosuppressants, anticancer agents, cardiovascular drugs, oral contraceptives, and lipid lowering agents that caused life-threatening events in several cases. The patient information label on the SJW products should provide enough information regarding the possible risk of interaction. Hyperforin seems to be the major ingredient responsible for CYP and P-gp inducing activity of SJW; thus, hyperforin-free products may be future candidates to decrease SJW's drug interactions.

Impact of Up-Scheduling Medicines on Pharmacy Personnel, Using Codeine as an Example, with Possible Adaption to Complementary Medicines: A Scoping Review

“…This is particularly important in light of the growing body of evidence reporting potential side effects and drug-CM interactions that can impact patient safety and clinical outcomes of therapy. A well-established drug-herb interaction is Hypericum perforatum (St John's Wort, or SJW) [7], which is used in the management of mild to moderate depression [7]. In Australia, St John's Wort is easily accessed over-the-counter (OTC).…”

Hyperforin-Induced Activation of the Pregnane X Receptor Is Influenced by the Organic Anion-Transporting Polypeptide 2B1

“…Beside its antidepressant activity, St. John's wort is known for its pronounced influence on expression and activity of genes involved in drug metabolism (Soleymani et al, 2017). Indeed, hyperforin enhances expression and activity of CYP3A4, thereby modifying the first-pass metabolism and clearance of concomitantly applied substrates (Wang et al, 2013).…”

Clinical relevance of St. John's wort drug interactions revisited

“…Twenty years after the appearance of the first reports of clinically relevant drug interactions with SJW, this herbal medicine still attracts significant attention in the matter of safety, efficacy, and mechanism of action. The most important information has been comprehensively summarized (Borrelli & Izzo, 2009;Chrubasik-Hausmann, Vlachojannis, & McLachlan, 2019;Gurley, Fifer, & Gardner, 2012;Izzo, 2004;Soleymani, Bahramsoltani, Rahimi, & Abdollahi, 2017;Whitten, Myers, Hawrelak, & Wohlmuth, 2006). The present review focuses mainly on the current available knowledge on SJW-related drug interactions, its clinical efficacy, the possible underlying mechanism of action, and the lessons we have learned from this particular herbal medicine.…”