Effects of treatment with a commercially available St John's Wort product (Movina®) on cholesterol levels in patients with hypercholesterolemia treated with simvastatin

Eggertsen, Robert; Andreasson, Åke; Andrén, Lennart

doi:10.1080/02813430701442768

Cited by 24 publications

(12 citation statements)

References 27 publications

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“…Furthermore, atorvastatin might inhibit P‐gp and may also be a substrate for this transporter (Holtzman et al ., ). With regard to HP, controlled clinical studies revealed that mean low‐density lipoprotein cholesterol level and total cholesterol are significantly higher after 4 weeks of treatment with products containing HP despite the use of statins (atorvastatin and simvastatin) (Andrén et al ., ; Eggertsen et al ., ) (Table ). HP lowers simvastatin plasma levels, whereas no interaction with pravastatin was observed (Sugimoto et al ., ).…”

Section: Hypericum Perforatum–drug Interactionsmentioning

confidence: 99%

“…HP lowers simvastatin plasma levels, whereas no interaction with pravastatin was observed (Sugimoto et al ., ). Furthermore, in patients with hypercholesterolemia receiving simvastatin, HP can increase low‐density lipoprotein levels (Eggertsen et al ., ) (Table ). Moreover, it is very likely that products containing HP may interact with atorvastatin (Andrén et al ., ).…”

Section: Hypericum Perforatum–drug Interactionsmentioning

confidence: 99%

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Hypericum perforatum : Pharmacokinetic, Mechanism of Action, Tolerability, and Clinical Drug-Drug Interactions

et al. 2013

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Hypericum perforatum (HP) belongs to the Hypericaceae family and is one of the oldest used and most extensively investigated medicinal herbs. The medicinal form comprises the leaves and flowering tops of which the primary ingredients of interest are naphthodianthrones, xanthones, flavonoids, phloroglucinols (e.g. hyperforin), and hypericin. Although several constituents elicit pharmacological effects that are consistent with HP's antidepressant activity, no single mechanism of action underlying these effects has thus far been found. Various clinical trials have shown that HP has a comparable antidepressant efficacy as some currently used antidepressant drugs in the treatment of mild/moderate depression. Interestingly, low-hyperforin-content preparations are effective in the treatment of depression. Moreover, HP is also used to treat certain forms of anxiety. However, HP can induce various cytochrome P450s isozymes and/or P-glycoprotein, of which many drugs are substrates and which are the main origin of HP-drug interactions. Here, we analyse the existing evidence describing the clinical consequence of HP-drug interactions. Although some of the reported interactions are based on findings from in vitro studies, the clinical importance of which remain to be demonstrated, others are based on case reports where causality can, in some cases, be determined to reveal clinically significant interactions that suggest caution, consideration, and disclosure of potential interactions prior to informed use of HP.

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Section: Hypericum Perforatum–drug Interactionsmentioning

confidence: 99%

Section: Hypericum Perforatum–drug Interactionsmentioning

confidence: 99%

Hypericum perforatum : Pharmacokinetic, Mechanism of Action, Tolerability, and Clinical Drug-Drug Interactions

et al. 2013

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“…Many patients are not aware of possibilities for interaction with increasing lipid values and different natural health products that you can buy on the counter [4,5]. We have used one commercial product in our trial but results may be similar with other glucosamine products Also positive effects are described of natural health products as for pomegranate preparations where reductions in LDL-cholesterol have been demonstrated [10,11].…”

Section: Discussionmentioning

confidence: 99%

“…It is also known that some of these products can interact with several prescribed drugs [3], causing increased levels for example of cholesterol and other lipids [4,5] when interacting with the metabolism of simvastatin and atorvastatin [4,5]. One drug that is commonly used of patients suffering from osteoarthritis is glucosamine, which is found naturally in the body and also is used by the body as one of the building blocks of cartilage.…”

Section: Introductionmentioning

confidence: 99%

No changes of cholesterol levels with a commercially available glucosamine product in patients treated with lipid lowering drugs: a controlled, randomised, open cross-over trial

Eggertsen

Andreasson

Andrén

2012

BMC Pharmacol Toxicol

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BackgroundThe widespread use of natural health products is also a problem, as they could interact with prescribed drugs in patients. One commonly used product is glucosamine for osteoarthritis and some reports have found increased values of cholesterol and other lipids in patients treated with simvastatin for hypercholesterolemia. The aim of this trial was to investigate the effects of glucosamine on s-cholesterol levels (total s-cholesterol, s-HDL, s-LDL) in primary care patients on treatment with simvastatin or atorvastatin.MethodsControlled, randomized, open, crossover pharmacodynamic study in two primary health care centres. Patients were treated with Artrox® (glucosamine) 625 mg twice daily and control (a commercially available multivitamin tablet Vitamineral®). The study started with a run-in period of four weeks followed by control or active treatment with randomization of sealed envelopes. Each treatment period was four weeks and the treatment with simvastatin or atorvastatin was unchanged during the study (12 weeks). 34 patients were treated with a stable dose of simvastatin (n=21) or atorvastatin (n=13) for at least three months. Assessments of total s-cholesterol, s-HDL, S-LDL and s-triglycerides were performed in the morning with the patients in a fasting condition. T-tests for paired samples were used for statistical analyses and a p-value <0.05 was considered significant. Endpoints were the differences in lipid values at week 8 and week 12.ResultsAll patients completed the study. No significant changes were seen on any of lipid levels in the simvastatin group.ConclusionThe actual glucosamine product did not change lipid levels of patients treated with simvastatin. Atorvastatin group was too small for safe calculations but was also without changes.Trial registrationEUDRACT2006-001458-28

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“…A marked increase in LDL cholesterol and total cholesterol was demonstrated [75]. In addition, administration of HP for 2 weeks before a single dose of simvastatin decreased the bioavailability of simvastatin and its active metabolite simvastatin hydroxyl acid.…”

Section: Simvastatinmentioning

confidence: 97%

An update on the ability of St. John's wort to affect the metabolism of other drugs

Rahimi

Abdollahi

2012

Expert Opinion on Drug Metabolism & Toxicology

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There are a number of drugs whose metabolism is reduced by HP. The authors point out that metabolic interactions between HP and drugs are not always unfavorable and sometimes have benefits (e.g., reduction of irinotecan toxicity and increase in clopidogrel responsiveness). HP does not have a significant influence on the kinetics of drugs such as carbamazepine, ibuprofen and theophylline. The use of HP preparations is not recommended in people who are taking immunosuppressants or cardiovascular drugs. With other medications, it is recommended that practitioners should only use HP preparations with a low hyperforin content and under careful monitoring. It is also recommended that because of the reduction in the bioavailability of oral contraceptives administered concurrently with HP, women who use HP preparations should use additional preventive methods to avoid unintended pregnancy.

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Effects of treatment with a commercially available St John's Wort product (Movina®) on cholesterol levels in patients with hypercholesterolemia treated with simvastatin

Cited by 24 publications

References 27 publications

Hypericum perforatum : Pharmacokinetic, Mechanism of Action, Tolerability, and Clinical Drug-Drug Interactions

Hypericum perforatum : Pharmacokinetic, Mechanism of Action, Tolerability, and Clinical Drug-Drug Interactions

No changes of cholesterol levels with a commercially available glucosamine product in patients treated with lipid lowering drugs: a controlled, randomised, open cross-over trial

An update on the ability of St. John's wort to affect the metabolism of other drugs

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