Johanniskraut: Interaktion mit Cyclosporin gefährdet Nierentransplantat und erhöht die täglichen Medikationskosten

Abstract

Apart from an increased risk of graft rejection, the interaction also had cost implications because the dosage of this expensive drug had to be increased. In the period from 1995 to April 2000 an amount of approximately 15,300.- [symbol: see text] (30,000.- DM) of cyclosporine medication was necessary to avoid transplant rejection. The trend of the graphs strongly suggests that the treatment with St John's wort was the cause of the drop in plasma cyclosporine. It is of particular interest since this long-term observation uniquely reveals the raise of costs.

Interactions between Herbs and Conventional Drugs: Overview of the Clinical Data

“…5-HT re-uptake inhibitors, 5-HT ligands). St. John’s wort has been shown to clinically interact with a number of conventional drugs mostly via these pharmacokinetic and/or pharmacodynamic mechanisms; such interactions take place with immunosuppressants (cyclosporine, tacrolimus, prednisone), hormones (oral pill, tibolone), cardiovascular drugs (the anticoagulants warfarin and phenprocoumon, the cardiac inotropic drug digoxin, the antilipidaemic drugs simvastatin, rosuvastatin and atorvastatin, the calcium blockers nifedipine and verapamil, the β 1 -adrenoreceptor blocker talinolol, the anti-anginal drug ivabradine), antiretroviral drugs (indinavir, nevirapine), anticancer drugs (irinotecan, imatinib), drugs acting on the CNS (anaesthetics, the anxyolityc drugs alprazolam, midazolam, quazepam and buspirone, the antidepressants sertraline, nefazodone, paroxetine, venlafaxine and amitriptyline, the anti-epileptic drugs mephenytoin, drugs for addicted patients, such as methadone and bupropion, the centrally acting muscle relaxant chlorzoxazone, the antitussive drug dextromethorphan), anti-ulcer medications (omeprazole), antidiarrhoeal drugs (loperamide), drugs acting on the respiratory system (theophylline, fexofenadine), antifungal drugs (voriconazole) and antimigraine medicines (eletriptan) [55,56,143,146,147,148,149,150,151,154,162,163,164,165,166,167,168,169,170,171,172,173,174,175,176,177,178,179,180,181,182,183,184,185,186,187,188,189,190,191,192,193,194,195,196,197,198,199,200,201,202,203,204,205,206,207,208,209,210,211,212,213,214,…”

Das Phytotherapeutikum Johanniskraut: Die Möglichkeit seiner Anwendung in der Onkologie

“…bei Absetzen zur erhöhten Toxizität zahlreicher Wirkstoffe mit geringer therapeutischer Breite, wie z. B. Ciclosporin, Tacrolimus, Digoxin, Theophyllin, Antidepressiva (Amitriptylin, Nortriptylin), Antikoagulantien, Antikonvulsiva und mehreren HIVwirksamen Medikamenten, führen kann [10,[21][22][23][24][25].…”

St John's Wort Supplements Endanger the Success of Organ Transplantation

“…The most recent case 15 is of a 55-year-old woman who had received a kidney transplant in 1985 and subsequently had been stable receiving cyclosporine therapy. In 1995, she started self-medicating with SJW (300 mg extract 3 times per day).…”

“…Eventually the patient was maintained using her previous cyclosporine dose. She had no permanent harm but the authors 15 calculate that the costs of temporarily increasing the dose of cyclosporine amounted to 30000 DM (US $14000).…”