Profound Drop of Cyclosporin a Whole Blood Trough Levels Caused by St. John???s Wort (Hypericum Perforatum)

Breidenbach, T.; Kliem,; Burg, M.E.L. van der; Radermacher, Jörg; Mw, Hoffmann; Klempnauer, J.

doi:10.1097/00007890-200005270-00052

Cited by 125 publications

(71 citation statements)

References 5 publications

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“…90,91 of particular importance, organ transplant patients should avoid the use of St John's wort as it stimulates cyclosporine metabolism and thus increases the chances of tissue rejection. 92 Citrus paradisi (grapefruit) ingestion also affects the metabolism of a wide variety of drugs. However, in contrast to St John's wort, grapefruit inhibits the activity of several CYP isoenzymes.…”

Section: Precautions Using Herbal Medications In Special Circumstancesmentioning

confidence: 99%

The safe usage of herbal medicines: counterindications, cross-reactivity and toxicity

Cock¹

2014

Phcog Commn.

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Background: Plants have been used therapeutically for thousands of years and continue to be the main treatment modality for a large percentage of the world's population. Furthermore, herbal medicine usage is increasing in Western countries as complementary (and sometimes alternative) treatments in conjunction with allopathic medicine. At the same time, the usage of allopathic medicines is being increasingly incorporated into the medicinal systems of developing countries, often resulting in the concurrent usage of both systems. Importance of the Study: Despite the widespread usage in developing countries and the trend of increasing medicinal plant usage in Western countries, herbal medicines remain understudied and there are misunderstandings amongst users and practitioners about the safe usage of these medications, particularly when used in conjunction with other medicines. Herbal medicines are generally not held to the same rigorous standards as allopathic medicines. There is usually a lack of industry regulation and manufacturing standards and guidelines, resulting in inferior (or unsafe) medicines being sold to consumers. Similarly, there is a lack of understanding amongst many medical practitioners of both traditional and allopathic medicine systems of how drugs from the two systems can be safely used together. Aim: The aim of this review is to summarise the current knowledge about herbal medicines and how they can be used safely, with the aim of not only highlighting some of the unsafe uses, but also to stimulate further research. I have also aimed to highlight the need for greater regulation and standardisation of herbal medicines.

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Section: Precautions Using Herbal Medications In Special Circumstancesmentioning

confidence: 99%

The safe usage of herbal medicines: counterindications, cross-reactivity and toxicity

Cock¹

2014

Phcog Commn.

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“…The interaction between SJW and cyclosporine is the most well documented among herb-drug interactions, as it has been highlighted by multiple case reports, case series (47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61), and clinical trials (25,41). A number of heart, renal, or liver transplant patients stabilized on cyclosporine showed decreased blood levels (associated, in some cases, with acute rejection episodes) after taking SJW at therapeutic dosage.…”

Section: Immunosuppressantsmentioning

confidence: 99%

Herb–Drug Interactions with St John’s Wort (Hypericum perforatum): an Update on Clinical Observations

Borrelli

Izzo

2009

AAPS J

236

190

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Abstract. St John's wort (SJW) extracts, prepared from the aerial parts of Hypericum perforatum, contain numerous pharmacologically active ingredients, including naphthodianthrones (e.g., hypericin and its derivatives), phloroglucinols derivatives (e.g., hyperforin, which inhibits the reuptake of a number of neurotransmitters, including serotonin), and flavonoids. Such extracts are widely used for the treatment of mild-to-moderate depression. As a monotherapy, SJW has an encouraging safety profile. However, relevant and, in some case, life-threatening interactions have been reported, particularly with drugs which are substrate of cytochrome P450 and/or P-glycoprotein. Well-documented SJW interactions include (1) reduced blood cyclosporin concentration, as suggested by multiple case reports as well as by clinical trials, (2) serotonin syndrome or lethargy when SJW was given with serotonin reuptake inhibitors, (3) unwanted pregnancies in women while using oral contraceptives and SJW, and (4) reduced plasma drug concentration of antiretroviral (e.g., indinavir, nevirapine) and anticancer (i.e., irinotecan, imatinib) drugs. Hyperforin, which is believed to contribute to the antidepressant action of St John's wort, is also strongly suspected to be responsible of most of the described interactions.

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“…201 In another case report, cyclosporin levels were found to drop a mean of 47% with the concurrent use of St John's wort in 30 patients with organ allograft transplants (range 33%-62%). 215 No other drug levels were changed, and on discontinuation of St John's wort, cyclosporin levels were significantly increased. Another case report confirms that St John's wort can reduce cyclosporin levels and lead to acute graft rejection.…”

Section: Human and Clinical Studiesmentioning

confidence: 99%

Drug—Botanical Interactions: A Review of the Laboratory, Animal, and Human Data for 8 Common Botanicals

2009

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Many Americans use complementary and alternative medicine (CAM) to prevent or alleviate common illnesses, and these medicines are commonly used by individuals with cancer. These medicines or botanicals share the same metabolic and transport proteins, including cytochrome P450 enzymes (CYP), glucuronosyltransferases (UGTs), and P-glycoprotein (Pgp), with over-thecounter and prescription medicines increasing the likelihood of drug-botanical interactions. This review provides a brief description of the different proteins, such as CYPs, UGTs, and Pgp. The potential effects of drug-botanical interactions on the pharmacokinetics and pharmacodynamics of the drug or botanical and a summary of the more common models used to study drug metabolism are described. The remaining portion of this review summarizes the data extracted from several laboratory, animal, and clinical studies that describe the metabolism, transport, and potential interactions of 8 selected botanicals. The 8 botanicals include black cohosh, Echinacea, garlic, Gingko biloba, green tea, kava, milk thistle, and St John's wort; these botanicals are among some of the more common botanicals taken by individuals with cancer. These examples are included to demonstrate how to interpret the different studies and how to use these data to predict the likelihood of a clinically significant drug-botanical interaction.

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Profound Drop of Cyclosporin a Whole Blood Trough Levels Caused by St. John???s Wort (Hypericum Perforatum)

Cited by 125 publications

References 5 publications

The safe usage of herbal medicines: counterindications, cross-reactivity and toxicity

The safe usage of herbal medicines: counterindications, cross-reactivity and toxicity

Herb–Drug Interactions with St John’s Wort (Hypericum perforatum): an Update on Clinical Observations

Drug—Botanical Interactions: A Review of the Laboratory, Animal, and Human Data for 8 Common Botanicals

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