Use of serotonergic antidepressants and St John’s wort in older Australians: a population-based cohort study

Rahman, Syed Ziaur; Basilakis, Jim; Rahmadi, Anton; Lujic, Sanja; Musgrave, Ian; Jorm, Louisa; Hay, Phillipa; Münch, Gerald

doi:10.1177/1039856213475681

Cited by 4 publications

(10 citation statements)

References 25 publications

(33 reference statements)

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“…Also, the proportion using St. John's Wort in particular is likely to be smaller. Some idea of the relative use of these two medicines can be gained from a recent examination of antidepressant use in the large, population based ‘45 and Up’ study in New South Wales (NSW) . Of 16 883 subjects reporting use of antidepressant medication or St. John's Wort, there were 1372 using fluoxetine and 689 using St. John's Wort.…”

Section: Discussionmentioning

confidence: 99%

“…Of 16 883 subjects reporting use of antidepressant medication or St. John's Wort, there were 1372 using fluoxetine and 689 using St. John's Wort. Intriguingly, of the 689 people using St. John's Wort, only 78 were being treated for depression . If this pattern holds more generally for younger subjects and the rest of Australia, this suggests that the larger number of ADR events for fluoxetine compared to St. John's Wort reflects their proportion of usage, assuming that underreporting of ADRs to St. John's Wort is similar to fluoxetine underreporting.…”

Section: Discussionmentioning

confidence: 99%

“…Given that in the ‘45 and Up’ study, only 9 of the 689 users of St. John's Wort reported concurrent use of conventional SSRIs, the high proportion of ADRs due to SSRI–St. John's Wort interactions is troubling . Combined St. John's Wort and SSRI usage places a user at a high risk of lethal and irreversible serotonin syndrome, which raises the question of whether the user is aware of the dangers of herbal–drug interactions …”

Section: Discussionmentioning

confidence: 99%

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A comparison of patterns of spontaneous adverse drug reaction reporting with St. John's Wort and fluoxetine during the period 2000–2013

Hoban

Byard

Musgrave

2015

Clin Exp Pharma Physio

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Herbal medicines are perceived to be safe by the general public and medical practitioners, despite abundant evidence from clinical trials and case reports that show herbal preparations can have significant adverse effects. The overall impact of adverse events to herbal medicines in Australia is currently unknown. Post marketing surveillance of medications through spontaneous adverse drug reaction (ADR) reports to the Therapeutic Goods Administration (TGA) is one way to estimate this risk. The patterns of spontaneously reported ADRs provide insight to herbal dangers, especially when compared with patterns of a mechanistically similar conventional drug. The study compared the pattern of spontaneously reported ADRs to St. John's Wort (Hypericum perforatum), a common herbal treatment for depression which contains selective serotonin reuptake inhibitors (SSRI), to fluoxetine, a commonly prescribed synthetic SSRI antidepressant. Spontaneous ADR reports sent to the TGA between 2000-2013 for St. John's Wort (n = 84) and fluoxetine (n = 447) were obtained and analysed. The demographic information, types of interaction, severity of the ADR, and the body systems affected (using the Anatomical Therapeutic Chemical classification system) were recorded for individual ADR cases. The majority of spontaneously reported ADRs for St. John's Wort and fluoxetine were concerning females aged 26-50 years (28.6%, 22.8%). The organ systems affected by ADRs to St John's Wort and fluoxetine have a similar profile, with the majority of cases affecting the central nervous system (45.2%, 61.7%). This result demonstrates that herbal preparations can result in ADRs similar to those of prescription medications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A comparison of patterns of spontaneous adverse drug reaction reporting with St. John's Wort and fluoxetine during the period 2000–2013

Hoban

Byard

Musgrave

2015

Clin Exp Pharma Physio

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“…11,12 Arguing against a strong increase in risk is an epidemiologic study that showed that a small number of adult Australians concurrently taking antidepressants and St. John's wort had no signs of serotonin syndrome. 13 Another case described a 50-year-old woman who took St. John's wort and a single dose of paroxetine and became incoherent, weak, and slow without any signs or symptoms of serotonin syndrome. 14 She recovered completely without intervention.…”

Section: Hypericummentioning

confidence: 98%

Herbal Adjuncts to Antidepressants

Yarnell

2015

Alternative and Complementary Therapies

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The intentional use of herbal medicines to increase efficacy or decrease adverse effects of antidepressant drugs is reviewed, with notes about situations (mostly isolated case studies) in which such combinations might have been harmful. Hypericum perforatum (St. John's wort), a common antidepressant herb, is reviewed first, given that there are a number of concerns about possible harms that might arise from its use with various antidepressants. Although a handful of case studies suggest that there are problems, there is little definitive information, and preclinical research suggests the possibility of benefits.The safety of combining various herbs with monoamine oxidase-inhibiting drugs is reviewed next. Studies supporting the use of Crocus sativus (saffron) and Ginkgo biloba (ginkgo) to offset sexual adverse effects of selective serotonin reuptake inhibitors (SSRIs) are reviewed. Pausinystalia yohimbe (yohimbe) and its alkaloid yohimbine's ability to augment antidepressant therapy is discussed. The use of the herbal formula Rikkunshi-tō (Liù Jūn Zǐ Wán) to offset gastrointestinal adverse effects of SSRIs is reviewed. Finally, research on combining Rauvolfia serpentina (Indian snakeroot) and its alkaloid reserpine with antidepressants is mentioned. Much more research is needed in this area, given how frequently antidepressant drugs and herbs are used by patients.

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“…Despite the warning of concomitant use of antidepressant medicines and St John's wort extract, cross‐sectional data on the use of antidepressants in Australia revealed that a number of people consumed both medicines . There is a need for improved consumer education about St John's wort extracts, as well as the application of more stringent standards to stores and online providers that sell these medications .…”

Section: Further Researchmentioning

confidence: 99%

Understanding drug interactions with St John's wort (Hypericum perforatumL.): impact of hyperforin content

Chrubasik‐Hausmann

Vlachojannis

McLachlan

2018

Journal of Pharmacy and Pharmacology

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Objective The aim of this study was to review herb-drug interaction studies with St John's wort (Hypericum perforatum L.) with a focus on the hyperforin content of the extracts used in these studies. Methods PUBMED was systematically searched to identify studies describing pharmacokinetic interactions involving St John's wort. Data on study design and the St John's wort extract or product were gathered to extract hyperforin content and daily dose used in interaction studies. Key findings This analysis demonstrates that significant herb-drug interactions (resulting in a substantial change in systemic exposure) with St John's wort products were associated with hyperforin daily dosage. Products that had a daily dose of <1 mg hyperforin were less likely to be associated with major interaction for drugs that were CYP3A4 or p-glycoprotein substrates. Although a risk of interactions cannot be excluded even for low-dose hyperforin St. John's wort extracts, the use of products that result in a dose of not more than 1 mg hyperforin per day is recommended to minimise the risk of interactions. Conclusions This review highlights that the significance of herb-drug interactions with St John's wort is influenced by the nature of the herbal medicines product, particularly the hyperforin content.

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Use of serotonergic antidepressants and St John’s wort in older Australians: a population-based cohort study

Abstract: Around 7% of the study population aged 45-65 years reported the use of SSRIs or SNRIs, decreasing to 5% above 70 years of age. It is of concern that some individuals used an SSRI concurrently with St John's wort.

Cited by 4 publications

References 25 publications

A comparison of patterns of spontaneous adverse drug reaction reporting with St. John's Wort and fluoxetine during the period 2000–2013

A comparison of patterns of spontaneous adverse drug reaction reporting with St. John's Wort and fluoxetine during the period 2000–2013

Herbal Adjuncts to Antidepressants

Understanding drug interactions with St John's wort (Hypericum perforatumL.): impact of hyperforin content

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