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St. John's Wort
Title: Second thoughts about safety of St. John's wort
Author: E. Ernst
Address: Exeter, UK
Source: The Lancet 354: 2014-2015 (December) 1999
Summary: Several reports have raised the possibility of important interactions between hypericum extracts and various prescribed drugs. At least 8 cases have been reported that suggest that hypericum extracts are potent inducers of hepatic enzymes. In all cases the patients were women (this may be a coincidence since women use hypericum extracts more frequently than men do), plasma concentrations of the concomitant medication were reduced, and all the comedications are metabolized by hepatic cytochrome P450 microsomal oxidase enzymes. Two recent preclinical studies confirm that hypericum extracts are hepatic enzyme inducers in humans. Other important interactions have been reported. Concomitant use of hypericum extracts in 5 patients while they were on a stable dose of serotonin-reuptake inhibitors has resulted in symptoms characteristic of central serotonin excess. Given the widespread use of hypericum extracts, the implications of the emerging evidence of adverse reactions are potentially serious. Even though the interaction data are preliminary, attention to 3 precepts seem prudent. Doctors should be aware that administration (or discontinuation) of hypericum extracts may significantly affect blood concentrations or many prescribed medicines. Patients must be encouraged to discuss their use of herbal remedies with their physician, and the prevalent misconception that natural always equates with harmless must be effectively refuted. Finally, regulatory bodies should take a fresh look at whether herbal medicines need regulation, since the perception of "risk free" may reflect incomplete understanding.