Hyperforin in St. John's wort drug interactions
Hyperforin in St. John's wort drug interactions
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DOI：
10.1007/s00228-006-0096-0
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发表时间：
2006-03-01
影响因子：
2.9
通讯作者：
Butterweck, V
中科院分区：
文献类型：
--
作者：
Madabushi, R;Frank, B;Butterweck, V
最近，草药与合成药物的相互作用成为人们特别感兴趣的焦点。在过去的3年中，发表了50多篇关于圣约翰草（贯叶连翘L.; SJW）和处方药。与SJW合并用药导致许多药物的血浆浓度降低，包括阿米替林、环孢素、地高辛、茚地那韦、伊立替康、华法林、苯丙香豆素、阿普唑仑、美托芬、辛伐他汀和口服避孕药。来自相互作用研究和病例报告的充分证据表明，SJW是细胞色素P450酶（特别是CYP 3A 4）和/或P-糖蛋白的强效诱导剂。最近的研究表明，SJW对酶的诱导程度与产品中贯叶金丝桃素的含量密切相关。不含大量贯叶金丝桃素（< 1%）的产品尚未显示出产生临床相关的酶诱导。另一方面，一些证据表明贯叶金丝桃素也可能有助于SJW的抗抑郁活性。然而，使用具有低贯叶金丝桃素量（< 1%）的SJW制剂的临床研究清楚地证明了这种植物提取物优于安慰剂，并且其在治疗轻度至中度形式的抑郁症中与丙咪嗪和氟西汀等效。在本文中，临床上显着的SJW相互作用的金丝桃素的背景下进行了严格的评估。
Recently, interactions of herbal medicines with synthetic drugs came into focus of particular interest. In the past 3 years, more than 50 papers were published regarding interactions between St. John's wort (Hypericum perforatum L.; SJW) and prescription drugs. Co-medication with SJW resulted in decreased plasma concentrations of a number of drugs including amitriptyline, cyclosporine, digoxin, indinavir, irinotecan, warfarin, phenprocoumon, alprazolam, dextrometorphane, simvastatin, and oral contraceptives. Sufficient evidence from interaction studies and case reports indicate that SJW is a potent inducer of cytochrome P450 enzymes (particularly CYP3A4) and/or P-glycoprotein. Recent studies could show that the degree of enzyme induction by SJW correlates strongly with the amount of hyperforin found in the product. Products that do not contain substantial amounts of hyperforin (< 1%) have not been shown to produce clinically relevant enzyme induction. On the other hand, some evidence suggests that hyperforin may also contribute to the antidepressant activity of SJW. However, clinical studies using SJW preparations with a low hyperforin amount (< 1%) clearly demonstrated the superiority of this plant extract over placebo and its equivalence to imipramine and fluoxetine in the treatment of mild to moderate forms of depression. In the present paper clinical significant SJW interactions are critically evaluated against the background of hyperforin.