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Indinavir concentrations and St John's wort.

S C Piscitelli, A H Burstein, D Chaitt

Lancet (London, England)

|February 22, 2000

Summary

St. John's wort significantly lowers exposure to the HIV drug indinavir in healthy individuals. This interaction may increase the risk of drug resistance and treatment failure in patients with HIV.

Area of Science:

Pharmacology
Drug Interactions
Herbal Medicine Interactions

Background:

St. John's wort is a popular herbal supplement with known interactions.
Indinavir is a critical protease inhibitor for managing HIV-1 infection.
Understanding herb-drug interactions is crucial for patient safety and treatment efficacy.

Purpose of the Study:

To quantify the effect of St. John's wort on the pharmacokinetic profile of indinavir in healthy volunteers.
To assess the clinical significance of this interaction for HIV treatment.

Main Methods:

Healthy volunteers were administered indinavir.
The impact of concomitant St. John's wort administration on indinavir exposure was measured.
Key pharmacokinetic parameters, including area under the curve and trough concentrations, were analyzed.

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Main Results:

St. John's wort reduced the area under the curve (AUC) of indinavir by a mean of 57%.
Extrapolated 8-hour indinavir trough concentrations decreased by 81%.
These reductions indicate a substantial decrease in overall drug exposure.

Conclusions:

Concomitant use of St. John's wort with indinavir leads to a significant reduction in indinavir exposure.
This interaction poses a risk for therapeutic failure and the development of drug resistance in HIV patients.
Clinicians should exercise caution when prescribing St. John's wort to patients on indinavir therapy.