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[St. John's wort: a pharmaceutical with potentially dangerous interactions]
A E Rätz1, M von Moos, J Drewe
1Abteilung Klinische Pharmakologie und Toxikologie, Kantonsspital Basel. raetza@uhbs.ch
Praxis
|June 16, 2001
Summary
St. John's wort, a popular herbal antidepressant, may cause dangerous drug interactions. Patients and doctors should be aware of potential risks, such as irregular bleeding with oral contraceptives, despite its perceived safety.
Area of Science:
- Pharmacology
- Herbal Medicine
- Drug Interactions
Background:
- St. John's wort is a widely used over-the-counter herbal remedy for depression.
- Its antidepressant effects are attributed to mechanisms similar to conventional antidepressants, including serotonin reuptake inhibition.
- It is often perceived as having a favorable safety profile compared to traditional antidepressants.
Observation:
- Despite its perceived safety, St. John's wort can cause adverse effects and interactions.
- Numerous case reports highlight hazardous interactions with various medications.
- This abstract details a case of irregular bleeding associated with oral contraceptive use.
Findings:
- St. John's wort interacts with multiple drug classes, including immunosuppressants (cyclosporine), anticoagulants, and oral contraceptives.
- It can reduce the efficacy of medications like digoxin, indinavir, amitriptyline, and theophylline.
- The case report specifically documents breakthrough bleeding in a patient using oral contraceptives.
Implications:
- Healthcare providers and patients may have a false sense of security regarding St. John's wort.
- Awareness of potential drug interactions is crucial for safe use of this herbal remedy.
- Further research and clear communication are needed to manage the risks associated with St. John's wort and drug combinations.