Antiretrovirals and St Johns Wort

A patient positive for HIV and taking antiviral agents should not consume St. John's wort, Echinacea, garlic, ginkgo and milk thistle because of interactions between these herbal remedies and antiretrovirals (39). St John's wort was shown to reduce the AUC of the HIV-1 protease inhibitor indinavir by a mean of 57% and decreased the extrapolated trough by 81%. The subjects received 300mg of St. John's wort three times a day for 14 days. The mean peak concentration (Cmax) decreased from 12.3 to 8.9ng/mL in healthy volunteers taking both indinavir and St. John's wort. More significant effect was observed in C8 concentrations where the mean value was reduced from 0.494 to 0.048ng/mL in the group taking both St. John's wort and indinavir. Reduction in indinavir concentrations of these magnitudes are clinically significant and could lead to treatment failure (40). Busti et al. (41) reported that atazanavir therapy can also be affected due to simultaneous use of St. John's wort. Co-administration of lopinavir/ritonavir with St. John's wort is also not recommended because of substantial reduction in lopinavir plasma concentrations (42).

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