Digoxin and St Johns Wort

Interaction between St. John's wort and digoxin is of clinical significance. Johne et al. reported that 10-day usage of St. John's wort resulted in a 33% decrease of peak and 26% decrease in trough serum digoxin concentrations. The mean peak digoxin concentration was 1.9 ng/mL in the placebo group and 1.4 ng/mL in the group taking St. John's wort. The AUC between 0 and 24 h was 25% lower in the group consuming St. John's wort compared to the placebo group (36). Digoxin is a substrate for P-glycoprotein, which is induced by St. John's wort. Durr (37) et al. also confirmed the lower digoxin concentrations in healthy volunteers who concurrently took St. John's wort. St John's wort's dose and preparation also affect phramacokinetics of digoxin. Mueller et al. reported that low daily dose of hyperforin containing St. John's wort does not affect pharmacokinetics of digoxin. In contrast, co-medication with high-dose hyperforin-rich extract resulted in a 24.8% decrease in AUC from time 0 to 24 h. A reduction of 37% was also observed in digoxin maximal plasma concentrations (38).

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