DrugSt Johns Wort Interactions Lower Concentrations of Therapeutic Drugs

Self-medication with St. John's wort may cause treatment failures due to significant reductions in plasma drug concentrations because of increase in clearance of drugs. Unrecognized use of St. John's wort is frequent among patients and may have important influences on the effectiveness and safety of drug therapy during hospital stay (23). Published reports indicate that St. John's wort significantly reduces steady-state plasma concentrations of cyclosporine, tacrolimus, amitriptyline, digoxin, fexofe-nadine, indinavir, methadone, midazolam, nevirapine, phenoprocoumon, squinavir, simvastatin, theophylline and warfarin (24). This long list of drugs includes immunosuppressant drugs (cyclosporine and tacrolimus), HIV protease inhibitors and HIV non-nucleoside reverse transcriptase inhibitors metabolized via CYP3A4. Increased clearance of oral contraceptives has also been reported.

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