A Review of the Benefits, Adverse Events, Drug Interactions, and ...

More documents

Recommendations

Info

are manufacturing and selling St. John's wort products to include cautions on their products, instructing that St. John's wort products should not be used concomitantly with any medicinal products. According to a report in the Irish Times (February 16, 2000) the FDA is working with herb manufacturers to ensure that labeling of St. John's wort products is revised in the United States, highlighting the potential for herb-drug interactions. In all this, it is important to keep a sense of proportion. St. John's wort has had thousands of years of safe use on a worldwide scale because it has been a traditional remedy of considerable importance in cultures as diverse as Ireland and China. It is ironic that, in part, the threat to its continued use actually arises from its recent proven success in the treatment of depression. An additional factor is its potential interaction with several potent prescription-only medicines, many of which, like warfarin, cyclosporin, and digoxin, require frequent blood tests for safe usage so that it should be easy enough to warn patients who are taking them that the concomitant taking of herbal medicines is to be avoided. The use by the public of St. John's wort to self-medicate for low-mood disorders is part of an evident sea-change as patients increasingly take control of their own health and demand equal partnerships with their medical advisors when it comes to treatment. The "prescription-only attitude" by the Irish authorities with regard to the treatment of depression should be contrasted with the more relaxed attitude of the Swedish MPA which accepts that "slight mood lowering has been deemed an appropriate indication for self medication." (QingYing, et al., 2000). Because the flavonoids in St. John's wort are believed to be responsible for activating the cytochrome P450 system (Breinholt, et al., 1999; Obermeier, et al., 1995) and these are widely found in our diet, a knee-jerk banning of St. John's wort or other herbs that may be found to have a similar action is a clear overreaction. What is needed is for politicians, legislators, and the medical establishment to recognize the legitimacy of extraordinary worldwide public demand for herbal medicine and to provide specific legislation for these medicines, ensuring that cautions about herb-drug interactions are appropriately declared at the point of prescription or sale. REFERENCES Association Européennes Speccialités Pharmaceutiques Grand. Herbal medicine products in the European Union--A report (ETD/97/336). Brussels, 1999. Anderson R, Flyrm N, Jain S, Samuels S, Perkins C, En-ders S. Testing is not enough: Do IDU know their serostatus [abstr]. Proceedings of the VIIIth International Conference on AIDS, Amsterdam, The Netherlands, 1992. Bailey DG, Malcolm J, Arnold O, Spence JD. Grapefruit juice-drug interactions. Br J Clin Pharmacol 1998;46(2): 101-110. Blumenthal M. Legal and regulatory: GAO criticizes FDA's proposed regulations on ephedrine containing dietary supplements HerbalGram 1999(47).123 . Brochmoller J, Rheum T, Bauer S, Kerb R, Hubner WD, Roots I. Hypericin and pseudohypericin: Pharmacokinetics and effects on photosensitivity in humans. Pharmacopsychiatry 1997;30(suppl. 2):S94--S101. Chan WK, Nguyen LT, Miller VP, Harris RZ. Mechanism based on inactivation of human cytochrome P450 3A4 by grapefruit juice and red wine. Life Sci 1998;62(10): 135-142. Conseil G, Baubichon-Cortay H, Dayan G, Jault JM, Barton D, Di Pietro A. Flavonoids: A class of modulators with bifunctional interactions at vicinal AT- and seroid-binding sites on a mouse P-glycoprotein. Proc Natl Acad Sci USA 1998;95:9831-9836. Cott JM. In vitro receptor binding and enzyme inhibition by Hypericum perforatum extract. Pharmacopsychiatry 1997;30:408-412. Cracchiolo C. Web site www.primenet.com/camilla/ST JOHN'S.FAQ. Djordjevic D, Nikolic J, Stephovic V. Ethanol interactions with other cytochrome P450 substrates, including drugs, xenobiotics and carcinogensis. Pathol Biol (Paris) 1998;46(10):760-770. Ernst E. Second thoughts about the safety of St. John's wort. Lancet, 1999;345:2014- 2016. European Union Council Directive, January 26, 1965 on the approximation of provisions laid down by law, regulation or administrative action relating to proprietary medicinal products (65/65 EEC). Official J Eur Union 1965;369(65):20-24. Fierenzuoli F, Luigi G. Safety of Hypericum perforaturn [letter]. J Altern Comp Med 1999;5(5):397-398.
Fugh-Berman A, Cott M. Dietary supplements and natural products as psychotherapeutic agents. Psychosomatic Med 1999;61:712-728. Geise AC. H,vpericism. Photochem Photobiol Rev 1980;5: 229255. Glue P, Clement RP. Cytochrome P450 enzymes and drug metabolism--basic concepts and methods of assessment. Cell Molec Neurobiol 1999;19(3):309-323· Golsch S, Vocks E, Rakoski J. Reversible increase in photosensitivity to UV-B caused by St. John's wort extract. Hautartz 1997;48:249. Gordon J. SSRIs and St. John's wort, possible toxicity Am Fam Physician 1998;62:31. Guengerich FP, Shimada T, Yurt CH, Yamazaki H, Raney KD, Their R, Coles B, Harris TM. Interactions of ingested food, beverage and tobacco components involving human cytochrome P450 lA', 2A6, ZE1, and 3A4 enzymes. Environ Health Persp 1994;102(suppl. 9):S49S53. Hansard. House of Lords, February 17, 2000:1335-1337. Harrison P. Herbal medicine takes root in Germany. GMA 7,1998;158:637-639. Irish Medicines Board (IMB). Circulated Response by the IMB (December 1999) to the Health Products Alliance Submission [copies available from the author]. Jobst KA, McIntyre M, St. George D, Whitelegg M. Safety of St. John's wort (Hypericum perforatum) [letter]. Lancet Breinholt V, Lauridsen ST, Dragstead LO. Differential effects of dietary flavonoids in drug metabolizing and antioxidant enzymes in female rat. Xenobiotica 1999; 29(12):1227- 1240 2000;355:575. ]ohne A, Brochrn611er ], Bauer S, Maurer A, Langheinrich, Roots I. Pharmacokinetic interaction of digoxin with an herbal extract from St. John's wort (Hypericum perforaturn). Clinical Pharmacol Thera 1999;66(4):338-345. Johnston N. Sun trap. New Scientist, July 24, 1999, p. 24. Kall MA. Dietary effect on mixed function, P450 lA2 activity assayed by estimation of caffeine metabolism in man. Hum Exp Toxicol 1995;14(10):801-807. Kim HL, Streltzer J, Goebert D. St. John's wort for depression. ] New Merit Dis 1999;187(9):532-539. Lantz MS, Buchalter E, Giambanco V. St. John's wort and ant/depressant drug interactions in the elderly. J Geriatr Psychiatry Neurol 1999;12:7-10. Linde K, Reamers G, Mulrow CD, Paul's A, Weiden-hammer W, Melchart D. St. John's wort for depression-an overview and meta-analysis of randomised clinical trials. BMJ 1996;313:253-258. Marcowitz JS, DeVane CL, Carson SW, Nahas Z, Bouton DW, Chike-Harris K, Leung JWW, R/sch SC. J Eur Coil Neuropsychopharmacol 1999;9 (suppl. 5):S367. Martin TG. Serotonin syndrome. Ann Emerg Med 1996; 28:520-526. McIntyre M. Position paper: Alternative licensing for herbal medicine-like products in the European Union. J Altern Complement Med 1999;5:110-113. Nathan PJ. The experimental and clinical pharmacology of St. John's wort (Hypericum perforatum L). Mol Psychiatry 1999;4:333-338. Nebel A, Schneider BJ, Baker R, Kroll D. Potential metabolic reaction between St. John's wort and theophylline. Ann Pharmacother 1999;33:502. Nierenberg AA, But T, Mathews J, Weiss AP. Mama associated with St. John's wort. Soc Biological Psychiatry 1999;46:1707-1708. Obermeier MT, White RE, Yang CS. Effects of bioflavonoids on hepatic P450 activities. Xenobiot/ca 1995;25:575-584. Oadrizek PR, Chan PJ, Patton WE, King A. Inhibition of human sperm motility by specific herbs used in alternative medicine. J Assist Reprod Genet 1999;16(2): 87-91. Philipp M, Kohnene i, Hiller K. Hypericum extract versus imipramine or placebo in patients with moderate depression. BMJ t999;3[9:15341539. Piscitelli SC, Burstein AH, Chait-t D, Alfaro PM, Falioon J. Indinavir concentrations and St. John's wort [letter]. Lancet 2000;355:547-548. Qin-Ying Y, Bergquist C, Gerden B. The safety of St. John's wort [letter]. Lancet 2000;355:576577. Rev JM, Waiter G. Hypericum perforatum (St. John's wort) in depression: Pest or blessing Med J Aust 1998;169: 583586. ,Roberts J-E, Wang RI-I, Tan IP, Datillo M and Chignell F. Hypericin (Active Ingredient in St. John's Wort) PhotoOxidation of Lens Proteins. Photochem Photobiol 1999; 69(6).
Page 1 and 2: Published in The Journal of Alterna
Page 3 and 4: Products as Psychotherapeutic Agent
Page 5 and 6: only medicines, such as cyclosporin
Page 7: treatment of mood disorders and dep

A Review of the Benefits, Adverse Events, Drug Interactions, and ...

Create successful ePaper yourself

Delete template?

Save as template?