Table 1.
Examples of clinical evidence of St John’s wort (SJW)–drug interaction mediated mainly by induction in healthy volunteers or patients *.
| Hypericum Extract | Subject Number | Drug Pharmacokinetic Parameters | Protein Involved | Ref. | |
|---|---|---|---|---|---|
|
Dose 3 × 300 mg/day |
Duration | ||||
| LI160 Rex Sund Jarsin LI160 Jarsin LI160 Jarsin LI160 Jarsin LI160 |
10 days 12 days |
13 male and 12 female 12 female 13 subjects 16 male and 4 female 10 male and 11 female 9 male |
↓ AUC and Cmax of digoxin ↓ AUC and Cmax of midazolam ↓ AUC of bosentan ↓ AUC and Cmax of ambrisentan ↓ Cmax of midazolam and fexofenadine ↓ AUC and Cmax of talinolol |
P-gp CYP3A4 CYP2C9/3A4 CYP3A4/5 CYP2C19 CYP3A4 and P-gpCYP3A4, P-gp |
[15] [56] [57] [43] [51] |
| Buyers Jarsin LI160 TruNatur LI160 Kira Buyers Buyers Solaray 3 × 325 mg/day Movina Jarsin LI160 Kira Kira Willmar Schwabe Pharm Jarsin LI160 Hyperiplant |
14 days | 6 male and 2 female 7 male and 5 female 8 male 12 subjects * 6 male and 6 female 12 male 12 male 15 male 8 male 16 male 14 male 15 male and 6 female 14 subjects 6 male and 6 female 4 male and 7 female * |
↓ AUC of indinavir ↓ AUC of midazolam ↓ AUC of simvastatin ↓ AUC of amitriptyline ↓ AUC and Cmax of imatinib ↓ AUC and Cmax of omeprazole ↓ AUC and Cmax of mephenitoin AUC and Cmax no change of repaglinide ↓ AUC and Cmax of verapamil ↓ AUC and Cmax of voriconazole ↓ AUC and Cmax of zolpidem ↓ AUC and Cmax of gliclazide ↓ AUC and Cmax of nifedipine ↓ AUC and Cmax of S-ketamine ↓ AUC of docetaxel |
CYP3A4 CYP3A4 CYP2C8/3A4 CYP3A4 CYP3A5, P-gp CYP2C19 CYP2C19 CYP2C8/3A4 CYP3A4 CYP3A4/5, P-gp CYP2C19 CYP3A4 CYP-2C9 CYP3A4 CYP3A4/2B6 CYP3A |
[13] [33] [36] [37] [45] [46] [47] [66] [49] [50] [55] [52] [53] [54] [58] |
| LichtwerPharma AG | 18 days | 2 male and 8 female * | ↓ AUC and Cmax of tacrolimus | CYP3A, P-gp | [48] |
| Modigen 2 × 300 mg/day | 21 days | 20 male | no effect steady-state of metformin |
[62] | |
| Rexall Sundown Buyers - |
56 days 28 days |
12 female 16 female 6 male and 6 female |
↓ AUC and Cmax of ethinyl estradiol/norethindrone combination ↓ AUC of ethinyl estradiol/norethindrone combination ↓6-hydroxychlorzoxazone/chlorzoxazone serum ratios (2-h) ↓1-dydroxymidazolam/midazolam serum ratios (1-h) in young and in elderly subjects |
CYP3A CYP3A4 CYP2E1 CYP3A4 |
[41] [42] [38] [39] |
| - | 31 days | 2 male and 2 female * | ↓of (R,S)-methadone concentration-to-dose ratios | [40] | |