Possible Interaction: Cyclosporine and St John's Wort

“Additionally, the metabolite pattern of CSA was substantially altered during SJW treatment.”

“RESULTS After 2 … of SJ co administration, dose-corrected AUC0-12, Cmax and Ctrough values for CSA de creased significantly by 46%[geometric mean ratio baseline/SJW (95% CI): 1.83 (1.63-2.05)], 42%[1.72 (1.42-2.08)], and 41%[1.70 (1.17-2.47)], respectively.”

“ St. John's wort , a popular over-the-counter drug for treatment of depression, might reduce concentrations of drugs such as cyclosporin and indinavir and lead to drug resistance and treatment failure.”

“Co-administration with SJW has resulted in significant reductions in trough plasma concentrations of indinavir and cyclosporin [1, 2].”

“Many commonly ingested substances such as grapefruit juice and Hypericum perforatum (St John's wort) have been found to interact with important therapeutic agents such as cyclosporine (INN, ciclosporin).”

“Thus, repeated administrations of SJW affect the pharmacokinetic profiles of CsA in dogs.”

“Lastly, multiple herb-drug interactions have been identified with St. John's wort that involve significantly reduced AUC and blood concentrations of warfarin, digoxin, indinavir, theophylline, cyclosporine , tacrolimus, amitriptyline, midazolam, and phenprocoumon.”

“Results from clinical studies and case reports indicate that self-administered SJW reduce steady state plasma concentrations of amitriptyline, cyclosporine , digoxin, fexofenadine, amprenavir, indonavir, lopinavir, ritonavir, saquinavir, benzodiazepines, theophyline, irinotecan, midazolan and warfarin.”

“ Hypericum perforatum (hypericum; St John's wort) decreased the blood concentrations of ciclosporin (cyclosporin), midazolam, tacrolimus, amitriptyline, digoxin, indinavir, warfarin, phenprocoumon and theophylline, but did not alter the pharmacokinetics of carbamazepine, pravastatin, mycophenolate mofetil and dextromethorphan.”

“In transplant patients, self-medication with St John's wort (Hypericum perforatum) has led to a drop in plasma levels of the immunosuppressant drug cyclosporine , causing tissue rejection.”

“Examples of conventional medications which may undergo significant CYP 3A4 induction by St. John's wort include cyclosporine , indinavir, and oral contraceptives.”