Acute heart transplant rejection due to Saint John's wort

Ruschitzka, Frank; Meier, Peter J.; Turina, Marko; Lüscher, Thomas F.; Noll, Georg

doi:10.1016/s0140-6736(99)05467-7

Cited by 612 publications

(297 citation statements)

References 4 publications

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“…P-gp expression is clearly induced by the over-the-counter antidepressant herbal SJW, and clinically relevant drug-drug interactions have been reported between SJW and a wide range of drugs. Chronic administration of SJW together with cyclosporin A has been associated with a significant reduction in cyclosporin plasma levels and a higher risk for acute organ rejection in transplanted patients [121,122]. In healthy volunteers, administration of SJW together with the HPI indinavir produced an approximately 57% lower plasma AUC of indinavir [123].…”

Section: Drug-drug Interactionsmentioning

confidence: 99%

Concise Review: Clinical Relevance of Drug–Drug and Herb–Drug Interactions Mediated by the ABC Transporter ABCB1 (MDR1, P-glycoprotein)

et al. 2007

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Key Words. P-glycoprotein • Drug interaction • Complementary and alternative medicine • CAM • Pharmacokinetics Pharmacodynamics LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Identify important sources of variability in drug exposure caused by drug interactions mediated by P-glycoprotein.2. Describe how unwanted drug-drug interactions may lead to unexpected serious toxicity or undertreatment.3. Prevent these interactions by individualizing pharmacotherapy; this means selecting noninteracting drugs or adapting the dose of (the) interacting drug(s).Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTThe importance of P-glycoprotein (P-gp) in drug-drug interactions is increasingly being identified. P-gp has been reported to affect the pharmacokinetics of numerous structurally and pharmacologically diverse substrate drugs. Furthermore, genetic variability in the multidrug resistance 1 gene influences absorption and tissue distribution of drugs transported. Inhibition or induction of P-gp by coadministered drugs or food as well as herbal constituents may result in pharmacokinetic interactions leading to unexpected toxicities or undertreatment. On the other hand, modulation of P-gp expression and/or activity may be a useful strategy to improve the pharmacological profile of anticancer P-gp substrate drugs. In recent years, the use of complementary and alternative medicine (CAM), like herbs, food, and vitamins, by cancer patients has increased significantly. CAM use substantially increases the risk for interactions with anticancer drugs, especially because of the narrow therapeutic window of these compounds. However, for most CAMs, it is unknown whether they affect metabolizing enzymes and/or drug transporter activity. Clinically relevant interactions are reported between St John's wort or grapefruit juice and anticancer as well as nonanticancer drugs. CAM-drug interactions could explain, at least in part, the large interindividual variation in efficacy and toxicity associated with drug therapy in both cancer and noncancer patients.

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Section: Drug-drug Interactionsmentioning

confidence: 99%

Concise Review: Clinical Relevance of Drug–Drug and Herb–Drug Interactions Mediated by the ABC Transporter ABCB1 (MDR1, P-glycoprotein)

et al. 2007

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“…Even though two recent multicenter trials in the USA have failed, 2,3 randomized clinical studies have shown that SJW extracts are significantly superior to placebo and similarly effective as standard antidepressants in the treatment of mild to moderately severe depression. [4][5][6] Significant drug interactions have been reported with cyclosporine and protease inhibitors, 7,8 but a commonly cited advantage of SJW continues to be its favorable side effect profile. Although reports of serious and potentially fatal adverse reactions are known, and probably underreported, 9 the majority of significant side effects described in clinical trials are considered mild to moderate or transient.…”

mentioning

confidence: 99%

St John's wort and imipramine-induced gene expression profiles identify cellular functions relevant to antidepressant action and novel pharmacogenetic candidates for the phenotype of antidepressant treatment response

Wong¹,

O'Kirwan²,

Hannestad³

et al. 2004

Mol Psychiatry

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Both the prototypic tricyclic antidepressant imipramine (IMI) and the herbal product St John's wort (SJW) can be effective in the treatment of major depressive disorder. We studied hypothalamic gene expression in rats treated with SJW or IMI to test the hypothesis that chronic antidepressant treatment by various classes of drugs results in shared patterns of gene expression that may underlie their therapeutic effects. Individual hypothalami were hybridized to individual Affymetrix chips; we studied three arrays per group treatment. We constructed 95% confidence intervals for expression fold change for genes present in at least one treatment condition and we considered genes to be differentially expressed if they had a confidence interval excluding 1 (or À1) and had absolute difference in expression value of 10 or greater. SJW treatment differentially regulated 66 genes and expression sequence tags (ESTs) and IMI treatment differentially regulated 74 genes and ESTs. We found six common transcripts in response to both treatments. The likelihood of this occurring by chance is 1.14 Â 10 À23 . These transcripts are relevant to two molecular machines, namely the ribosomes and microtubules, and one cellular organelle, the mitochondria. Both treatments also affected different genes that are part of the same cell function processes, such as glycolytic pathways and synaptic function. We identified single-nucleotide polymorphisms in the human orthologs of genes regulated both treatments, as those genes may be novel candidates for pharmacogenetic studies. Our data support the hypothesis that chronic antidepressant treatment by drugs of various classes may result in a common, final pathway of changes in gene expression in a discrete brain region.

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“…Several clinically relevant drug-drug interactions have been reported between SJW and a wide range of drugs. Chronic administration of SJW together with cyclosporin A has been associated with a significant reduction in cyclosporin plasma levels and a higher risk for acute organ rejection in transplanted patients (18,19). In healthy volunteers, administration of SJW together with the protease inhibitor indinavir produced an approximately 57% lower plasma AUC of indinavir (20).…”

Section: Pharmacokinetics and Drug Interactions Of Herbal Medicines: mentioning

confidence: 99%

Pharmacokinetics and Drug Interactions of Herbal Medicines: A Missing Critical Step in the Phytomedicine/Drug Development Process

Obodozie¹

2012

Readings in Advanced Pharmacokinetics - Theory, Methods and Applications

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Acute heart transplant rejection due to Saint John's wort

Cited by 612 publications

References 4 publications

Concise Review: Clinical Relevance of Drug–Drug and Herb–Drug Interactions Mediated by the ABC Transporter ABCB1 (MDR1, P-glycoprotein)

Concise Review: Clinical Relevance of Drug–Drug and Herb–Drug Interactions Mediated by the ABC Transporter ABCB1 (MDR1, P-glycoprotein)

St John's wort and imipramine-induced gene expression profiles identify cellular functions relevant to antidepressant action and novel pharmacogenetic candidates for the phenotype of antidepressant treatment response

Pharmacokinetics and Drug Interactions of Herbal Medicines: A Missing Critical Step in the Phytomedicine/Drug Development Process

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