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Incidence and clinical
relevance of the interactions and side effects of Hypericum
preparations.
Schulz
V.
volkschu@t-online.de
Observational studies with
preparations of St. John's wort have recorded an incidence of adverse
events (AE) among those treated of between 1 and 3%. This is some ten
times less than with synthetic antidepressants. The most common adverse
events (1 per 300000 treated cases) among the spontaneous reports in the
official register concern reactions of the skin exposed to light.
Investigations in volunteers have shown that the threshold dose for an
increased risk of photosensitisation is about 2-4 g/day of a usual
commercial extract (equivalent to approximately 5-10 mg of the hypericin
that causes the phenomenon). In view of the newly observed side effects
and interactions, the following additional restrictions on use appear
justified: as with all preparations in this group of indications,
hypericum preparations must not be taken at the same time as other
antidepressants. If co-medication with coumarin-type anticoagulants is
unavoidable, it must only be undertaken provided the physician closely
monitors clotting parameters. Co-medication with ciclosporin and
indinavir, and for the time being, other protease inhibitors used in
anti-HIV treatment, is absolutely contraindicated. Without exception,
all preparations of St. John's wort must only be available through
pharmacies.
Publication Types:
- Case Reports
- Review
- Review, Tutorial
PMID: 11315759 [PubMed - indexed for
MEDLINE]
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