Posted by Sunnely on December 27, 2001, at 22:27:16
In reply to Can you take st. johns wort with an anti-psychotic, posted by borderliner21 on December 27, 2001, at 15:09:12
> Can you take st. johns wort with an anti-psychotic?
Among the newer generation of antipsychotics, Seroquel will most likely be affected by St. John's wort (SJW). SJW enhances the action of the enzyme called CYP3A4. Seroquel largely depends on this enzyme for its metabolism. Theoretically, the combined use of SJW and Seroquel could lead to lowering of Seroquel blood level and loss of its effectiveness. Geodon is partly metabolized by CYP3A4. It is mainly metabolized by an enzyme called aldehyde oxidase. There are no known inhibitors or inducers of this enzyme. Although the combined use of SJW and Geodon may (minimally) lower the blood level of Geodon via CYP3A4, it is unlikely to lead to clinically significant effects. Clozapine is partly metabolized by CYP3A4. However, it largely depends on the enzyme CYP1A2 for its metabolism. Although theoretically, the combination of clozapine and SJW may lead to some decrease in clozapine blood level, it is unlikely to lead to clinically significant effects. Risperdal is largely dependent on CYP2D6 for its metabolism. However, there is one report to indicate that CYP3A4 may also be involved. Based on this, theoretically, the blood level of Risperdal may decrease if combined with SJW but the clinically effects are unclear.
Other psychotropic drugs are heavily dependent on CYP3A4 for their metabolism. For example, the combined use of SJW and Xanax, SJW and BuSpar, SJW and Halcion may lead to loss of anti-anxiety (increased anxiety or panic) or hypnotic effects (insomnia). Serzone also relies on CYP3A4 for its metabolism. Theoretically, the combined use of SJW and Serzone may lead to reduction in Serzone blood level and loss of effectiveness. The possibility of serotonin syndrome also exists.
There have been anecdotal reports of "serotonin syndrome" developing with the combined use of SJW and certain SSRIs (e.g. Prozac, Paxil, Zoloft). This condition is usually caused by the combined use of serotonin-enhancing drugs. It is usually a mild interaction and usually resolves shortly once the offending drug(s) stopped. Although uncommon, fatalities have been reported. Serotonin syndrome is probably unlikely to occur with the combined use of SJW and an antipsychotic. Theoretically, the serotonin antagonism effects of the newer antipsychotics may even help alleviate the condition.
A number of nonpsychotropic drugs are heavily dependent on CYP3A4 for their metabolism. For example, the combined use of SJW and cyclosporine (anti-rejection drug) may lead to transplant rejection; the combined use of SJW and digoxin may lead to acute heart failure.
poster:Sunnely
thread:87968
URL: http://www.dr-bob.org/babble/20011222/msgs/87998.html