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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Franz on October 11, 2007, at 7:06:38
Hello,
I am planning to try a small dose of S. J. Wort (Hypericum) during the day to help control anxiety, irritability and elevate mood (if it works). The problem is I found this:
St. John's Wort may reduce the thyroid activity of drugs such as levothyroxine (Synthroid).
http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31402/348539.htmlI am taking a small dose of levothyroxine. How serious can be the interaction?. Sould I take the hypericum at night (it won´t "protect" me during the day I think)?. Currently I take a small dose alprazolam (0.25mg) or bromazepam (1.5mg) at night (clonazepam depresses me). I am trying Passion Flower to take during the day not to take another dose of benzo. I am thinking of SJW because I think I need something more antidepressant. I tried SJW before at recommended doses but it made me sleepy like a SSRI. Maybe a low dose but for more extended time works well.
Suggestions?. SAME is expensive and so is tianeptine. Too bad SJW interacts with everything and has the photosensitivity problems.
Thanks.
Posted by tenman on October 11, 2007, at 11:52:51
In reply to S. J. Wort (hypericum) and levothyroxine, posted by Franz on October 11, 2007, at 7:06:38
I would not use the SJW. It will decrease your thyroxin levels.
Have you tried Rhodiola Rosea? If not, I would forgo the SJW in favor of that. I use 100mgs. of the New Chapter variety in the morning and it provides a strong calming antidepressant effect. Start your dose there and work your way up slowly gauging effect and tolerance. New Chapter is the brand I recommend, if you go with someone else make sure it is standardized for 3% Rosavins and .08-1% Salidrosides.
Posted by Franz on October 11, 2007, at 13:10:25
In reply to Re: S. J. Wort (hypericum) and levothyroxine, posted by tenman on October 11, 2007, at 11:52:51
> I would not use the SJW. It will decrease your thyroxin levels.
Too much?. I am on 50 mcg T4
>
> Have you tried Rhodiola Rosea?Yes, did not notice anything. maybe it was a bad brand. Not possible for me to get Rhodiola now.
> If not, I would forgo the SJW in favor of that. I use 100mgs. of the New Chapter variety
Ia that a brand name?. Source?.
>in the morning and it provides a strong calming antidepressant effect. Start your dose there and work your way up slowly gauging effect and tolerance. New Chapter is the brand I recommend, if you go with someone else make sure it is standardized for 3% Rosavins and .08-1% Salidrosides.
OK, thanks, I will take note but for now it is impossible.
Posted by alan2102 on October 11, 2007, at 14:47:59
In reply to Re: S. J. Wort (hypericum) and levothyroxine » tenman, posted by Franz on October 11, 2007, at 13:10:25
> > I would not use the SJW. It will decrease your thyroxin levels.
>
> Too much?. I am on 50 mcg T4That's not a lot. That's slightly more than
one grain; not a lot. Could you take the SJW
and then increase the thyroid SLIGHTLY to
compensate? Or take at different times?
The link you gave provides no details as
to the nature of the interaction -- if it
inhibits absorption, or messes with
deiodination, or screws up receptors, or
whatever. It would be nice to know what's
going on. But simply increasing the thyroid
dose, cautiously and modestly, might be all
you need.
Posted by tenman on October 11, 2007, at 17:54:20
In reply to Re: S. J. Wort (hypericum) and levothyroxine, posted by alan2102 on October 11, 2007, at 14:47:59
SJW is an agonist at PXR. Not only will this enhance degradation via CYP activity, it will also reduce absorption in the small intestine. SJW has a long half-life so taking split doses will not matter much once steady state levels have been reached.
What about SAM-e? I get a robust antidepressant effect from that. Have you tried it?
Posted by Franz on October 11, 2007, at 18:33:10
In reply to Re: S. J. Wort (hypericum) and levothyroxine, posted by tenman on October 11, 2007, at 17:54:20
> SJW is an agonist at PXR. Not only will this enhance degradation via CYP activity, it will also reduce absorption in the small intestine. SJW has a long half-life so taking split doses will not matter much once steady state levels have been reached.
Even if I take a monodose of SJW at night?
>
> What about SAM-e? I get a robust antidepressant effect from that. Have you tried it?
>
>Yes, I mentioned it, but it is expensive.
Posted by TenMan on October 11, 2007, at 18:48:35
In reply to Re: S. J. Wort (hypericum) and levothyroxine » tenman, posted by Franz on October 11, 2007, at 18:33:10
Have you tried TMG? It is inexpensive and will increase SAM-e levels in the body. If that is not available then I guess you could try to bump up your thyroxine dose as alan suggested.
Posted by alan2102 on October 11, 2007, at 21:53:05
In reply to Re: S. J. Wort (hypericum) and levothyroxine, posted by tenman on October 11, 2007, at 17:54:20
> SJW is an agonist at PXR. Not only will this
> enhance degradation via CYP activity, it will
> also reduce absorption in the small intestine.Interesting. I looked up the CYP that SJW
activates and it is CYP3A4, which as far as
I can tell does not degrade thyroxine (though
I might have missed something).Alan
Posted by Franz on October 13, 2007, at 8:16:48
In reply to Re: S. J. Wort (hypericum) and levothyroxine, posted by alan2102 on October 11, 2007, at 21:53:05
> > SJW is an agonist at PXR. Not only will this
> > enhance degradation via CYP activity, it will
> > also reduce absorption in the small intestine.
>
> Interesting. I looked up the CYP that SJW
> activates and it is CYP3A4, which as far as
> I can tell does not degrade thyroxine (though
> I might have missed something).
>
> Alan
>Thanks. I should look further into this, but the info is hard to find and evaluate for me.
I found this:
St. John's Wort Hypericum
Half Life 26 hours
Washout 6 days Nonehttp://www.mentalmeds.org/book_files/chap2.html#tth_sEc2.3.2
It does not mention thyroid interactions in the list taken from:
http://nccam.nih.gov/health/stjohnswortMaybe the germans know more. Commission E?.
Posted by Franz on October 13, 2007, at 8:19:55
In reply to Re: S. J. Wort (hypericum) and levothyroxine » Franz, posted by TenMan on October 11, 2007, at 18:48:35
> Have you tried TMG? It is inexpensive and will increase SAM-e levels in the body. If that is not available then I guess you could try to bump up your thyroxine dose as alan suggested.
>
>I tried TMG and did not get the same effect from SAMe. Too bad because it is cheap.
Maybe I should try SJW (not cheap)or keep taking the 0.25 mg alprazolam (inexpensive and maybe it is not too bad long term) and passion flower during the day.
This is the end of the thread.
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