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115 - Drug interactions

Drug interactions

442 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 People may regard herbal remedies as ‘natural’ and therefore harmless.35 Many are not aware of the potential of such remedies for causing adverse effects or interacting with other drugs. A large study from Germany (n = 588), where SJW is a licensed antidepressant, found that for every prescription written for SJW, one person purchased SJW without seeking the advice of a doctor.36 Many of these people had severe or persistent depression but few told their doctor that they took SJW. A small US study (n = 22) found that people tend to take SJW because it is easy to obtain alternative medicines and also because they perceive herbal medicines as being purer and safer than prescription medicines. Few would discuss this medication with their conventional healthcare provider.37 Clinicians need to be proactive in asking patients if they use such treatments and try to dispel the myth that natural is a synonym for safe. References

  1. Velingkar VS, et al. A current update on phytochemistry, pharmacology and herb–drug interactions of Hypericum perforatum. Phytochem Rev 2017; 16:725–744.
  2. Booker A, et al. St John’s wort (Hypericum perforatum) products: an assessment of their authenticity and quality. Phytomedicine 2018; 40:158–164.
  3. National Institute for Health and Care Excellence. Depression in adults: treatment and management. NICE guideline [NG222]. 2022 (last updated May 2024, last checked May 2024); https://www.nice.org.uk/guidance/ng222.
  4. Linde K, et al. St John’s wort for major depression. Cochrane Database Syst Rev 2008; (4):CD000448.
  5. Ng QX, et al. Clinical use of Hypericum perforatum (St John’s wort) in depression: a meta-­analysis. J Affect Disord 2017; 210:211–221.
  6. Apaydin EA, et al. A systematic review of St. John’s wort for major depressive disorder. Syst Rev 2016; 5:148.
  7. Sarris J, et al. Plant-­based medicines (phytoceuticals) in the treatment of psychiatric disorders: a meta-­review of meta-­analyses of randomized controlled trials. Can J Psychiatry 2021; 66:849–862.
  8. Volz H.P. Hypericum and depression. In: Riederer P, Laux G, Nagatsu T, Le W, Riederer C (eds) NeuroPsychopharmacotherapy. Cham: Springer; 2020:1–8.
  9. Sarris J, et al. Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: the World Federation of Societies of Biological Psychiatry and Canadian Network for Mood and Anxiety Treatments Taskforce. World J Biol Psychiatry 2022; 23:424–455.
  10. Asher GN, et al. Comparative benefits and harms of complementary and alternative medicine therapies for initial treatment of major depressive disorder: systematic review and meta-­analysis. J Altern Complement Med 2017; 23:907–­919.
  11. Gartlehner G, et al. Pharmacological and non-­pharmacological treatments for major depressive disorder: review of systematic reviews. BMJ Open 2017; 7:e014912.
  12. Chen JA, et al. Association between patient beliefs regarding assigned treatment and clinical response: reanalysis of data from the Hypericum Depression Trial Study Group. J Clin Psychiatry 2011; 72:1669–1676.
  13. Chen JA, et  al. Association between physician beliefs regarding assigned treatment and clinical response: re-­analysis of data from the Hypericum Depression Trial Study Group. Asian J Psychiatr 2015; 13:23–29.
  14. Zhao X, et al. The efficacy and safety of St. John’s wort extract in depression therapy compared to SSRIs in adults: a meta-­analysis of randomized clinical trials. Adv Clin Exp Med 2023; 32:151–161.
  15. Eatemadnia A, et al. The effect of Hypericum perforatum on postmenopausal symptoms and depression: a randomized controlled trial. Complement Ther Med 2019; 45:109–113.
  16. Galeotti N. Hypericum perforatum (St John’s wort) beyond depression: a therapeutic perspective for pain conditions. J Ethnopharmacol 2017; 200:136–146.
  17. Cleare A, et al. Evidence-­based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol 2015; 29:459–525.
  18. Russo E, et al. Hypericum perforatum: pharmacokinetic, mechanism of action, tolerability, and clinical drug–drug interactions. Phytother Res 2014; 28:643–655.
  19. Crampsey DP, et al. Nasal insertion of St John’s wort: an unusual cause of epistaxis. J Laryngol Otol 2007; 121:279–280.
  20. Bostock E, et al. Mania associated with herbal medicines, other than cannabis: a systematic review and quality assessment of case reports. Front Psychiatry 2018; 9:280.
  21. Rodrigues Cordeiro C, et al. Triggers for acute mood episodes in bipolar disorder: a systematic review. J Psychiatr Res 2023; 161:237–260.
  22. Sarris J. Herbal medicines in the treatment of psychiatric disorders: 10-­year updated review. Phytother Res 2018; 32:1147–1162.
  23. Fisher KA, et al. St. John’s wort-­induced supraventricular tachycardia. Cureus 2021; 13:e14356.
  24. Soleymani S, et al. Clinical risks of St John’s wort (Hypericum perforatum) co-­administration. Expert Opin Drug Metab Toxicol 2017; 13:1047–1062.
  25. Chrubasik-­Hausmann S, et al. Understanding drug interactions with St John’s wort (Hypericum perforatum L.): impact of hyperforin content. J Pharm Pharmacol 2018; 71:129–138.

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