Izzo A A
Department of Experimental Pharmacology, University of Naples Federico II, Naples, Italy.
Int J Clin Pharmacol Ther. 2004 Mar;42(3):139-48. doi: 10.5414/cpp42139.
St. John's Wort (SJW, Hypericum perforatum) is effective in mild-to-moderate depression. As a monotherapy, SJW has an encouraging safety profile. However, numerous reports indicate the possibility of important interactions with prescribed drugs. SJW has been shown to lower the plasma concentration (and/or the pharmacological effect) of a number of drugs including alprazolam, amitriptyline, cyclosporine, digoxin, fexofenadine, indinavir, irinotecan, methadone, nevirapine, simvastatin, tacrolimus, theophylline, warfarin, phenprocoumon and oral contraceptives. Induction of P-glycoprotein and/or cytochrome P450 (CYP) enzymes (particularly CYP 3A4) by SJW could explain such pharmacokinetic interactions. When combined with serotonin reuptake inhibitor, antidepressants (e.g. sertaline, paroxetine, nefazodone) or buspirone, SJW can cause serotonergic syndrome. SJW represents a herbal medicine with a high potential for drug interactions. Some of such interactions may have serious clinical consequences.
圣约翰草（SJW，贯叶连翘）对轻至中度抑郁症有效。作为单一疗法，圣约翰草具有令人鼓舞的安全性。然而，大量报告表明它与处方药存在重要相互作用的可能性。已证明圣约翰草会降低多种药物的血浆浓度（和/或药理作用），这些药物包括阿普唑仑、阿米替林、环孢素、地高辛、非索非那定、茚地那韦、伊立替康、美沙酮、奈韦拉平、辛伐他汀、他克莫司、茶碱、华法林、苯丙香豆素和口服避孕药。圣约翰草对P-糖蛋白和/或细胞色素P450（CYP）酶（特别是CYP 3A4）的诱导作用可以解释这种药代动力学相互作用。当与5-羟色胺再摄取抑制剂、抗抑郁药（如舍曲林、帕罗西汀、奈法唑酮）或丁螺环酮合用时，圣约翰草可导致5-羟色胺能综合征。圣约翰草是一种具有很高药物相互作用可能性的草药。其中一些相互作用可能会产生严重的临床后果。
