Zhou Shufeng, Chan Eli, Pan Shen-Quan, Huang Min, Lee Edmund J D
Department of Pharmacy, Faculty of Science, National University of Singapore.
J Psychopharmacol. 2004 Jun;18(2):262-76. doi: 10.1177/0269881104042632.
There is a worldwide increasing use of herbs which are often administered in combination with therapeutic drugs, raising the potential for herb-drug interactions. St John's wort (Hypericum perforatum) is one of the most commonly used herbal antidepressants. A literature search was performed using Medline (via Pubmed), Biological Abstracts, Cochrane Library, AMED, PsycINFO and Embase (all from their inception to September 2003) to identify known drug interaction with St John's wort. The available data indicate that St John's wort is a potent inducer of CYP 3A4 and P-glycoprotein (PgP), although it may inhibit or induce other CYPs, depending on the dose, route and duration of administration. Data from human studies and case reports indicate that St John's wort decreased the blood concentrations of amitriptyline, cyclosporine, digoxin, fexofenadine, indinavir, methadone, midazolam, nevirapine, phenprocoumon, simvastatin, tacrolimus, theophylline and warfarin, whereas it did not alter the pharmacokinetics of carbamazepine, dextromethorphan, mycophenolic acid and pravastatin. St John's wort decreased the plasma concentration of the active metabolite SN-38 in cancer patients receiving irinotecan treatment. St John's wort did not alter the pharmacokinetics of tolbutamide, but increased the incidence of hypoglycaemia. Several cases have been reported that St John's wort decreased cyclosporine blood concentration leading to organ rejection. St John's wort caused breakthrough bleeding and unplanned pregnancies when used concomitantly with oral contraceptives. It also caused serotonin syndrome when coadministered with selective serotonin-reuptake inhibitors (e.g. sertaline and paroxetine). Both pharmacokinetic and pharmacodynamic components may play a role in these interactions. Because the potential interaction of St John's wort with other drugs is a major safety concern, additional systematic research on herb-drug interactions and appropriate regulation in herbal safety and efficacy is needed.
世界各地对草药的使用日益增加，这些草药常与治疗药物联合使用，从而增加了草药与药物相互作用的可能性。圣约翰草（贯叶连翘）是最常用的草药抗抑郁药之一。通过使用Medline（经Pubmed）、生物学文摘数据库、考克兰图书馆、联合和补充医学数据库、心理学文摘数据库以及Embase（均从创建至2003年9月）进行文献检索，以确定与圣约翰草已知的药物相互作用。现有数据表明，圣约翰草是细胞色素P450 3A4（CYP 3A4）和P-糖蛋白（PgP）的强效诱导剂，尽管根据给药剂量、途径和持续时间，它可能抑制或诱导其他细胞色素P450（CYPs）。人体研究和病例报告的数据表明，圣约翰草可降低阿米替林、环孢素、地高辛、非索非那定、茚地那韦、美沙酮、咪达唑仑、奈韦拉平、苯丙香豆素、辛伐他汀、他克莫司、茶碱和华法林的血药浓度，而它不会改变卡马西平、右美沙芬、霉酚酸和普伐他汀的药代动力学。圣约翰草可降低接受伊立替康治疗的癌症患者体内活性代谢物SN-38的血浆浓度。圣约翰草不会改变甲苯磺丁脲的药代动力学，但会增加低血糖的发生率。已有数例报告称，圣约翰草可降低环孢素血药浓度，导致器官排斥反应。圣约翰草与口服避孕药同时使用时，会引起突破性出血和意外怀孕。它与选择性5-羟色胺再摄取抑制剂（如舍曲林和帕罗西汀）合用时，还会引起5-羟色胺综合征。药代动力学和药效学成分可能在这些相互作用中都起作用。由于圣约翰草与其他药物的潜在相互作用是一个主要的安全问题，因此需要对草药与药物的相互作用进行更多系统研究，并对草药的安全性和有效性进行适当监管
