European Journal of Clinical Pharmacology

, Volume 62, Issue 3, pp 225–233 | Cite as

Hyperforin in St. John’s wort drug interactions

  • Rajanikanth Madabushi
  • Bruno Frank
  • Bernd Drewelow
  • Hartmut Derendorf
  • Veronika Butterweck
Pharmacokinetics and Disposition


Recently, interactions of herbal medicines with synthetic drugs came into focus of particular interest. In the past 3 years, more than 50 papers were published regarding interactions between St. John’s wort (Hypericum perforatum L.; SJW) and prescription drugs. Co-medication with SJW resulted in decreased plasma concentrations of a number of drugs including amitriptyline, cyclosporine, digoxin, indinavir, irinotecan, warfarin, phenprocoumon, alprazolam, dextrometorphane, simvastatin, and oral contraceptives. Sufficient evidence from interaction studies and case reports indicate that SJW is a potent inducer of cytochrome P450 enzymes (particularly CYP3A4) and/or P-glycoprotein. Recent studies could show that the degree of enzyme induction by SJW correlates strongly with the amount of hyperforin found in the product. Products that do not contain substantial amounts of hyperforin (<1%) have not been shown to produce clinically relevant enzyme induction. On the other hand, some evidence suggests that hyperforin may also contribute to the antidepressant activity of SJW. However, clinical studies using SJW preparations with a low hyperforin amount (<1%) clearly demonstrated the superiority of this plant extract over placebo and its equivalence to imipramine and fluoxetine in the treatment of mild to moderate forms of depression. In the present paper clinical significant SJW interactions are critically evaluated against the background of hyperforin.


Drug interactions Hypericum perforatum Herbal medicine St. John’s wort 


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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Rajanikanth Madabushi
    • 1
  • Bruno Frank
    • 2
  • Bernd Drewelow
    • 3
  • Hartmut Derendorf
    • 1
  • Veronika Butterweck
    • 1
  1. 1.Department of Pharmaceutics, College of PharmacyUniversity of FloridaGainesvilleUSA
  2. 2.Kneipp Werke WürzburgWürzburgGermany
  3. 3.Institute of Clinical PharmacologyUniversity of RostockRostockGermany

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