title: St John's Wort: effect on CYP3A4 activity.
abstract: BACKGROUND
  St John's Wort is a widely used herbal product. Information regarding its potential for drug interactions is required for responsible treatment of patients using St John's Wort. CYP3A4 is a metabolic enzyme implicated in most clinically significant drug-drug interactions.
  
  
  OBJECTIVE
  To determine the in vivo effect of reagent-grade St John's Wort extract on CYP3A4 activity through evaluation of urinary 6-beta-hydroxycortisol/cortisol ratios.
  
  
  METHODS
  Thirteen subjects ranging in age from 18 to 25 years participated in this unblinded, multiple-dose, single-treatment before-after trial conducted in a university-based pharmacokinetics and biopharmaceutics laboratory. Each subject ingested a 300-mg tablet of reagent-grade St John's Wort extract standardized to 0.3% hypericin three times a day for 14 days. Baseline and posttreatment CYP3A4 activity was assessed with the urinary 6-beta-hydroxycortisol/cortisol ratio after a 24-hour urine collection.
  
  
  RESULTS
  The mean +/- SD urinary 6-beta-hydroxycortisol/cortisol ratio significantly increased (P = .003) from a baseline value of 7.1 +/- 4.5 to 13 +/- 4.9. The mean +/- SD percentage increase was 114% +/- 95%, with a range from -25% to 259%. All but one subject had an increase in the ratio.
  
  
  CONCLUSIONS
  Treatment with St John's Wort for 14 days resulted in significant increases in the urinary 6-beta-hydroxycortisol/cortisol ratio. This finding suggests that St John's Wort is an inducer of CYP3A4.
authors.affiliation: Department of Pharmacy, St Agnes Hospital, University of Maryland, Baltimore, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Roby
authors.forename: G D
authors.initials: GD
authors.lastname: Anderson
authors.forename: E
authors.initials: E
authors.lastname: Kantor
authors.forename: D A
authors.initials: DA
authors.lastname: Dryer
authors.forename: A H
authors.initials: AH
authors.lastname: Burstein
mesh_terms: D000293:Adolescent; D000328:Adult; D002851:Chromatography, High Pressure Liquid; D051544:Cytochrome P-450 CYP3A; D003577:Cytochrome P-450 Enzyme System / Q000187:drug effects / Q000378:metabolism*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D020902:Hypericum; D008297:Male; D008875:Middle Aged; D006899:Mixed Function Oxygenases / Q000187:drug effects / Q000378:metabolism*; D010936:Plant Extracts / Q000494:pharmacology; D010946:Plants, Medicinal; D012016:Reference Values
chemical_list: D010936:Plant Extracts; D003577:Cytochrome P-450 Enzyme System; D006899:Mixed Function Oxygenases; C104464:CYP3A protein, human; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human; D006854:Hydrocortisone