Interaction of Hypericum perforatum (St. John's wort) with cyclosporin A metabolism in a patient after liver transplantation.
Immunosuppressive therapy in patients after liver transplantation requires careful monitoring of blood levels for immunosuppressive agents such as cyclosporin A. A variety of drugs are capable of interfering with the metabolism of cyclosporin A. We observed a 63-year-old patient who received a liver allograft for cryptogenic liver cirrhosis in 1998. This patient developed severe acute rejection 14 months after transplantation which was associated with a sudden drop in cyclosporin A levels. Two weeks previously, he had started taking the herbal drug Hypericum perforatum (2 x 900 mg/day) for increasing episodes of depression. The cyclosporin A dosage later had to be doubled, which caused some side effects. Finally, an assessment of oral cyclosporin A resorption suggested an enhanced cyclosporin A metabolism. Hypericum perforatum was stopped. Both cyclosporin A dosage and blood levels immediately returned to normal. The liver function recovered completely. In conclusion, this observation is a previously undescribed drug interaction of a widely used herbal drug (Hypericum perforatum, i.e. St. John's wort) in a patient after liver transplantation.
Karliova
M
M
Department of Gastroenterology and Hepatology, University Hospital Essen, Germany.
Treichel
U
U
Malagò
M
M
Frilling
A
A
Gerken
G
G
Broelsch
C E
CE
D000928:Antidepressive Agents / Q000009:adverse effects*; D016572:Cyclosporine / Q000378:metabolism*; D004347:Drug Interactions; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D020902:Hypericum; D007166:Immunosuppressive Agents / Q000378:metabolism*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010946:Plants, Medicinal
D000928:Antidepressive Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine