title: Hypericum perforatum: pharmacokinetic, mechanism of action, tolerability, and clinical drug-drug interactions.
abstract: Hypericum perforatum (HP) belongs to the Hypericaceae family and is one of the oldest used and most extensively investigated medicinal herbs. The medicinal form comprises the leaves and flowering tops of which the primary ingredients of interest are naphthodianthrones, xanthones, flavonoids, phloroglucinols (e.g. hyperforin), and hypericin. Although several constituents elicit pharmacological effects that are consistent with HP's antidepressant activity, no single mechanism of action underlying these effects has thus far been found. Various clinical trials have shown that HP has a comparable antidepressant efficacy as some currently used antidepressant drugs in the treatment of mild/moderate depression. Interestingly, low-hyperforin-content preparations are effective in the treatment of depression. Moreover, HP is also used to treat certain forms of anxiety. However, HP can induce various cytochrome P450s isozymes and/or P-glycoprotein, of which many drugs are substrates and which are the main origin of HP-drug interactions. Here, we analyse the existing evidence describing the clinical consequence of HP-drug interactions. Although some of the reported interactions are based on findings from in vitro studies, the clinical importance of which remain to be demonstrated, others are based on case reports where causality can, in some cases, be determined to reveal clinically significant interactions that suggest caution, consideration, and disclosure of potential interactions prior to informed use of HP.
authors.affiliation: Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy; Pharmacovigilance's Center Region Calabria, University Hospital Mater Domini, Catanzaro, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Russo
authors.forename: Francesca
authors.initials: F
authors.lastname: Scicchitano
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Whalley
authors.forename: Carmela
authors.initials: C
authors.lastname: Mazzitello
authors.forename: Miriam
authors.initials: M
authors.lastname: Ciriaco
authors.forename: Stefania
authors.initials: S
authors.lastname: Esposito
authors.forename: Marinella
authors.initials: M
authors.lastname: Patanè
authors.forename: Roy
authors.initials: R
authors.lastname: Upton
authors.forename: Michela
authors.initials: M
authors.lastname: Pugliese
authors.forename: Serafina
authors.initials: S
authors.lastname: Chimirri
authors.forename: Maria
authors.initials: M
authors.lastname: Mammì
authors.forename: Caterina
authors.initials: C
authors.lastname: Palleria
authors.forename: Giovambattista
authors.initials: G
authors.lastname: De Sarro
mesh_terms: D000873:Anthracenes; D000928:Antidepressive Agents / Q000494:pharmacology; D000998:Antiviral Agents / Q000494:pharmacology; D003863:Depression / Q000188:drug therapy; D041743:Herb-Drug Interactions; D006801:Humans; D020902:Hypericum / Q000737:chemistry*; D010569:Perylene / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D010696:Phloroglucinol / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D010936:Plant Extracts / Q000494:pharmacology* / Q000627:therapeutic use; D010946:Plants, Medicinal / Q000737:chemistry*; D013729:Terpenes / Q000493:pharmacokinetics
chemical_list: D000873:Anthracenes; D000928:Antidepressive Agents; D000998:Antiviral Agents; D010936:Plant Extracts; D013729:Terpenes; D010569:Perylene; C004965:hypericin; D010696:Phloroglucinol; C056602:pseudohypericin; C001654:hyperforin
keywords: Hypericum perforatum; P-glycoprotein; St. John's wort; cytochrome P450; drugs; interaction