title: Reduction of hyperbilirubinemia with hypericum extract (St. John's Wort) in a patient with Crigler-Najjar syndrome type II.
abstract: OBJECTIVE
  Crigler-Najjar syndrome (CN) type II is a congenital disease with unconjugated hyperbilirubinemia due to a deficiency of uridine 5'-diphospho-glucuronosyltransferase 1A1. Since the currently proposed treatment with phenobarbital is associated with adverse reactions, we investigated the effect of hypericum extract.
  
  
  METHODS
  Repetitive determination of total serum bilirubin in a female with CN type II before, during and after daily treatment with 900 mg hypericum extract on two occasions for 8 weeks. Confirmation of the enzyme-inducing effect of hypericum using the cytochrome P450 3A4 probe drug i.v. midazolam.
  
  
  RESULTS
  Hypericum reduced midazolam exposure by 42% and the total serum bilirubin concentration by 30 to 35%.
  
  
  CONCLUSIONS
  Hypericum extract is a potential alternative to phenobarbital in patients with CN type II.
authors.affiliation: Division of Clinical Pharmacology & Toxicology, University Hospital Basel and Department of Biomedicine, University of Basel, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Kummer
authors.affiliation: Division of Clinical Pharmacology & Toxicology, University Hospital Basel and Department of Biomedicine, University of Basel, Switzerland.
authors.forename: Felix
authors.initials: F
authors.lastname: Hammann
authors.affiliation: Division of Clinical Pharmacology & Toxicology, University Hospital Basel and Department of Biomedicine, University of Basel, Switzerland.
authors.forename: Manuel
authors.initials: M
authors.lastname: Haschke
authors.affiliation: Division of Clinical Pharmacology & Toxicology, University Hospital Basel and Department of Biomedicine, University of Basel, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Krähenbühl
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001663:Bilirubin / Q000097:blood; D003414:Crigler-Najjar Syndrome / Q000188:drug therapy* / Q000235:genetics; D051544:Cytochrome P-450 CYP3A / Q000096:biosynthesis / Q000378:metabolism*; D004790:Enzyme Induction / Q000187:drug effects; D005260:Female; D018757:GABA Modulators / Q000493:pharmacokinetics / Q000627:therapeutic use; D014453:Glucuronosyltransferase / Q000235:genetics; D006801:Humans; D006932:Hyperbilirubinemia / Q000188:drug therapy*; D020902:Hypericum; D008874:Midazolam / Q000008:administration & dosage / Q000493:pharmacokinetics; D010634:Phenobarbital / Q000627:therapeutic use; D010936:Plant Extracts / Q000008:administration & dosage / Q000627:therapeutic use*; D000077297:Pregnane X Receptor; D011987:Receptors, Steroid / Q000378:metabolism; D055815:Young Adult; D000099148:UGT1A1 Enzyme
chemical_list: D001663:Bilirubin; D051544:Cytochrome P-450 CYP3A; D018757:GABA Modulators; D014453:Glucuronosyltransferase; D008874:Midazolam; D010634:Phenobarbital; D010936:Plant Extracts; D000077297:Pregnane X Receptor; D011987:Receptors, Steroid; D000099148:UGT1A1 Enzyme; C422326:Hypericum extract LI 160; C510163:CYP3A4 protein, human
keywords: Crigler-Najjar syndrome; hyperbilirubinemia; hypericum; uridine 5′-diphospho-glucuronosyltransferase 1A1