Alarmist rhetoric about St John's Wort

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An alarmist study - funded by the pharmaceutical industry - is once again seeking to vilify St John's Wort.  The study uses rhetoric including: "Like many other CAM treatments, SJW interacts dangerously with other common medications.", and: "These interactions are likely to lead to dangerous consequences such as serotonin syndrome, heart disease due to impaired efficacy of antihypertensives, or unplanned pregnancy due to contraceptive failure."

Here at The CMA we take the view that the potential interractions with other drugs should be hilighted - however, we believe that alarmist rhetoric such as this below is at best unhelpful - and at worst mischevious.

Here is an overview of the study and the link to the source is at the end of this page:

(SJW) is the leading complementary and alternative medicine (CAM) treatment for depression and related psychiatric disorders in the United States. Like many other CAM treatments, SJW interacts dangerously with other common medications. Prescription of SJW with oral contraceptives, blood thinners, benzodiazepines, cancer chemotherapy medicines, digoxin, human immunodeficiency virus medicines, statins, immunosuppressants, selective serotonin reuptake inhibitors (SSRIs), or verapamil is not recommended due to potential interactions.1–3

 

St John's Wort can reduce the concentration of most of these drugs in the body, resulting in impaired efficacy and treatment failure.2,3 However, with antidepressants such as SSRIs, serotonin syndrome (with possible mania) is the main concern.2  Here we report on a study which was designed to assess how often SJW is being prescribed or taken with these other medications.

Frequent use of SJW in potentially harmful combinations was observed. These interactions are likely to lead to dangerous consequences such as serotonin syndrome, heart disease due to impaired efficacy of antihypertensives, or unplanned pregnancy due to contraceptive failure. Patients may have a false sense of safety with so-called “natural” treatments like SJW. Particularly for patients who are taking many other medications, SJW may be no safer than standard allopathic treatments.

Limitations of the study include the fact that only medications recorded by the physician could be analyzed. Patients who were using SJW or other therapies that interact with it, but did not inform their physician fully, would not be included, so this study may actually underestimate the rate of SJW interactions.

It is crucial for physicians to know the dangers of “natural” treatments and to communicate the risks to patients effectively.4,5 In addition, labeling requirements for herbal supplements such as SJW need to provide appropriate cautions and risk information.4 Physicians also need to be trained to always ask, in a nonjudgmental and understanding manner, whether the patient is taking any supplements, vitamins, minerals, or herbs. Particularly before prescribing any of the common drugs that might interact with SJW, clinicians should be sure they have determined whether patients are using this very popular CAM treatment.

Funding for this study came from:

The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Dr. Feldman is a consultant and speaker for Galderma, Connetics, Abbott Labs, Warner Chilcott, Centocor, Amgen, Photomedex, Genentech, BiogenIdec, and Bristol Myers Squibb. Dr. Feldman has received grants from Galderma, Astellas, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, Coria/Valeant, Pharmaderm, Ortho Pharmaceuticals, Aventis Pharmaceuticals, Roche Dermatology, 3M, Bristol Myers Squibb, Stiefel/GlaxoSmithKline, Novartis, Medicis, Leo, HanAll Pharmaceuticals, Celgene, Basilea, and Anacor and has received stock options from Photomedex. Mr. Davis and Dr. Taylor have no conflicts to disclose.

References:

1. S Shi, U Klotz. Drug interactions with herbal medicines. Clin Pharmacokinet 2012;51:77–104.

2. F Borrelli, AA Izzo. Herb-drug interactions with St John's wort (Hypericum perforatum): An update on clinical observations. AAPS J 2009;11:710–727.

3. R Madabushi, B Frank, B Drewelow, et al. Hyperforin in St. John's wort drug interactions. Eur J Clin Pharmacol 2006;62:225–233.

4. KA Clauson, ML Santamarina, JC Rutledge. Clinically relevant safety issues associated with St. John's wort product labels. BMC Complement Altern Med 2008;8:42.

5. JR Davidson, H Rampes, M Eisen, et al. Psychiatric disorders in primary care patients receiving complementary medical treatments. Compr Psychiatry 1998;39:16–20. 

 Source:

http://www.medicalnewstoday.com/articles/279010.php

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