St. John's wort
This article was originally published in The Tan Sheet
Executive Summary
Thirty-nine of 472 SJW-related adverse event reports submitted to FDA through Dec. 11, 2000 indicated "possible" pharmacokinetic interactions with substrates of P450 CYP3A and/or p-glycoprotein (cyclosporin, levonorgestrel/ estradiol and sildenafil) as well as serotonin reuptake inhibitors, according to agency researchers. AERs show SJW may result in exaggerated hypertensive reactions when taken with SSRIs and "decrease expected effect" of the three drugs, but researchers stress "additional studies are needed to assess mechanistic issues and the full spectrum of clinical implications arising from these interactions." FDA and NIH issued warnings on concomitant use of SJW supplements and protease inhibitors in early 2000 (1"The Tan Sheet" Feb. 14, 2000, p. 19)