Interaction of Hypericum perforatum (St. John's wort) with cyclosporin A metabolism in a patient after liver transplantation

• Published in: Journal of hepatology 2000-11, Vol.33 (5), p.853-855
• Main Authors: Karliova, Marc, Treichel, Ulrich, Malagò, Massimo, Frilling, Andrea, Gerken, Guido, Broelsch, Christoph Erich
• Format: Article
• Language: English
• Subjects: Antidepressive Agents - adverse effects; Biological and medical sciences; Cyclosporin A; Cyclosporine - metabolism; Drug interaction; Drug Interactions; Drug toxicity and drugs side effects treatment; Graft Rejection - etiology; Humans; Hypericum; Hypericum perforatum; Immunosuppressive Agents - metabolism; Liver Transplantation; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Plants, Medicinal; Toxicity: blood
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/S0168-8278(00)80321-9

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 (2×900 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.