MajorImmunosuppressants. Calcineurin inhibitors×Antidepressants. Other antidepressants of herbal origin
Updated · Methodology
Mechanism
St. John's wort is a potent inducer of the CYP3A4 enzyme (and of CYP2C9 and P-glycoprotein). After 1–2 weeks it speeds up the breakdown of Ciclosporin and lowers its blood level, weakening its effect.
Symptoms
Fall in ciclosporin blood levels, risk of acute transplant rejection (confirmed in case reports).
Management
Contraindicated in transplant patients. Monitor ciclosporin levels; if the herb was used, stop it and track drug concentration.
Check the full regimen, not just this pair
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Sources
- British Journal of Pharmacology: Clinical relevance of St. John's wort drug interactions revisited (2020)– Nicolussi S, et al. Br J Pharmacol. 2020;177(6):1212-1226.