MajorAntiretroviral, non-nucleoside reverse transcriptase inhibitor (NNRTI)×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 Efavirenz and lowers its blood level, weakening its effect.
Symptoms
Fall in antiretroviral levels, loss of HIV virological control and risk of drug resistance.
Management
Contraindicated with antiretroviral therapy. Do not use St. John's wort during HIV treatment.
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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.