St. John's Wort: A Case Study

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Pharmacodynamics St. John’s Wort, also known as Hypericum perforatum, contains multiple substances that produce medicinal effects within the body. The two most active components are hyperforin and hypericin, which produce therapeutic benefits (Russo et al., 2014). Hyperforin and hypericin have been found to impact neurotransmitter activity, specifically by decreasing neurotransmitter reuptake, resulting in mood stabilization and analgesia (Russo et al., 2014). In addition to its neurologic effects, St. John’s Wort has been shown to offer anti- inflammatory benefits through immune response regulation and anti-infective qualities resulting from impairment of bacterial and viral growth (Wolfle, Seelinger, & Schempp, 2014). Additionally, St John’s Wort provides therapeutic benefits through antioxidative and liver protective properties (Okmen & Balpinar, 2017). The overall effectiveness of St. John’s Wort in clinical use is variable. Although there are benefits when used in treating depression, there is inconsistent individual treatment response. …show more content…

John’s Wort stimulates activity of CYP isoenzymes, specifically CYP 3A4, CYP2E1, and CYP2C19 (Russo et al., 2014) as well as CYP1A2, CYP2C19 (Saper, 2014). With increased production, there is amplified metabolism of certain medications that require the identified CYP isoenzymes. The result is decreased efficacy of the affected medications. There is also increased production of P-glycoprotein with St. John’s Wort, which causes decreased absorption in the small intestine and kidneys, leading to enhanced renal excretion (Russo et al, 2014). Factors affecting the degrees of CYP and P-glycoprotein stimulation include ethnicity and hyperforin levels, which can vary among supplements (Russo et al., 2014). Use of St. John’s Wort is contraindicated in conjunction with medications that involve the specified CYP isoenzymes. Examples of these medications include warfarin, digoxin, and theophylline (Russo et al.,

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