AIDSWEEKLY Plus; Monday, February 21, 2000
Prepared by AIDS Weekly editors from staff and other reports

Herbal remedies - especially St. John's wort (Hypericum perforatum) - and complementary medicines are widely used despite a lack of information about their pharmacology and potential to interact with drugs.

In the first research letter, Stephen Piscitelli and colleagues from the U.S. National Institutes of Health (NIH), Bethesda, Maryland, evaluated the effect of St. John's wort on plasma concentrations of an HIV-1 protease inhibitor called indinavir and its effect on eight volunteers who were non-HIV positive. Lancet 2000 Feb 12;355(9203):547-8

Their study showed a large reduction in blood plasma indinavir concentrations due to the pharmacological interaction with St. John's wort.

These results have important clinical implications for HIV infected patients receiving these two agents since low plasma concentrations of protease inhibitors are a cause of antiretroviral resistance and treatment failure.

Stephen Piscitelli commented to The Lancet: "There is a misconception that herbal products like St. John's wort are safe, but this study demonstrates that there can be dangerous interactions when taken with other drugs prescribed to treat medical conditions. It is important for patients to tell their health care providers about their use of herbal products and complementary medicines."

In a second research letter, Frank Ruschitzka and colleagues from University Hospital, Zurich, Switzerland, reported acute rejection in two heart transplant patients due to a metabolic interaction of St. John's wort and the drug cyclosporine. They observed two patients who had previously undergone heart transplant and were later admitted to hospital three weeks after taking St. John's wort to alleviate symptoms of mild depression.Lancet 2000 Feb 12;355(9203):548-9

St. John's wort lowered the plasma cyclosporine levels; subsequent cardiac biopsy revealed acute heart transplant rejection. Withdrawal of St. John's wort resulted in a return to normal cyclosporine levels and no further episodes of rejection occurred.

Ruschitzka and Georg Noll commented to The Lancet: "The common misconception that herbs always equate with no risk must be effectively disproved. Hence, authorities should reconsider whether herbal medicines (as conventional drugs) need regulation and should be tested for safety, tolerability, and efficacy for the benefit of our patients."

Piscitelli et al. can be contacted through Sara Byars, Communications Department, NIH Clinical Center, 6100 Executive Blvd., Ste 3C01, Bethesda, Maryland 20892-7511, USA. Tel +1 301 496-2563 or 301 594-5788; e-mail <sbyars@nih.gov>.

Dr. Georg Noll can be contacted at Division of Cardiology, University Hospital, 8091 Zurich, Switzerland. Tel +41 1 255 2182; fax +41 1 255 4251; e-mail <Karnog@usz.unizh.ch>.

This article was prepared by AIDS Weekly editors from staff and other reports.

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