AIDS TREATMENT NEWS No. 079 - May 15, 1989
John S. James
Both patients had been using tablets containing St. John's wort extracts for four or five weeks (we do not know what kind of tablets, or what doses), when transaminase levels were found to be about five times normal. In both cases the levels returned to normal after the patients stopped using the tablets. Neither was using any other treatment likely to cause the high levels. Both were asymptomatic, and neither had baseline tests run before they started using the herbal extracts.
We talked to Dr. David Payne in Mesa, Arizona, who has several dozen patients who are using hypericin extracts (many from St. John's wort tablets), and he has not seen any problem of abnormal liver-function tests. He has seen many HIV-positive patients with elevated liver-function values without any treat- ment. In those using hypericin, the values often go down.
At this point we do not know whether St. John's wort extracts are causing abnormal liver-function tests in some peo- ple, or whether those patients would have had high values anyway. The tests have returned to normal after the treatment was stopped, and there is no evidence of any lasting harm. But it would be dangerous to ignore a potential problem by not getting the tests (which are usually given as part of a blood-chemistry panel). Anyone using St. John's wort should tell their physi- cian, and should have a blood-chemistry panel including liver functions probably within the first few weeks of starting, if they plan to continue using the herb, so that the treatment can be discontinued if necessary.
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