⚠️ Mechanism
St. John's wort induces CYP3A4 and P-glycoprotein, dramatically increasing cyclosporine metabolism.
📋 Effect
Subtherapeutic cyclosporine levels; transplant rejection risk
💊 Management
Absolutely avoid combination. Life-threatening interaction for transplant patients.
Plain Language Summary
This combination is dangerous and should be avoided. St. John's Wort causes the body to break down cyclosporine much faster than normal, which can lead to dangerously low levels of the medication. This can result in a high risk of organ transplant rejection.
Source
Breidenbach T et al. Transplantation 2000; Ruschitzka F et al. Lancet 2000
Supporting Research
The effect of Hypericum perforatum on postmenopausal symptoms and depression: A randomized controlled trial
Hypericum extract LI 160 and fluoxetine in mild to moderate depression: a randomized, placebo-controlled multi-center study in outpatients
[Hypericum perforatum extract in treatment of mild to moderate depression. Clinical and pharmacological aspects]
Hypericum perforatum versus fluoxetine in the treatment of mild to moderate depression
Efficacy of continuation treatment with hypericum perforatum in depression
Predicting stable treatment response in patients with major depression treated with hypericum extract WS 5570/5572
Adverse Event Profile: St Johns Wort
Medical Disclaimer: This interaction record is for informational and educational purposes only and does not constitute medical advice. Drug-supplement interactions can be dangerous. Always consult your healthcare provider or pharmacist before combining any supplement with prescription medications. Do not stop or change any medication without professional guidance.