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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Brandon on February 20, 2000, at 12:58:11
Hi Cam,
I've been taking a small dose of Dilantin (100mgs. at bedtime) for depression and anxiety. I've wanted to try to augment it with some St. Johns Wort. Unfortunately Dilantin interacts with a lot of substances. Do you know of any interactions posed here? Dilantin is partially cleared by the P-450 enzyme and St. Johns Wort increases the amount of this enzyme so would that mean lower levels of Dilantin? I really dont know squat about all of these enzymes.
If you know anything I would really appreciate it.
Thanks
Posted by Cam W. on February 20, 2000, at 15:46:25
In reply to Q for CamW, posted by Brandon on February 20, 2000, at 12:58:11
> Hi Cam,
>
> I've been taking a small dose of Dilantin (100mgs. at bedtime) for depression and anxiety. I've wanted to try to augment it with some St. Johns Wort. Unfortunately Dilantin interacts with a lot of substances. Do you know of any interactions posed here? Dilantin is partially cleared by the P-450 enzyme and St. Johns Wort increases the amount of this enzyme so would that mean lower levels of Dilantin? I really dont know squat about all of these enzymes.
> If you know anything I would really appreciate it.
> Thanks
>
>
Brandon - This is a complicated question, complicated further by the number of constituents (chemicals) in the St.John's Wort, many of which we aren't completely certain what they do or don't do. I was not aware that St.John's Wort was an inducer of the cytochrome P450 (CYP) system and my answer would deprend upon which family of cytochromes it induces. Personally, I do not believe that SJW is a very strong inducer of any CYP family or we would have definitely noticed it's effects before now.As to phenytoin (Dilantin), it is a very potent inhibitor of two of the CYP families of enzymes. These are called CYP-3A3/4 and CYP-1A2. These enzyme systems affect and metabolize a multitude of drugs and foods Dilantin can change blood level concentrationsof many psychotropic medications (eg SSRIs, TCAs, some benzodiazepines, calcium channel blockers and other heart drugs, certain anti-AIDs drugs, certain antibiotics, etc. Similar events will happen with the CYP-1A2 emzyme system.
This does not mean the these medications cannot be taken together. It means that 'some' of the drugs may have to have their dosage adjusted, depending on several factors (eg Dilantin dose, extent of metabolism of other drug by that system, therapeutic window of that other drug, how that other drug affects Dilantin's kinetics, etc.). This is where the art of medicine comes into play. Usually interactions due to this system are seen after the fact, by the emergence of side effects. To complicate things even more, different people will naturally produce different amounts of enzyme naturally. Also, there are many more CYP enzymes system involved in the metabolism of drugs. Researchers are just now scratching the surface of all the implication of drug interactions within the CYP system.
As to you question, "Does Dilantin interact pharaceutically with St.John's Wort? Probably to some extennt, given the amount of chemicals in St.John's Wort. But is a potential interaction 'clinically significant"? I would not be able to hazard a guess that I could back up with research.
Would I take St.John's Wort with Dilantin? - No!
Hope this helps - Cam W.
Posted by Brandon on February 20, 2000, at 17:16:18
In reply to Re: Q for CamW, posted by Cam W. on February 20, 2000, at 15:46:25
Thanks for the response Cam if I do try it I will definitely start low and go slow but spring is coming up and since my moods are very reactive to the season I will probably scrap it altogether, once again thanks!
Brandon
Posted by jd on February 20, 2000, at 20:53:19
In reply to Re: Q for CamW, posted by Brandon on February 20, 2000, at 17:16:18
Brandon,
I'm not sure if you saw, but there was some mainstream news this week about SJW interacting with other medicines. You may want to check out the Feb. 11 Associated Press article "Studies indicate St. John's wort may interfere with medications." Here's an address for the article at cnn.com:http://cnn.com/2000/HEALTH/alternative/02/11/stjohns.wort.ap/index.html
There's no mention of Dilantin per se, but it's a good idea to be cautious: as much as it's a proven antidepressant, SJW is teeming with active compounds that aren't very well understood yet!
best,
jd
Posted by Cam W. on February 20, 2000, at 23:03:08
In reply to Re: SJW and med interactions, posted by jd on February 20, 2000, at 20:53:19
> Brandon,
> I'm not sure if you saw, but there was some mainstream news this week about SJW interacting with other medicines. You may want to check out the Feb. 11 Associated Press article "Studies indicate St. John's wort may interfere with medications." Here's an address for the article at cnn.com:
>
> http://cnn.com/2000/HEALTH/alternative/02/11/stjohns.wort.ap/index.html
>
> There's no mention of Dilantin per se, but it's a good idea to be cautious: as much as it's a proven antidepressant, SJW is teeming with active compounds that aren't very well understood yet!
>
> best,
> jdjd - Did the AP article say where it came from? The media is the WORST place to get your scientific information. The CBC, CTV and A-Channel in Edmonton have all tried to screw around the words I have said. I now have a problem believeing anything anything any newa nedia say anymore. It would be much appreciated to find out where they received their figures. Usually,'they' are, a doctor (not close to the investigation) or a scientist that has been misquoted, to make the story sound as they, the media) want want it too. When did REPORTING THE NEWS change to MAKING THE NEWS? Sorry for the rant, I would like to see the scientific studies proven the SJW/drug interactions. I have been expecting these for years, although, I don't believe they will be of much clinical significance. Sincerely - Cam W.(sorry for the rant).
Posted by JohnL on February 21, 2000, at 5:30:08
In reply to Q for CamW, posted by Brandon on February 20, 2000, at 12:58:11
I totally agree with Cam's views of the media. He hit the nail on the head. For a defininition of the word bias, or inaccurate, just turn on any of the major news networks. Fox News is the only decent one.
Unlike Cam though I would and have tried SJW with various prescrips. As you mentioned, going low and slow is wise. That way we can catch any unexpected adverse reactions early. And there will be some. For example, with Paxil SJW was horrible and scary. Abondoned very quickly. With Zoloft, OK. With Prozac pretty darn good. With Lamictal OK. Lithium OK. With each trial I started at 1 pill a day to test the waters before continuing. In the old days they used to mix MAOIs+TCAs+stimulants. That to me makes SJW with whatever seem pretty tame.
Posted by jd on February 21, 2000, at 15:22:36
In reply to Re: SJW and med interactions, posted by Cam W. on February 20, 2000, at 23:03:08
Cam,
While I certainly share your skepticism of medical reporting in the media, the AP article draws on two reports just published in *The Lancet*--about as reputable as you can get, no? There's actually been a spate of articles lately in referreed journals about drug-herb interactions in general, and the meds with which Saint John's Wort specifically interacts could end up being rather numerous.
best,
jd> > Brandon,
> > I'm not sure if you saw, but there was some mainstream news this week about SJW interacting with other medicines. You may want to check out the Feb. 11 Associated Press article "Studies indicate St. John's wort may interfere with medications." Here's an address for the article at cnn.com:
> >
> > http://cnn.com/2000/HEALTH/alternative/02/11/stjohns.wort.ap/index.html
> >
> > There's no mention of Dilantin per se, but it's a good idea to be cautious: as much as it's a proven antidepressant, SJW is teeming with active compounds that aren't very well understood yet!
> >
> > best,
> > jd
>
> jd - Did the AP article say where it came from? The media is the WORST place to get your scientific information. The CBC, CTV and A-Channel in Edmonton have all tried to screw around the words I have said. I now have a problem believeing anything anything any newa nedia say anymore. It would be much appreciated to find out where they received their figures. Usually,'they' are, a doctor (not close to the investigation) or a scientist that has been misquoted, to make the story sound as they, the media) want want it too. When did REPORTING THE NEWS change to MAKING THE NEWS? Sorry for the rant, I would like to see the scientific studies proven the SJW/drug interactions. I have been expecting these for years, although, I don't believe they will be of much clinical significance. Sincerely - Cam W.(sorry for the rant).
This is the end of the thread.
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