2 English reference excerpt St. John's wort
3 Instructions for St. John's wort extract 3. 1 Drug name St. John's wort extract
3.2 English name St. John's wort extract
3.3 alias St. John's wort extract Lu Youtai
3.4 classification of nervous system drugs >: antipsychotics, antidepressants and anxiolytics >: others
3.5 dosage form 300mg. Storage method: room temperature, dark and dry place; St John's wort extract capsules.
3.6 The pharmacological action of St. John's wort extract can inhibit the reuptake of norepinephrine (NE), 5- hydroxytryptamine (5HT) and dopamine (DA) by presynaptic membrane at the same time, and increase the concentration of three neurotransmitters in synaptic cleft. The extract of St. John's wort also slightly inhibited catecholamine o- methyltransferase (COMT), which could inhibit the excessive metabolism of neurotransmitters.
3.7 Pharmacokinetics of St. John's wort extract: hypericin is 28. 1 ~ 4 1.7h, and hypericin is 9 ~ 22.8h ..
3.8 indications of St. John's wort extract are clinically applied to depression, anxiety and/or anxiety.
3.9 Contraindications of St. John's wort extract 1. It is forbidden for people who are allergic to St. John's wort extract.
2. Be careful with light-sensitive skin.
3. 10 Precautions 1. /kloc-The data of drug use for children under 0/2 years old is insufficient.
2. Effect of drugs on pregnancy: The safety of drugs used during pregnancy is not clear, and should be avoided in the early pregnancy. The US Food and Drug Administration (FDA) classifies the pregnancy safety of St. John's wort extract as Grade C.
3. The effect of drugs on lactation. The safety of drugs used by lactating women is not clear and should be avoided.
3. 1 1 Adverse reactions of St. John's wort extract 1. Cardiovascular system: can cause edema and hypertension crisis.
2. Central nervous system: common mania, hypomania, anxiety and schizophrenia relapse, accompanied by restlessness, fatigue, headache and abnormal sensation.
3. Metabolic/endocrine system: It can be seen that the body temperature rises and the concentration of thyrotropin increases.
4. Urogenital system: frequent urination and frigidity can be seen.
5. Liver: Liver enzymes are elevated.
6. Gastrointestinal tract: anorexia, diarrhea, nausea, stomach pain or epigastric pain, dry mouth and constipation can be seen.
7. Skin: Photosensitive reactions may occur, including burning sensation, tingling sensation (abnormal sensation), dermatitis, skin blackening and blistering. Itching and rash can also be seen.
3. Usage and dosage of 1 2 St. John's wort extract1 Take 300mg orally once, 2 ~ 3 times a day.
2. Routine dosage for children: oral:1children over 2 years old: 300mg once, 2-3 times a day.
3. Reference of foreign usage and dosage: (1) Routine dosage for adults: oral: 300mg once, three times a day. (2) Routine dosage for children: 6- 12-year-old children take orally, 200-400 mg per day, and take it in batches. /kloc-The dose of children over 0/2 years old is the same as that of adults.
3. 13 drug interaction 1. The combination of St. John's wort extract and aminolevulinic acid has synergistic phototoxicity and enhanced phototoxicity, so it should be avoided.
2. The combination of St. John's wort extract with monoamine oxidase inhibitors (MAOls), nefazodone, 5HT reuptake inhibitors (such as trazodone), 5HT antagonists (such as fluamphetamine), venlafaxine, buspirone and tricyclic antidepressants will increase the risk of serotonin syndrome, and should be avoided. You can only take St. John's wort extract after stopping MAOIs 14 days, and you can only take MAOIs after stopping St. John's wort extract for 9 days. St. John's wort extract can only be taken after stopping nefazodone for 6 to 7 days, and St. John's wort extract can only be taken after stopping nefazodone for 2 weeks. After stopping venlafaxine 1 ~ 2 days, only St. John's wort extract can be taken, and venlafaxine can only be taken after stopping St. John's wort extract for 2 weeks. Selective 5HT reuptake inhibitors can only be used after 2 weeks of stopping using St. John's wort extract.
3. The combination of St. John's wort extract and 5HT receptor agonist can cause the enhancement of 5HT effect and the contraction of cerebral vessels. The combination of the two should be avoided, and care should be taken when necessary.
4. St. John's wort extract can enhance the 5HT effect of dextromethorphan.
5. St. John's wort extract combined with opioid analgesics can enhance sedation. The combination of the two should be cautious, and the possible excessive sedation of the central nervous system should be closely monitored.
6. St. John's wort extract can induce CYP 3A4, and increase the blood concentration of carbamazepine. Attention should be paid to monitoring adverse reactions when they are used together.
7. St. John's wort extract can induce CYP 2E 1 and reduce the metabolism of chlorzoxazone. The sustained effect of chlorzoxazone should be monitored when it is used together.
8. St. John's wort extract induces cytochrome P450 3A4(CYP 3A4) and P glycoprotein, which can reduce sirolimus, tacrolimus, cyclosporine, etoposide, estrogen, paclitaxel, barbiturates, hydroxymethylglutaryl coenzyme A reductase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors (such as indinavir) by increasing metabolism, reducing biological activity or reducing concentration. Another case reported that the combination of St. John's wort extract and estrogen caused subcutaneous hemorrhage. St. John's wort extract should be avoided to be used together with the above drugs. If necessary, the blood drug concentration (sirolimus, tacrolimus, cyclosporine), efficacy and adverse reactions (barbiturates) should be monitored.
9. St. John's wort extract can accelerate metabolism by inducing CYP 3A4, and reduce the efficacy of imatinib, anticoagulant, levothyroxine, phenytoin, tamoxifen, verapamil, benzodiazepines, β -adrenergic receptor blockers, methadone and mifepristone. St. John's wort extract should be avoided to be used with imatinib, anticoagulant, phenytoin, β -adrenoceptor blocker and methadone. If it needs to be used together with verapamil, it should be closely observed and the dosage of the latter should be adjusted if necessary. If it is used with benzodiazepines and mifepristone, it should be monitored.
10. The extract of St. John's wort induces CYP 3A4 and UDP- glucuronosyltransferase Lal, which reduces the curative effect of irinotecan. The combination of the two drugs should be avoided, and irinotecan can only be taken after stopping using St. John's wort extract for 2 weeks.
1 1. St. John's wort extract can induce CYP3A4 and CYP 2D6, which reduces the curative effect of cyclophosphamide, so the combination of them should be avoided.
12. St. John's wort extract can induce CYP 2D6 and reduce the curative effect of isoquinidine, so the contract between them should be monitored.
13. St. John's wort extract can induce CYP 1A2, accelerate the metabolism of theophylline and clozapine, and reduce its curative effect. Avoid the combination of theophylline and theophylline, and monitor the plasma concentration and curative effect of theophylline when necessary; When combined with clozapine, the dosage of clozapine should be reduced and its adverse reactions should be monitored.
14. St. John's wort extract induces CYP 2C 19, which accelerates the metabolism of omeprazole and reduces its blood concentration. The combination of the two drugs needs to increase the dose of omeprazole.
15. St. John's wort extract can induce P glycoprotein, and the combination with digoxin can increase the clearance rate of the latter and reduce the curative effect, so the combination of the two drugs should be avoided.
16. the combination of St. John's wort extract and amiodarone will reduce the concentration of the latter, so the combination of the two should be avoided.
17. St. John's wort extract can prevent topoisomerase ⅱ from forming * * * valence complex with acridine, and reduce the efficacy of acridine, so the combination of them should be avoided.
18. St. John's wort extract can reduce the efficacy of reserpine, and the continuous effect of reserpine should be monitored when combined.
19. the combination of St. John's wort extract and antidiabetic drugs can cause hypoglycemia, so it is necessary to be cautious when they are used together.
20. The combination of St. John's wort extract and * * * may increase the risk of shock and/or retardation. St John's wort extract should be stopped for at least 5 days before anesthesia.
2 1. The combination of St. John's wort extract and loperamide may cause delirium, confusion, excitement and disorientation, so it should be used with caution.
22. St. John's wort extract can induce CYPA2 and increase caffeine metabolism.
23. The combination of St. John's wort extract and tyramine-containing food can increase catecholamine activity and increase the risk of hypertensive crisis, so we should be cautious when using them together.
3. 14 expert comments 1. During taking the extract of St. John's wort, skin should be avoided from being exposed to strong sunlight for a long time (especially allergic skin) to avoid allergic reaction. Once skin reaction similar to sunburn occurs, stop using St. John's wort extract immediately.
2. Excessive use of St. John's wort extract can cause weight loss, changes in clinical chemical test parameters, mild renal injury, liver injury and hematological changes. Excessive use of St. John's wort extract should avoid light and ultraviolet radiation for at least 1 week.
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