Amitriptyline-hypericum

Amitriptyline
Type Antidepressant
Group TCA
links
ATC-code N06AA09
Medscape Amitriptyline
PubChem 2160
PubMed Amitriptyline
Kompas (Dutch) Amitriptyline
Wikipedia Amitriptyline
Hypericum
Type Antidepressant
Group other
links
EMEA 10130408en
PubMed Hypericum
Kompas (Dutch) hypericum extract
Wikipedia St John's wort

Switch medication from amitriptyline to hypericum.

Nietinrijdenbord.png Stop amitriptyline
  • Before day 1: gradually reduce dosage of amitriptyline to a maximum of 100 mg/day, when this dosage is > 100 mg/day.
  • Day 1: reduce dosage of amitriptyline to 50 mg/day.
  • Day 8: reduce dosage of amitriptyline to 25 mg/day.
  • Day 15: stop administration of amitriptyline.
Eenrichtingbord.png Start hypericum
  • Day 15-22: a wash-out period of one week is necessary.[1][2][3]
  • Day 23: start administration of hypericum in a dosage of 300 mg three times a day (900 mg/day).
Letopbord.png Cave
Infobord.png More information
  • Hypericum induces enzymes of the CYP P-450 type and P-gp type.
  • Hypericum might have MAO-inhibiting and/or COMT-inhibiting properties.
  • Many studies reported that hypericin is the main source of pharmacological effects of hypericum. However the IC50 of hypericin to inhibit MAO A and MAO B is 100- to 1000-fold higher than accessible Cmax values of hypericin after oral administration of hypericum.[4]
  • The T1/2 of hypericum is 19 - 37 hour.[5]
  1. ↑ Imai H, Kotegawa T, Tsutsumi K, Morimoto T, Eshima N, Nakano S, Ohashi K. The recovery time-course of CYP3A after induction by St John's wort administration. Br J Clin Pharmacol. 2008 May;65(5):701-7.
  2. ↑ Wurglics M, Schubert-Zsilavecz M. Hypericum perforatum: a 'modern' herbal antidepressant: pharmacokinetics of active ingredients. Clin Pharmacokinet. 2006;45(5):449-68.
  3. ↑ Derijks HJ, Janknegt R, Heerdink ER, De Koning FH, Krekels MM, Looij BJ, Egberts AC. Influence of antidepressant use on glycemic control in patients with diabetes mellitus: an open-label comparative study. J Clin Psychopharmacol. 2009 Aug;29(4):405-8.
  4. ↑ Wurglics M, Schubert-Zsilavecz M.Hypericum perforatum: a 'modern' herbal antidepressant: pharmacokinetics of active ingredients. Clin Pharmacokinet. 2006;45(5):449-68.
  5. ↑ KNMP; Informatorium Medicamentorum 2015; Monografie "hypericum" (Dutch)
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