Escitalopram-hypericum

Escitalopram
Type Antidepressant
Group SSRI
links
Medscape Escitalopram
PubChem 10832572
PubMed Escitalopram
Kompas (Dutch) Escitalopram
Wikipedia Escitalopram
Hypericum
Type Antidepressant
Group other
links
EMEA 10130408en
PubMed Hypericum
Kompas (Dutch) hypericum extract
Wikipedia St John's wort

Switch medication from escitalopram to hypericum.

Nietinrijdenbord.png Stop escitalopram
  • Before day 1: gradually reduce dosage of escitalopram to a maximum of 10 mg/day, when this dosage is >10 mg/day.
  • Day 1: reduce dosage of escitalopram to a maximum of 5 mg/day.
  • Day 8: stop administration of escitalopram.
Eenrichtingbord.png Start hypericum
  • Day 8-15: a wash-out period of 1 week is necessary.[1][2][3][4]
  • Day 16: start administration of hypericum in a dosage of 300 mg three times a day (900 mg/day).
Letopbord.png Cave
  • Occurrence of the serotonin syndrome is possible without wash-out period. [5][6]
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.[7]
  • The T1/2 of hypericum is 19 - 37 hour.[4]
  • The reduction of the SSRI doses in 7-14 days could cause emotional instability, headache and flu-like symptoms. One could extend this period.
  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. ↑ 4.04.1 KNMP; Informatorium Medicamentorum 2015; Monografie "escitalopram" (Dutch) Cite error: Invalid <ref> tag; name "informatorium" defined multiple times with different content
  5. ↑ F. Borelli et al.Herb-drug interactions with St John's wort (Hypericum perforatum): an update on clinical observations. AAPS J. 2009 Dec;11(4):710-27
  6. ↑ Izzo AA. Drug interactions with St John's wort (Hypericum perforatum): a review of the clinical evidence. Int J Clin Pharmacol Ther. 2004 Mar;42(3):139-48
  7. ↑ Wurglics M, Schubert-Zsilavecz M.Hypericum perforatum: a 'modern' herbal antidepressant: pharmacokinetics of active ingredients. Clin Pharmacokinet. 2006;45(5):449-68.
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