- Day 1: Stop hypericum.
- The administration of hypericum can be stopped abruptly. Induction of CYP enzymes will last at least 14 more days.
- Day 1: simultaneously start administration of agomelatine in a dosage of 25 mg/day.
- If necessary, increase dosage of agomelatine to 50 mg/day.
- Hypericum induces CYP1A2, which metabolizes agomelatine
- 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.
- Switches are based on literature references on this page and expert opinions of the authors. The authors have used pharmacokinetic and receptor affinity properties to determine the switch schedules
- Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
- McAllister-Williams RH et al. The use of antidepressants in clinical practice: focus on agomelatine. Hum Psychopharmacol. 2010 Mar 1;25(2):95-102
- 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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