- 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: Increase with about 25% of target dose per 3 days.
- Plasma monitoring for TCA's is advisable, because of plasma-reponse relations, genetic polymorphism and under or overdosing.
- The ratio of amitriptyline/nortriptyline could change because of CPY2C19 induction. Sum plasmalevels are not likely to change because CYP2D6 is barely affected.
- Occurrence of the serotonin syndrome is possible without wash-out period.
- 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.
- (dutch) monografie.org tricyclische-antidepressiva
- 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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