Switch medication from nortriptyline to hypericum.
- Before day 1: gradually reduce dosage of nortriptyline to a maximum of 50 mg/ day, when this dosage is > 50 mg/day.
- Day 1-3: reduce dosage of nortriptyline to 25 mg/day.
- Day 4-7: reduce dosage of nortriptyline to 10 mg/day.
- Day 8: stop administration of nortriptyline.
- Day 8-15: a wash-out period of one week is necessary.
- Day 16: start administration of hypericum in a dosage of 300 mg three times a day (900 mg/day).
- Occurrence of serotonin syndrome is theoretically possible, so caution is necessary.
- 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.
- The T1/2 of hypericum is 19 - 37 hour.
- Wurglics M, Schubert-Zsilavecz M.Hypericum perforatum: a 'modern' herbal antidepressant: pharmacokinetics of active ingredients. Clin Pharmacokinet. 2006;45(5):449-68.
- KNMP; Informatorium Medicamentorum 2015; Monografie "hypericum" (Dutch)
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