Switch medication from paroxetine to hypericum.
- Day -7: reduce dosage of paroxetine to 20 mg/day, if this dosage is > 20 mg/day.
- Day 0: dosage of paroxetine is 20 mg/day.
- Day 1: reduce dosage of paroxetine to 10 mg/day.
- Day 8: reduce dosage of paroxetine to 5 mg/day.
- Day 15: stop administration of paroxetine.
- Day 15-22: a wash-out period of about 1 week is necessary.
- Day 23: start administration of hypericum in a dosage of 300 mg three times a day (900 mg/day).
- 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.
- The T1/2 of hypericum is 19 - 37 hour.
- ↑ 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.
- ↑ Wurglics M, Schubert-Zsilavecz M. Hypericum perforatum: a 'modern' herbal antidepressant: pharmacokinetics of active ingredients. Clin Pharmacokinet. 2006;45(5):449-68.
- ↑ 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.
↑ 4.04.1 KNMP; Informatorium Medicamentorum 2015; Monografie "paroxetine" (Dutch)
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- ↑ 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
- ↑ 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
- ↑ 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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