Switch medication from sertraline to hypericum.
- Before day 1: Gradually reduce dosage of sertraline to a maximum of 50 mg/ day, when this dosage is > 50 mg/day.
- Day 1: Reduce dosage of sertraline to a dosage of 25 mg/ day
- Day 8: Stop administration of sertraline
- Day 9-23: a wash-out period of at least one week is necessary.
- Day 24: 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.
- ↑ 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.
- ↑ KNMP; Informatorium Medicamentorum 2015; Monografie "hypericum" (Dutch)
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