Difference between revisions of "Hypericum-amitriptyline"

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| to = amitriptyline   
 
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* Administration of hypericum can be stopped abruptly.
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| start =
* '''Day 1-7:''' a wash-out period of one week is necessary.
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* '''Day 8:''' start administration of amitriptyline in a dosage of 25 mg/day.
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* If necessary, increase dosage of amitriptyline to 50 mg/day.
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* Start low, go slow.
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| info =
| info =  
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{{TCAplasmalevelmonitoring}}
* Occurrence of the serotonin syndrome is theoretically possible.
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* The ratio of amitriptyline/nortriptyline could change because of CPY2C19 induction. Sum plasmalevels are not likely to change because CYP2D6 is barely affected.  
* Hypericum slows the metabolism of amitriptyline via CYP3A4. This effect may persist up to two weeks after stopping hypericum, so caution is necessary.}}
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Latest revision as of 14:09, 4 August 2023

Hypericum
Type Antidepressant
Group other
links
EMEA 10130408en
PubMed Hypericum
Kompas (Dutch) hypericum extract
Wikipedia St John's wort
Amitriptyline
Type Antidepressant
Group TCA
links
ATC-code N06AA09
Medscape Amitriptyline
PubChem 2160
PubMed Amitriptyline
Kompas (Dutch) Amitriptyline
Wikipedia Amitriptyline

Switch medication from hypericum to amitriptyline.[1] [2]

Nietinrijdenbord.png Stop hypericum
  • Day 1: Stop hypericum.
  • The administration of hypericum can be stopped abruptly. Induction of CYP enzymes will last at least 14 more days.
Eenrichtingbord.png Start amitriptyline
  • Day 1: Increase with about 25% of target dose per 3 days.
Infobord.png More information
  • Plasma monitoring for TCA's is advisable, because of plasma-reponse relations, genetic polymorphism and under or overdosing.[3]
  • 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.[4]
  1. 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
  2. Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
  3. (dutch) monografie.org tricyclische-antidepressiva
  4. 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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