Switch medication from hypericum to citalopram.
- Day 1-14:Gradually decrease the dosage of hypericum.
- Day 15: stop administration of hypericum.
- Day 15-30: a wash-out period of at least two weeks is necessary.
- Day 31: start citalopram 20 mg/day or escitalopram 10 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.
- 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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