Difference between revisions of "Hypericum-amitriptyline"

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| to = amitriptyline   
 
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* '''Day 1-14:'''Gradually decrease the dosage of hypericum.
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{{Stophyp}}
* '''Day 15:''' stop administration of hypericum.
 
 
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* '''Day 15-22:''' a wash-out period of one week is necessary.<ref>{{Pubmed|18294328|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.}}</ref><ref>{{Pubmed|16640452|Wurglics M, Schubert-Zsilavecz M. Hypericum perforatum: a 'modern' herbal antidepressant: pharmacokinetics of active ingredients. Clin Pharmacokinet. 2006;45(5):449-68.}}</ref><ref>{{Pubmed|19593191|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.}}</ref><ref name="informatorium">{{KNMP|amitriptyline}}</ref>
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{{TCAincrease25p3d}}
* '''Day 23:''' start amitriptyline 25 mg/day. Increase the dose with about 25% of the target dose every 3 days.
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{{TCAplasmalevelmonitoring}}
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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.
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{{caveSS}}
 
{{HypericumInfo}}
 
{{HypericumInfo}}
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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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