Citalopram-hypericum
From Psychiatrienet
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Switch medication from citalopram to hypericum.[1] [2]
Stop citalopram - Before day 1: gradually reduce dosage of citalopram to a maximum of 20 mg/day, when this dosage is > 20 mg/day.
- Day 1: reduce dosage of citalopram to a maximum of 10 mg/day.
- Day 8: stop administration of citalopram
- Before day 1: gradually reduce dosage of citalopram/escitalopram to a maximum of 20 mg/day, resp. 10 mg/day.
- Day 1: reduce dosage of citalopram/escitalopram to 10 mg/day, resp. 5 mg/day.
- Day 8: stop administration of citalopram/escitalopram.
Start hypericum- Day 8-22: a wash-out period of 2 weeks is necessary.
- Day 23: start administration of hypericum in a dosage of 300 mg three times a day (900 mg/day).
Cave- Occurrence of the serotonin syndrome is possible without wash-out period.
More information- 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.[3]
- ↑ 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
- ↑ Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
- ↑ 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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