Imipramine-hypericum

Before day 0: gradually reduce dosage of imipramine to a maximum of 75 mg/day, when this dosage is > 75 mg/day.
Day 1: reduce dosage of imipramine to 50 mg/day.
Day 8: reduce dosage of imipramine to 25 mg/day.
Day 15: stop administration of imipramine.

Start hypericum

Day 15-22: a wash-out period of one week is necessary.
Day 23: 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.

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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[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.

[Wurglics2006-3] 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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Imipramine-hypericum

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