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Switch medication from bupropion to hypericum.[1] [2]
Stop bupropion - Before day 0: gradually reduce dosage of bupropion to a maximum of 300 mg/day, when this dosage is > 300 mg/day.
- Day 1: reduce dosage of bupropion to 150 mg/day.
- Day 8: stop administration of bupropion.
Start hypericum- Day 8-14: a wash-out period of one week.
- Day 15: start administration of hypericum in a dosage of 300 mg three times a day (900 mg/day).
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]
Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- ↑ 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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