Switch medication from duloxetine to hypericum.[1]
[2]
Stop duloxetine
- Before day 1: gradually reduce dosage of duloxetine to a maximum of 60 mg/day, when this dosage is > 60 mg/day.
- Day 1: reduce dosage of duloxetine to 30 mg/day.
- Day 8: stop administration of duloxetine.
Start hypericum
- Day 8-12: a wash-out period is necessary.
- Day 13: start administration of hypericum in a dosage of 300 mg three times a day (900 mg/day).[3]
[4][5][6]
Cave
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.[7]
- ↑ 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.
- ↑ 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.
- ↑ Wurglics M, Schubert-Zsilavecz M. Hypericum perforatum: a 'modern' herbal antidepressant: pharmacokinetics of active ingredients. Clin Pharmacokinet. 2006;45(5):449-68.
- ↑ 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.
- ↑ KNMP; Informatorium Medicamentorum 2023; Monografie "duloxetine" (Dutch)
- ↑ Wurglics M, Schubert-Zsilavecz M.Hypericum perforatum: a 'modern' herbal antidepressant: pharmacokinetics of active ingredients. Clin Pharmacokinet. 2006;45(5):449-68.
The editors of psychiatrienet.nl take the greatest care to provide up-to-date and accurate information on this site. Nevertheless, mistakes and omissions cannot be entirely excluded. No rights devolve from the information provided. The editors and other providers of information to this site accept no responsibility for the content of this site or for the information provided therein; neither do they accept responsibility for possible damages which may derive from the use of the information on this site or from the linked sites. The editorial board accepts no responsibility for the content of the (linked) sites, for access to them, or for the products and services on these sites, nor for the occurrence of errors, viruses, and/or disruptions in service.
Stop duloxetine 
Start hypericum
Cave
More information