LONDON-An interaction between cyclosporine and the herbal remedy St. John's wart has led to acute rejection in two heart transplant patients, according to the February 12 issue of The Lancet (2000;355:548).
"Treatment with St. John's wort was associated with a drop in cyclosporine values below the therapeutic range and acute transplant rejection," Frank Ruschitzka and colleagues at University Hospital in Zurich reported. Both patients, who had their heart transplants 11 and 20 months earlier, were admitted to the hospital three weeks after beginning to take St. John's wort for depression. The authors observed that St. John's wort had lowered the patients' plasma cyclosporine levels. Biopsy revealed acute heart transplant rejection, and withdrawal of St. John's wort resulted in a return to normal cyclosporine levels. No further rejection episodes occurred.
In the same issue of The Lancet, Stephen C. Piscitelli and colleagues at the National Institutes of Health in Bethesda, Maryland, reported that St. John's wort significantly compromised the effectiveness of indinavir, a protease inhibitor that is often used to treat human immunodeficiency virus (2000;355:547). Their study was conducted in eight volunteers who were not infected with HIV.
"Patients and health care professionals need to be aware of this interaction. Most people taking medications to treat HIV infection should avoid using St. John's wort," said coauthor Judith Falloon in a news release issued by the NIH.
"The results were dramatically conclusive," Dr. Piscitelli said. "All the participants showed a marked drop in blood levels of indinavir after taking St. John's wort. The drop ranged from 49% to 99%."
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