Interaction between a commercially available St. John's wort product (Movina) and atorvastatin in patients with hypercholesterolemia.

• OBJECTIVE: The aim of this study was to assess the effect of treatment with a St. John's wort product (Movina) on cholesterol [total cholesterol, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol] and triglyceride levels in patients with hypercholesterolemia on treatment with a stable dose of atorvastatin in a controlled, randomised, open, crossover interaction study. METHODS: Sixteen patients with hypercholesterolemia treated with a stable dose of atorvastatin (10-40 mg/daily) for at least 3 months were treated with Movina one tablet (containing 300 mg of hypericum perforatum) twice daily and control (a commercially available multivitamin tablet Vitamineral). After a run-in period of 4 weeks, patients were randomised to treatment with either Movina or control for 4 weeks in a crossover design. The atorvastatin dose was kept unchanged during the study period (12 weeks), and assessments of total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides were performed in the morning with the patients in the fasting condition. The difference between control and active treatment in LDL cholesterol after 4 weeks of treatment was the primary endpoint. RESULTS: All patients completed the study. The St. John's wort product significantly increased the serum level of LDL cholesterol compared with control (2.66 mmol/l compared with 2.34 mmol/l, p = 0.004). A significant increase in total cholesterol was also observed (5,10 mmol/l compared with 4.78 mmol/l, p = 0.02). No statistically significant change was observed in HDL cholesterol (1.59 mmol/l and 1.56 mmol/l, p = 0.49) or in triglycerides (1.87 mmol/l and 1.94 mmol/l, p = 0.60). No product-related side effects were reported CONCLUSION: An interaction was observed between the studied St.-John's-wort-containing product and atorvastatin. Physicians and patients should be aware of this interaction and if treatment with a St. John's wort product is considered necessary, then there may be a need for increasing the dose of atorvastatin.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Allmänmedicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- General Practice (hsv//eng)

Nyckelord

Aged

Cholesterol

blood

Cholesterol

HDL

blood

Cholesterol

LDL

blood

Cross-Over Studies

Cytochrome P-450 Enzyme System

biosynthesis

Enzyme Induction

Female

Heptanoic Acids

pharmacokinetics

therapeutic use

Herb-Drug Interactions

Humans

Hydroxymethylglutaryl-CoA Reductase Inhibitors

pharmacokinetics

therapeutic use

Hypercholesterolemia

blood

drug therapy

Hypericum

Intestines

drug effects

enzymology

metabolism

Liver

drug effects

enzymology

Male

Middle Aged

P-Glycoprotein

biosynthesis

Plant Preparations

pharmacology

Pyrroles

pharmacokinetics

therapeutic use

Time Factors

Treatment Outcome

Triglycerides

blood

Up-Regulation

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