HOW TO USE HYPERICIN

AIDS TREATMENT NEWS has published several articles and updates on hypericin, an antiviral available in extracts of the St. John's wort plant (see AIDS TREATMENT NEWS numbers 79, 77, 75, 74, and 63). Almost all the reports we are hearing from users are good, a fact not always reflected in our articles, as we have felt obligated to publish reports of side effects or possible dangers immediately, but have not hurried into print with the reports of benefits. Few people who have told us about their use of hypericin have failed to report benefits, usually objective improvements in symptoms, blood-test results, or both, often entirely unexpected. However, we have only received about 25 reports overall, and it is possible that we have seen a biased picture because persons who did not see any effects may not have bothered to contact us. We hope that the survey elsewhere in this issue will help to correct such bias. And the upcoming prospective monitoring study by San Francisco's Community Research Alliance (also described in this issue) should obtain better information than any survey could.

There has also been confusion about how to use hypericin. We have reported several different dosage regimens, and different brands. AIDS TREATMENT NEWS has a policy against making its own treatment recommendations; but we have closely followed the use of hypericin herbal extracts, and since little information is available, we decided to summarize the picture as we see it.

The following three standardized extracts contain significant amounts of hypericin: Yerba Prima St. John's wort tablets, Psychotonin tincture, or Hyperforat tincture. "Standardized" means that the concentration should be uniform from batch to batch.

Of the three, the Yerba Prima tablets are much less expensive than the other two, which must be imported from Germany. As far as we know, the tablets are just as good.

AIDS TREATMENT NEWS had a chemist test several brands, as we previously reported. Two other products, St. John's wort tinctures from Herb Pharm and from Jarrow Formulas, were found to contain comparable amounts of hypericin. These products are not standardized for hypericin content, however, so the concentration may vary.

Not acceptable are products which have not been independently tested. As there are no standards for herbal products in the United States, a product can be labeled "St. John's wort" no matter how little St. John's wort or hypericin it contains. Even some European extracts may have ten times less hypericin as the products we named above. We could not test everything, however, and other products we do not know about may also be good.

Also not acceptable are teas made from dried St. John's wort, which is sold in health-food stores. As previously reported, we have heard of little or no benefits from these teas, and one report of possible harm.

Hypericin may be especially effective for persons who are also using AZT.

What about the dose? For the Yerba Prima tablets, with which we are most familiar, the usual dose is two or three of the 250 mg, 0.14 percent hypericin tablets per day. Some people are using as many as six tablets every day. (The dose recommended on the bottle is two.) There are also intermittent schedules being tried, in which the tablets are not used every day.

Absorption and blood-level studies are now being done, with hypericin being administered intravenously, intramuscularly, and orally. Dose recommendations may change in the future. AIDS TREATMENT NEWS will report information as it develops.

The most important safety precaution, in our view, is to have liver function tests (often included in a blood-chemistry panel) within several weeks of starting hypericin. In a handful of cases, persons using hypericin have been found to have elevated transaminase values, and their physicians had them stop all treatments which might have been responsible. While no one is sure that St. John's wort caused the problem, it would be unsafe to take risks until more is known.

Another precaution is to avoid exposure to sunlight or ultraviolet light. Photosensitivity (abnormal sensitivity to sunlight) due to St. John's wort extracts has been so rare in humans that there is debate about whether it happens at all. But again it seems better to err on the side of safety.

Drowsiness has been reported when people have used large doses of hypericin-containing extracts.

One conservative strategy for using hypericin would be to continue it only if there are clear benefits. In most of the reports we have heard, unmistakable improvements in symptoms and/or blood work were seen within a few weeks. One approach to risk reduction would be to accept the probably small risks of the treatment provided that there is clear benefits to balance the risk, but to discontinue use if there was no evidence that it was helping.