HYPERICIN NOTES

Our hypericin survey (published in AIDS TREATMENT NEWS # 80, June 2, 1989) is taking longer than expected to analyze, but we plan to have a report in the next issue. Meanwhile we must pass on recent information about potential side effects.

We previously published reports of several people who had to stop taking extracts of St. John's wort (the herb which contains hypericin) because blood-chemistry panels showed elevated levels of liver enzymes. Recently we heard of three more such cases. The two for whom the best data is available showed gradual rises over a two-month period while they used the herb. There is no proof that the St. John's wort caused the abnormal liver function tests, but until more is known, persons using the herb should have a blood-chemistry panel (such as SMA 25) which includes liver-function tests. Physicians usually recommend that patients stop all medicines, temporarily at least, if these tests become seriously abnormal.

Also, St. John's wort may act like a kind of antidepressant called an MAO inhibitor -- although no one knows for sure. MAO inhibitors are dangerous if combined with certain other drugs, and even any of a long list of foods and beverages. In AIDS TREATMENT NEWS #74, we pointed out that this problem was possible, although it seemed remote.

But recently we heard of one case where this interaction might have occurred. The patient combined St. John's wort with a tricyclic antidepressant (a kind of drug which must not be combined with an MAO inhibitor) and suffered rapid heart beats, skipped beats, and anxiety. This is the only case we have heard of such a problem. But since this reaction is dangerous, the physician who brought this case to our attention suggested that St. John's wort extracts should not be combined with prescription antidepressants, and possibly not with certain foods either.

More information can be found in medical reference books, which list foods and drugs which must not be combined with MAO inhibitors, and symptoms which may occur is they are combined.

It is possible that these problems with St. John's wort extracts -- if they exist at all -- are caused not by hypericin, but by some other chemicals in the plant. In that case, the problems could be overcome by using pure hypericin, from which the other chemicals had been removed.