Natural Medicines Newsletter

Volume 2, Issue 12, 03/23/2010

Question

Why should patients receiving cyclosporine (Gengraf, Neoral, Sandimmune) for the prevention of kidney organ transplantation rejection not take St. John's Wort (Hypericum perforatum)?

Answer

It is well known that developments in immunosuppressive therapy during the past two decades have led to the improvements in solid-organ rejection related mortality.¹  While there are several immunosuppressive agents available for the prevention of solid-organ rejection, the calcineurin inhibitor, cyclosporine (Gengraf, Neoral, Sandimmune), is still one of the main treatment options.^2,3  Unfortunately, cyclosporine's metabolic and elimination pathways can be complex and result in clinically relevant drug-drug interactions.^2-5 

These drug interactions can also extend over into herbal or natural medicines as well.  Specifically, St. John's wort (Hypericum perforatum) is known to...

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