From the Guidelines
The concomitant use of Ibogaine and St. John's Wort (Hypericum perforatum) is highly risky due to the potential for significant interactions.
Key Interactions
- St. John's Wort is known to induce cytochrome P450 3A4 (CYP3A4), which may reduce plasma concentrations of drugs metabolized by this enzyme, such as Ibogaine 1.
- The use of St. John's Wort with other medications can lead to reduced efficacy or increased risk of adverse effects due to its effects on CYP3A4 and other enzymes 1.
- Concomitant use of St. John's Wort with certain medications is not recommended due to the potential for suboptimal drug concentrations, as seen with antiretroviral drugs 1.
Clinical Implications
- Patients taking Ibogaine should avoid concomitant use of St. John's Wort to minimize the risk of interactions and ensure optimal treatment efficacy.
- Clinicians should closely monitor patients for potential interactions and adjust treatment regimens as needed to minimize risks.
- The lack of standardization and quality control in herbal supplements like St. John's Wort can make it challenging to determine the risks of interactions, emphasizing the need for caution when using these products with other medications 1.
From the Research
Risk of Concomitant Use of Ibogaine and St. John's Wort
There are no direct research papers to assist in answering this question regarding the specific risk of concomitant use of Ibogaine and St. John's Wort (Hypericum perforatum). However, the available evidence discusses the potential interactions of St. John's Wort with various drugs due to its ability to induce cytochrome P450 enzymes (CYP) and P-glycoprotein.
Mechanism of Interaction
- St. John's Wort is known to induce CYP3A4 and possibly the P-glycoprotein transporter, which can lead to decreased plasma concentrations of concomitantly used drugs 2, 3, 4.
- This induction can result in significant interactions with a variety of clinically important drugs, including those with a narrow therapeutic window 4.
Reported Interactions with St. John's Wort
- Interactions have been identified with drugs such as alprazolam, amitriptyline, cyclosporine, digoxin, fexofenadine, indinavir, irinotecan, methadone, nevirapine, simvastatin, tacrolimus, theophylline, warfarin, and oral contraceptives 2, 5, 4, 6.
- Pharmacodynamic interactions have also been reported, such as an increased risk of serotonergic syndrome when combined with selective serotonin re-uptake inhibitors 2, 5, 3.
General Precautions
- Healthcare practitioners should caution patients against mixing herbs and pharmaceutical drugs due to the potential for significant interactions 5.
- Close therapeutic drug monitoring, proper dose and regimen adjustment, patient education, and communication between the patient and physician are recommended when combining St. John's Wort with conventional drugs 4.