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St. John's Wort and Organ Transplants

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Not a Good Combination

Do not take St. John's Wort (hypericum perforatum) before, during or after a transplant of any kind (heart, kidney, liver, bone marrow, etc.) especially if you are taking the anti-organ rejection drug cyclosporine (NEORAL, SANDIMMUNE).

A letter in the May, 2000 issue of The Lancet from doctors at an organ transplant service in Hannover, Germany, reported the following experience.

One of their kidney transplant patients showed a severe decrease in cyclosporine blood levels in spite of significantly increasing the dose. Later they found out the patient was taking St. John's Wort. When the patient stopped the St. John's Wort, cyclosporine blood levels began to increase, and the dosage of cyclosporine was lowered.

After this episode, all transplant patients (45) with unexplained low cyclosporine levels were asked if they had taken St. John's Wort. Most of them took the herb inconsistently and did not report it to their doctors. One kidney and one liver transplant patient had a rejection reaction due to low cyclosporine blood levels that could not be explained any other way. Both were taking St. John's Wort at the time of the reaction, making the herb the likely cause of the rejection.

The German doctors concluded their letter by saying, "Apart from an increased risk of graft (organ) rejection, the interaction also raises costs because the dosage of an expensive drug has to be increased."

If you have been using cyclosporine with St. John's Wort, the herb should be stopped only under the supervision of your doctor because cyclosporine blood levels may increase, requiring an adjustment in the dose of cyclosporine.

 

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