Trial reportBritish journal of clinical pharmacology2003
Alterations in cyclosporin A pharmacokinetics and metabolism during treatment with St John's wort in renal transplant patients.
Trial report in British journal of clinical pharmacology, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 2 syntheses or guidelines pooled it, 187 citations in OpenAlex.
- The effect of St John's wort extracts on CYP3A: a systematic review of prospective clinical trials.British journal of clinical pharmacology · 2006Pooled it
- Interaction of St John's wort with conventional drugs: systematic review of clinical trials.BMJ (Clinical research ed.) · 2004Pooled it
- Impact of cytochrome P-450 inhibition by cimetidine and induction by carbamazepine on the kinetics of hypericin and pseudohypericin in healthy volunteers.European journal of clinical pharmacology · 2004Trial
- Herbal Extracts and Plant-Derived Bioactives in Atopic Dermatitis: Evidence, Mechanisms, Pediatric Safety, and Translational Priorities.Food science & nutrition · 2026Review
- Interactions between cytochrome P450 enzymes and traditional Chinese herbs: A comprehensive review.Journal of the Chinese Medical Association : JCMA · 2026Review
- Deciphering the Relative Contribution of CYP3A4 Versus P-Glycoprotein for the Shared Substrate Cyclosporine-Commentary on Lown et al.Clinical pharmacology and therapeutics · 2025Article
- Herbal Medicine Use Among Transplant Recipients in Saudi Arabia: Prevalence and Risk Awareness.Annals of transplantation · 2025Article
- Predicting Food-Drug Interactions between Piperine and CYP3A4 Substrate Drugs Using PBPK Modeling.International journal of molecular sciences · 2024Article
- Review
- Treatment of Lupus Nephritis from Iranian Traditional Medicine and Modern Medicine Points of View: A Comparative Study.Evidence-based complementary and alternative medicine : eCAM · 2021Review
- A Generic Model for Quantitative Prediction of Interactions Mediated by Efflux Transporters and Cytochromes: Application to P-Glycoprotein and Cytochrome 3A4.Clinical pharmacokinetics · 2019Article
- Herbal Interaction With Chemotherapeutic Drugs-A Focus on Clinically Significant Findings.Frontiers in oncology · 2019Review
- A regulatory science viewpoint on botanical-drug interactions.Journal of food and drug analysis · 2018Review
- A Model for Predicting the Interindividual Variability of Drug-Drug Interactions.The AAPS journal · 2017Article
- Pharmacokinetic Herb-Drug Interactions: Insight into Mechanisms and Consequences.European journal of drug metabolism and pharmacokinetics · 2016Review
- Chinese herbal medicines and chronic kidney disease: a positive outcome in a large patient study in Taiwan.Kidney international · 2015Article
- Article
- Intake of St John's wort improves the glucose tolerance in healthy subjects who ingest metformin compared with metformin alone.British journal of clinical pharmacology · 2015Article
- Ciclosporin 10 years on: indications and efficacy.The Veterinary record · 2014Review
- Cyclosporine and herbal supplement interactions.Journal of toxicology · 2014Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimThis study investigated the effects of St John's wort extract (SJW) on the pharmacokinetics and metabolism of the immunosuppressant cyclosporin A (CSA).
methodsIn an open-label study, 11 renal transplant patients received 600 mg SJW extract daily for 14 days in addition to their regular regimen of CSA. Blood concentrations of CSA and its metabolites AM1, AM1C, AM9, AM19, and AM4N were measured by HPLC.
resultsAfter 2 weeks of SJW coadministration, dose-corrected AUC0-12, Cmax and Ctrough values for CSA decreased significantly by 46%[geometric mean ratio baseline/SJW (95% CI): 1.83 (1.63-2.05)], 42%[1.72 (1.42-2.08)], and 41%[1.70 (1.17-2.47)], respectively. CSA doses were increased from a median of 2.7 mg day(-1) kg(-1) at baseline to 4.2 mg day(-1) kg(-1) at day 15, with the first dose adjustment required only 3 days after initiation of SJW treatment. Additionally, the metabolite pattern of CSA was substantially altered during SJW treatment. Whereas dose-corrected AUC values for AM1, AM1c and AM4N significantly decreased by 59%, 61%, and 23% compared with baseline, AUC values for AM9 and AM19 were unchanged. Following the increase in CSA dose, observed AUC and Cmax values for AM9, AM19, and AM4N increased by 20-51% and 43-90%, respectively.
conclusionAdministration of SJW extract to patients receiving CSA treatment resulted in a rapid and significant reduction of plasma CSA concentrations. Additionally, the substantial alterations in CSA metabolite kinetics observed may affect the toxicity profile of the drug.
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