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Nephrol Dial Transplant (2003) 18: 819-822
© 2003 European Renal Association-European Dialysis and Transplant Association

Brief Report

Impact of St John's wort treatment on the pharmacokinetics of tacrolimus and mycophenolic acid in renal transplant patients

Ingrid Mai, Elke Störmer, Steffen Bauer, Hagen Krüger, Klemens Budde1 and Ivar Roots

Institute of Clinical Pharmacology and 1 Department of Internal Medicine and Nephrology, University Medical Center Charité, Humboldt University of Berlin, Berlin, Germany

Background. This study investigated the effect of St John's wort (SJW) extract on the pharmacokinetics of the immunosuppressants tacrolimus (TAC) and mycophenolic acid (MPA).

Methods. Ten stable renal transplant patients received 600 mg SJW extract for 14 days in addition to their regular regimen of TAC and mycophenolate mofetil.

Results. Dose-corrected AUC(0–12) of TAC decreased significantly from 180 ng/ml/h at baseline to 75.9 ng/ml/h after 2 weeks of SJW treatment. To maintain therapeutic TAC concentrations, dose adjustments from a median 4.5 mg/day at baseline to 8.0 mg/day under SJW treatment were required. Two weeks after discontinuation of SJW, TAC doses were reduced to a median of 6.5 mg/day. MPA pharmacokinetics remained unaffected by comedication with hypericum extract.

Conclusions. Administration of SJW extract to patients receiving TAC treatment can result in a serious drug interaction leading to markedly reduced TAC blood concentrations associated with the risk of organ rejection.

Keywords: drug interaction; immunosuppression; mycophenolic acid; St John's wort; tacrolimus; transplantation

Correspondence and offprint requests to: Dr Ingrid Mai, Institut für Klinische Pharmakologie der Charité, Humboldt-Universität zu Berlin, Schumannstr. 20/21, D-10098 Berlin, Germany. Email: ingrid.mai{at}charite.de


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