An example of herbal drug interactions in the community
Herbal remedies should always be considered when reviewing patients' medication, although research on drug interactions with herbal remedies has been sparse. St John's wort is a herbal remedy that has been around for hundreds of years to treat mental health problems, and is bought over the counter in the UK for mild-to-moderate depression, as well as for seasonal affective disorder (SAD), mild anxiety and sleep problems (Mind, 2020). Although it is not a ‘drug’ regulated and approved by the Medicines and Healthcare products Regulatory Agency (MHRA), it is popular for its perceived antidepressant effects, and knowledge of it and its interactions with other medications is important.
St John's wort (Hypericum perforatum) contains many active substances, such as hypericin and hyperforin, which are thought to have an effect on mood. These substances are believed to work in the same way as standard antidepressant medications, increasing the activity of serotonin and noradrenaline to help regulate mood (Mind, 2020). St John's wort should not be used to self-medicate if patients are experiencing struggles with mental health without talking to a doctor first, as this may be dangerous, and it may not be the right drug for the patient. It may also interact with a medication the patient is already taking (for example, the combined pill) and may have an adverse effect if the person is bipolar (Mind, 2020), causing hypomania.
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