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Invited Critique |

St John's Wort Supplements Endanger the Success of Organ Transplantation—Invited Critique

Sean Cao, MD
Arch Surg. 2002;137(3):319. doi:10.1001/archsurg.137.3.319.
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Although the causal relationship between SJW and the lowering of cyclosporine levels has been well documented and the potential loss of allograft owing to rejection is real, several points of discussion arise:

  • The identity of the chemical makeup of SJW should be presented and its structure compared with some similar compounds that have either interaction with P-glycoprotein or the cytochrome P450 system. This will enhance the possible direct effect of SJW on cyclosporine A levels.

  • The authors need to be sure that no other confounding medication can also affect cyclosporine A metabolism since, though it is not clearly stated, these transplant recipients are supposed to be receiving only standard immunosuppressive medication at that time since transplantation has taken place months or years prior to taking SJW.

  • Although one cannot avoid SJW active ingredients in all common foodstuffs, it is important to not actively supplement oneself daily with SJW since it might be the cumulative dosage of SJW that causes alteration in cyclosporine A metabolism.

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