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The Pharmaceutical Journal
Vol 268 No 7185 p197-203
16 February 2002

Interaction between St John's wort and OCs highlighted

CSM advice

The Committee on Safety of Medicines advises that St John's wort should not be taken with the following medicines: indinavir, warfarin, ciclosporin, oral contraceptives, digoxin, theophylline. Clinically important interactions are also likely with other HIV protease inhibitors, HIV non-nucleoside reverse transcriptase inhibitors, anticonvulsants, and psychotropic medicines, including selective serotonin reuptake inhibitors, and triptans.

The interaction between St John's wort (Hypericum perforatum) and oral contraceptives has been highlighted in the national press recently. This followed a report from the Adverse Drug Reactions Database of the Medicinal Products Agency, Sweden, of two cases of pregnancy resulting from a decrease in the effect of oral contraceptives taken with products containing St John's wort.

In the United Kingdom, since February 2000, the Medicines Control Agency has received seven reports of women who have become pregnant while taking St John's wort at the same time as oral contraceptives — one of whom had also taken emergency hormonal contraception. A separate report of a woman becoming pregnant after using emergency contraception while taking St John's Wort was also received.