Drug Interaction Case Study Examples

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Case study on:

Drug interaction between St. John Wort (Hypericum Perforatum) extract and Ibuprofen as a possible cause of upper gastrointestinal bleeding.

Author:

Fabrizio Codebo’

Free Lance Remote Healthcare Provider HCPC Registered Paramedic PA34987

65 Federation Road
Plymouth
PL3 6BR
UK

Email address (preferred contact): fabrizio.codebo@yahoo.co.uk

Correspondence address:
C/o
A. Codebo’
Via Della Costa 20 E
Alpignano (To)
Italy.

Box 1
Description of the Event
The case refers to a 51 year old Caucasian male employed as a technician aboard a vessel experiencing a sudden onset of four, consecutive episodes of haematemesis. The patient expectorated a total of approximately 80 millilitres of frank blood, within the first 20
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Making an analogy, the potent serotonin inhibiting effect of SJW gives ground to similar speculations on possible UGIB triggered by the combined use of this herbal remedy and NSAIDs.
Relevant for the case in subject is Bell et al. (12), who demonstrated that the mean residence of IBF in individuals treated with SJW appeared significantly lowered after a 21 day trial. In our particular case the patient stated that he abruptly interrupted the self-administration of SJW a few days before the bleeding, while he kept himself on heavy doses of IBF. The consequent speculation brings to light the possibility of a sudden increase of IBF residence time following a sudden interruption of SJW administration, with risks of overdosing.
The main limitation of the research is represented by the lack of studies on drug interactions for different dosages of SJW and NSAID, inclusive of OTC preparations such as IBF. The possibility of self-prescribed OTC NSAIDs taken by the patient in addition with prescribed therapy, represents not just a possible source of bias in present and future researches, but also an hazardous situation with possible lethal
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Loke YK, Trivedi AN, Singh S. Meta-analysis: gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and non-steroidal anti-inflammatory drugs: META-ANALYSIS: GASTROINTESTINAL BLEEDING WITH SSRIS AND NSAID. Alimentary Pharmacology & Therapeutics. 2007 Oct 5;27(1):31–40.
6. Izzo AA. Drug interactions with St. John’s Wort (Hypericum perforatum): a review of the clinical evidence. Europe PubMed Central. 2004;42(3):139–48.
7. Izzo AA, Ernst E. Interactions Between Herbal Medicines and Prescribed Drugs. Drugs. 2001;61(15):2163–75.
8. Dürr D, Stieger B, Kullak-Ublick GA, Rentsch KM, Steinert HC, Meier PG, et al. St John’s Wort induces intestinal P-glycoprotein/MDR1 and intestinal and hepatic CYP3A4. Clinical Pharmacology and Therapeutics. 2000;68(6):598–604.
9. Johne A, Brockmöller J, Bauer S, Maurer A, Langheinrich M, Roots I. Pharmacokinetic interaction of digoxin with an herbal extract from St John’s wort (Hypericum perforatum). Clinical Pharmacology and Therapeutics. 1999;66(4):338–45.
10. Müller WE, Singer A, Wonneman M. Hyperforin--antidepressant activity by a novel mechanism of action. Thieme E-Journals – Pharmacopsychiatry. 2001;34(Suppl

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