Influence of St. John ’s Wort on Intravenous Fentanyl Pharmacokinetics, Pharmacodynamics, and Clinical Effects A Randomized Clinical Trial

Conclusions St. John ’s wort did not alter fentanyl pharmacokinetics, pharmacodynamics or clinical effects, suggesting no effect on hepatic clearance or blood-brain barrier efflux. Patients taking St. John’s wort will likely not respond differently to IV fentanyl for anesthesia or analgesia.Editor ’s PerspectiveWhat We Already Know about This TopicThe popular herbal medicine, St. John ’s wort, is a potent inducer of several cytochrome P450 enzymes, including CYP3A4, which plays a role in the metabolism of fentanyl. St. John’s wort may also influence the expression of P-glycoprotein, which can alter the movement of drugs across the blood–brain barrier.What This Article Tells Us That Is NewThe pharmacokinetics and pharmacodynamics (pupillary diameter over time) were examined in volunteers before and after treatment with St. John ’s wort. No differences were seen, suggesting that this herbal medication does not influence the clinical behavior of fentanyl.
Source: Anesthesiology - Category: Anesthesiology Source Type: research