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Thread: St. John's Wort, Suboxone, and CYP3A4

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    St. John's Wort, Suboxone, and CYP3A4 
    #1
    Okay, so supposedly, St. John's Wort is a CYP3A4 inducer, right? If that's the case, then anything that is metabolized by that enzyme should be metabolized a lot faster when taken in conjunction with St. John's Wort. If this is true, doesn't it make sense that St. John's Wort would cause Suboxone to have a much shorter half-life and thus duration of action? If not, then where did my logic fail me?
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    #2
    Ex-Bluelighter
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    um i'm not sure but i'm pretty sure that st. john's wort has some kind of MAOI in it which makes it very dangerous to take with other drugs or even foods
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    #3
    Bluelighter epiks's Avatar
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    St Johns warts isn't dangerous with other foods / drugs. There may be a couple (I've never heard of any) I'm not saying there isn't any food/drug you shouldn't mix with it. But in general, you will be fine.

    To the OP - I take suboxone and st johns warts every morning and things like valerian root at night. I've never really noticed st johns adding any of the effects you mentioned.
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    #4
    Bluelighter
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    yea i take st. johns wart daily with suboxone and did not notice any effects. maybe if you take a lot of SJW?
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    #5
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    Why is St. John's Wort dangerous? The active ingredient in St. John's Wort is a monoamine oxidase inhibitor (MAOI)
    http://atheism.about.com/library/glo...tjohnswort.htm
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    #6
    Bluelighter Znegative's Avatar
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    The active ingredient In St.John's Wort, is Hypericum Perforatum and Hyperforin Though some formulas sold as St.John's Wort do not contain Hyperforin.

    St.Johns Wort's mechanism of action, from what I've read, is not entirely understood. It's thought to have weak Monoamine Oxidase Inhibitor properties, but it also effects seretonin, dopamine, and neuroepinephrine. Hypericin is thought to also activate GABA-A, GABA-B, and Glutimate Receptors.

    Monoamine Oxidase Inhibitor's can be dangerous because they have potentially lethal interactions with many foods, prescription medications, OTC's, and supplement's (such as St.Johns Wort). Combining MAOI's with certain anti-depressants or serotonergic drugs, stimulants, and certain opioids(Tramadol, Meperidine) can cause Seretonin Syndrome, which is a drug reaction that can be potentially lethal.

    As for St.Johns' Wort, it can cause multiple drug interactions through the induction of cytochrome P450 enzyme CYP3A4 and CYP2C9, resulting in increased metabolism And decreased concentration and effect. Buprenorphine, Methadone, Midazolam, and Alprazolam are just a few of the drugs known to have interactions with St.John's Wort. According to this study, buprenorphine is a rather potent inhibitor of CYP2D6, while Nor-Buprenorphine, Bupe's potent full-agonist metabolite, showed weak inhibition. Some people take St.John's Wort to try and inhibit the absorption of buprenorphine in hopes that the norbuprenorphine will fill up the receptor sites instead. I've personally tried it three times. The first time I noticed no noticeable interaction, the second two times (when I was at a slightly lower dosage) I experienced a shortened duration of buprenorphine's effects, and the urge to redose out of discomfort. No high was ever experienced.

    There are also studys that show that St.John's Wort Causes drug interaction through the induction of the P-Glycoprotein Efflux Transporter. This can also cause a decrease in absorption and duration in certain drugs such as methadone, though it appears to not effect absorption or metabolism of buprenorphine.
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    #7
    OMG Thats so weird I was just thinking about this, I was hoping that it would speed up metabolism of bupe so one would be able to take a full opiate/opiod agonist quicker instead of waiting the full 48-96 hours before dosing this could be very valuable information!!
    Quote Originally Posted by mrflowers00 View Post
    Why is St. John's Wort dangerous? The active ingredient in St. John's Wort is a monoamine oxidase inhibitor (MAOI)
    http://atheism.about.com/library/glo...tjohnswort.htm
    St johns wort is a very weak MAOI
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    #8
    Bluelighter jaysofab's Avatar
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    so question anyone knw if you should take sjw or bupe first to try and experience an effect
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