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St. Johns Wort and Suboxone - Need Help Here!


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#1 Bghead8che

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Posted 10 May 2008 - 10:11 PM


I am on Suboxone, typically prescribed for opiate addition, for chronic pain. I take 4 mgs 3 times a day. In addition to chronic pain I also have mild-moderate depression and am weaning of SSRIs.

I started Perkia St. Johns Wort 3 times a day and stopped after reading the following:
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http://www.answers.c...ride?cat=health

What drug(s) may interact with Buprenorphine (Suboxone)?

• amiodarone
• bosentan
• butorphanol
• clarithromycin
• erythromycin
• fluoxetine
• fluvoxamine
• levomethadyl
• medicines for fungal infections (examples: fluconazole, itraconazole, ketoconazole, voriconazole)
• medicines for seizures
• methadone
• mifepristone, RU-486
• nalbuphine
• naltrexone
• nefazodone
• pentazocine
• rifampin
• some medicines used to treat HIV infection or AIDS
• St. John's wort

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I was really disappointed as I wanted to replace my SSRI w/ St. Johns Wort. What type of interaction would occur? Is it a toxicity issue or an issue of one drug not being metobolized? I know there are some knowledgeable people on these forums so I thought you might be able to help me out. I did try St. Johns Wort for 6 days and ended up w/ a nasty withdrawal leading me to believe St. Johns Wort interacts strongly w/ Suboxone.

Can someone with knowledge in pharmacology comment? I’ll take educated guesses!

Thanks,

-Brian

#2 Bghead8che

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Posted 10 May 2008 - 10:55 PM

I found this doing a Google search:

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buprenorphine and St. John's wort (Moderate Drug-Drug)

MONITOR: Coadministration with drugs that are inducers of CYP450 3A4 may decrease the plasma concentrations and efficacy of buprenorphine, which is metabolized in the liver by the isoenzyme. In addition, some of these inducers (anticonvulsants and barbiturates) may have additive central nervous system-depressant effects with buprenorphine.

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Apparently they are both CYP450 inducers so if I understand correctly by taking SJW it would prevent the proper metabolism of Suboxone, hence my severe withdrawal. I would also imagine the SJW was not metabolized either so they were in effect canceling each other out. Sounds like I can't take both. I still don't know if it is a dangerous combination or just one of drug efficacy. I am definitely disappointed as I need Suboxone for pain management and wanted to taper of my SSRI and use SJW instead.

-Brian

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#3 ajnast4r

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Posted 11 May 2008 - 12:18 AM

i think it may be an issue of both... i believe st johns wort induces the same cytochromes that are metabolizing buprenorphine and could in theory lessen the effects. st johns worts effects are complex, its not just acting through serotogenic pathways so there may be an actual dangerous interaction.

i dont have time to look into it right now, but i will check back in the thread later tonight or tomorrow.

#4 Bghead8che

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Posted 11 May 2008 - 03:34 AM

i think it may be an issue of both... i believe st johns wort induces the same cytochromes that are metabolizing buprenorphine and could in theory lessen the effects. st johns worts effects are complex, its not just acting through serotogenic pathways so there may be an actual dangerous interaction.

i dont have time to look into it right now, but i will check back in the thread later tonight or tomorrow.


Please do respond. I appreciate your feedback. There is no doubt my body experienced a horrible reaction to both.

-Brian

#5 Halo657

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Posted 19 September 2008 - 07:07 PM

i think it may be an issue of both... i believe st johns wort induces the same cytochromes that are metabolizing buprenorphine and could in theory lessen the effects. st johns worts effects are complex, its not just acting through serotogenic pathways so there may be an actual dangerous interaction.

i dont have time to look into it right now, but i will check back in the thread later tonight or tomorrow.


Please do respond. I appreciate your feedback. There is no doubt my body experienced a horrible reaction to both.

-Brian



I'm with you in the same boat last night i took one dose of SJW and felt like i was going through withdrawls. As it is i am forced to walk with a cane but that made me want to die. It only last about seven hours and i think that there was a flood of Suboxon because it hit me all at once but i still had to take an extra pill and a half for the day.

#6 Bghead8che

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Posted 21 September 2008 - 02:27 AM

i think it may be an issue of both... i believe st johns wort induces the same cytochromes that are metabolizing buprenorphine and could in theory lessen the effects. st johns worts effects are complex, its not just acting through serotogenic pathways so there may be an actual dangerous interaction.

i dont have time to look into it right now, but i will check back in the thread later tonight or tomorrow.


Please do respond. I appreciate your feedback. There is no doubt my body experienced a horrible reaction to both.

-Brian



I'm with you in the same boat last night i took one dose of SJW and felt like i was going through withdrawls. As it is i am forced to walk with a cane but that made me want to die. It only last about seven hours and i think that there was a flood of Suboxon because it hit me all at once but i still had to take an extra pill and a half for the day.


Hi Halo,

I had to learn the hard way that you can NOT take SJW and Suboxone together. SJW interferes so strongly that you will end up in withdrawl. I had to choose between Suboxone or SJW and I choose to drop SJW. Interestingly SJW interferes with 50% of ALL medications.

-Brian

#7 Halo657

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Posted 22 September 2008 - 04:21 AM

i think it may be an issue of both... i believe st johns wort induces the same cytochromes that are metabolizing buprenorphine and could in theory lessen the effects. st johns worts effects are complex, its not just acting through serotogenic pathways so there may be an actual dangerous interaction.

i dont have time to look into it right now, but i will check back in the thread later tonight or tomorrow.


Please do respond. I appreciate your feedback. There is no doubt my body experienced a horrible reaction to both.

-Brian



I'm with you in the same boat last night i took one dose of SJW and felt like i was going through withdrawls. As it is i am forced to walk with a cane but that made me want to die. It only last about seven hours and i think that there was a flood of Suboxon because it hit me all at once but i still had to take an extra pill and a half for the day.


Hi Halo,

I had to learn the hard way that you can NOT take SJW and Suboxone together. SJW interferes so strongly that you will end up in withdrawl. I had to choose between Suboxone or SJW and I choose to drop SJW. Interestingly SJW interferes with 50% of ALL medications.

-Brian


The guy at CVS kept telling me there was no interaction but i was clearly sweating and my entire body felt like it was falling apart. I walk with a cane so i take the suboxone for pain and boy was i ever. I hate pharmicists they always have to be the smartest person in theroom.

#8 luv2increase

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Posted 22 September 2008 - 05:33 AM

I'm with you in the same boat last night i took one dose of SJW and felt like i was going through withdrawls.



That is because the SJW made it so the suboxone was ridded from your system quicker than normal which in turn induced withdrawal. This means that they would be safe to take together yet unwise if you want to get the full effects from your suboxone medication. If SJW inhibited CYP450 rather than enhancing/inducing it, it would be potentially very dangerous because there would ultimately be an accumulation of suboxone in your system which could possibly cause respiratory distress and death.

#9 Bghead8che

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Posted 22 September 2008 - 11:39 PM

I'm with you in the same boat last night i took one dose of SJW and felt like i was going through withdrawls.



That is because the SJW made it so the suboxone was ridded from your system quicker than normal which in turn induced withdrawal. This means that they would be safe to take together yet unwise if you want to get the full effects from your suboxone medication. If SJW inhibited CYP450 rather than enhancing/inducing it, it would be potentially very dangerous because there would ultimately be an accumulation of suboxone in your system which could possibly cause respiratory distress and death.


The interaction is so strong I highly recommend one does not take them together. You would have to take a boat load of Suboxone to overcome the SJW. It is not worth the risk IMHO.

-Brian

#10 luv2increase

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Posted 22 September 2008 - 11:45 PM

The interaction is so strong I highly recommend one does not take them together. You would have to take a boat load of Suboxone to overcome the SJW. It is not worth the risk IMHO.
-Brian


What interaction? There is no interaction. The SJW basically just makes it so the suboxone is excreted out of the body quicker thus allowing opiate withdrawal to ensue.


It's a no-brainer to not take both at the same time. This isn't a safety concern but a concern that it would cause one to have the negative feelings associated with opiate withdrawal.

#11 Bghead8che

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Posted 26 September 2008 - 02:55 AM

The interaction is so strong I highly recommend one does not take them together. You would have to take a boat load of Suboxone to overcome the SJW. It is not worth the risk IMHO.
-Brian


What interaction? There is no interaction. The SJW basically just makes it so the suboxone is excreted out of the body quicker thus allowing opiate withdrawal to ensue.


It's a no-brainer to not take both at the same time. This isn't a safety concern but a concern that it would cause one to have the negative feelings associated with opiate withdrawal.


Is it really necessary to argue semantics? I don't think anyone was confused by my choice of words or was unclear as to what I meant. Suboxone and St. Johns Wort "INTERACT" in that Suboxone is not metabolized resulting in an "INTERACTION". And to those of us on Suboxone, taking SJW involves the "RISK" of going into withdrawal or the risk of not having the anti-depressant properties of SJW work.

As far as being a "no-brainer", well, yes, it is a no-brainer AFTER you are aware of the interaction. However how many people know that SJW and Suboxone should not be taken together off the top of their heads?

I am sorry to hear you have chronic pain. I suffer from the same. I've gone from Ultram to Oxys and it took me 10 years to realize I can't stand the cognitive inhibition of any of them not to mention the physical dependence.

-Brian

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#12 luv2increase

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Posted 26 September 2008 - 05:57 AM

delete post

Edited by luv2increase, 26 September 2008 - 11:54 PM.





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