The pharmacokinetics of the desogestrol was also not affected by co-administration of the St. John’s wort extract. There was a small decrease in ethinylestradiol and 3- ketodesogestrel but it was not considered significant. In addition, there was no break through bleeding induced by the addition of the St. John’s wort extract.[1]

Comments

The results of this study are in contrast to other previous reports and studies. Two reports have shown break-through bleeding and spotting with co-administration of St. John’s wort and OCs.[2],[3]

Three studies indicate an alteration of the pharmacokinetics of the OC with co-administration of St. John’s wort. [4], [5], [6] These studies used a different St. John’s wort preparation (80% methanolic extract) and at a much higher dose (900 mg) containing a much higher amount of hyperforin (20-35 mg) than the current study.

The lower daily total dose and hyperforin intake would appear to be the likely reason for the lack of interaction of the St. John’s wort extract with the OC pharmacokinetics in this current study. Accordingly, using a lower dose St. John’s wort extract with reduced hyperforin content does not appear to interact with OC nor cause breakthrough bleeding (an indication of possible ovulation).

References

[2] Ernst E. Second thoughts about safety of St. John’s wort. Lancet 1999;354:2014-2016.

[3] Raetz A, vonMoos M, Drewe J. Johanniskraut: ein Phytopharmakon mit potentiell gefahrlichen Interaktionen. Praxis 2001;90:843-849.

[4] Pfrunder A, Schiesser M, Gerber S, et al. Interaction of St. John’s wort with low-dose oral contraceptive therapy: a randomized controlled trial. Br J Clin Pharmacol 2003;56:683-690

[5] Hall S, Wang Z, Huang S, Hamman M, et al. The interaction between St. John’s wort and an oral contraceptive. Clin Pharmacol Ther 2003; 74:525-535.

[6] Murphy P, Kern S, Stanczyk F, Westhoff C. Interaction of St. John’s wort with oral contraceptives: effects on the pharmacokinetics of norehindrone and ethinyl estradiol, ovarian activity and breakthrough bleeding. Contraception 2005;71:402-408

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