Letter to the Editor: Redefining St John's Wort

Abstract

To the Editor: I am writing in response to the November/December 1998 Editorial, “Dietary Supplements: Safe…, at Certain Speeds,” by Alan Matarasso, MD (Aesthetic Surg J 1998;18:442-3). I was especially interested in the editorial because some of our products contain St John's wort. Dr Matarasso states that St John's wort has a mild monoamine oxidase (MAO) inhibitory effect, “[t]herefore, use of these supplements should be discontinued 2 weeks before surgery, and they should not be used simultaneously with meperidine, as with other MAO inhibitors.” His reference is “Danger Alert—St John's Wort is Monoamine Oxidase Inhibitor,” by Stephen H. Jackson, MD, published in the California Society of Anesthesia (CSA) Bulletin's March/April 1998 issue.1 This would be an excellent recommendation if St John's wort was in fact an MAO inhibitor. Dr Jackson observes that MAO inhibitors can interact detrimentally with meperidine, which is frequently used as a postsurgical analgesic and is also used in the recovery room to treat postanesthesia shivering. His warning is based on his belief that St John's wort is an MAO inhibitor: “The potential concern with St John's wort is that the hypericum extract, hypericin, has been identified by the German equivalent of our FDA as a monoamine oxidase inhibitor.”1 The agency to which he refers is the German Commission E. Dr Jackson states that much of his information is from two sources: The American Medical Association's (AMA's) Council on Scientific Affairs report, “Alternative Medicine,” …