France - Following the recent publication of several papers describing significant interactions between St John's wort (Hypericum perforatum) and digoxin, theophylline, indinavir, ciclosporin, certain oral anticoagulants, antidepressants and oral contraceptives, the Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSPS) has made the following recommendations:

1. Patients not yet taking St John's wort:

• patients being treated with antiretroviral agents, and particularly indinavir (Crixivan®), for HIV infection should not take St John's wort in view of the risk of decreased efficacy of the treatment.

• patients being treated with antidepressants should not take St John's wort concomitantly because of the risk of adverse reactions (restlessness, nausea, gastric disturbance).

• women taking oral contraceptives should not take St John's wort concomitantly because of the risk of a diminution in the contraceptive effect.

• in general, St John's wort should not be taken concomitantly with any other medicinal treatment in view of the risk of a drug interaction which could result in a reduction in the efficacy of the medicines.

2. Patients under treatment must not discontinue taking St John's wort without medical advice.

Although St John's wort has been promoted as a treatment for mood disorders and is available as a food supplement, it is not approved as a medicine in France.

Reference: Communiqué from the Agence Française de Sécurité Sanitaire des Produits de Santé, 1 March 2000.