Reproductive System Medications and Drug-OTC-Herbal Interactions
Commonly referred by many as St. John’s Wort, Hypericum Perforatum is an herbal formulation whose ability to interact with many other pharmaceutical products has raised eye brows among many patients and clinicians about its use. According to Moretti et al. (2009) St. John’s Wort is not always recommended by physicians and those who take it do it for the purpose of reducing depression. Women are at an increased risk of abusing the herb especially when they realize that a doctor’s intervention would not completely eliminate their health crisis.
This is the situation that Emily found herself in when she combined the herb with the oral contraception.
When Emily came to the clinic for the second time in a pregnant state confirms the effect of Hypericum Perforatum had on the reproductive system. Research has indicated that indeed St. John’s Wort is effective in the management of depression that is mild to moderate but not severe depression. In as much as it may have helped Emily deal with the depression that accompanies use of oral contraceptives, it had gone a notch higher to reduce its efficacy. As such, her involvement in unprotected coitus with her spouse would not prevent her from being pregnant. Most national agencies in the UK, US, Australia and many more countries have more than once warned on the danger posed by combining herbal medication with contraceptives. Izzo et al. (2016) found out that the problem is made worse by the fact that herbalists make their own formulations which may not be standard, resulting in adverse effects among those who seek their services. To date, even the Food and Drug Agency is yet to understand the mechanisms involved when the herbal formulation interacts with other drugs. Unwanted pregnancies are something that most women would not want to be associated with.
There is a detailed interaction between St. John’s Wort herb and oral contraceptives. Basing my argument on Workman & LaCharity (2016), one major way in which the herb will with no doubt cause a significant interference when used with other drugs. One of the major ways is induction of cytochrome P40. The enzymes in this system function to reduce the efficacy of oral contraceptives that contain ethinyl estradiol and norethindrone components. Long term use of St. John’s Wort apparently increases the clearance of norethindrone, thereby decreasing its half life. In so doing, the oral pill will not be effective in controlling one from getting the pregnancy. It is important to note that St. John’s Wort neither has direct nor indirect effects on reproductive hormones in women. As such the affected persons should not be worried on the likelihood of the herb to affect their reproductive systems.
To effectively handle the dilemma that Emily currently faces, it would be prudent for the clinician to relay accurate information on the mechanisms involved in her subsequent becoming pregnant despite using a pill. The information is essential in the sense that it will make. Emily and other women on oral contraceptives need to be aware of the side effects of the drugs so that they are prepared to handle them. In addition their current contraception, they should be advised to consider using barrier method of contraception. Barrier contraception has been found to work well with St. John’s Wort, since it completely puts off excessive bleeding. Management in this case is mainly psychological and health education, bearing in mind that the pregnancy is at an advanced stage and only legal and ethical aspects should be considered before the pregnancy can be terminated.
References
Izzo, A. A., Hoon‐Kim, S., Radhakrishnan, R., & Williamson, E. M. (2016). A critical approach to evaluating clinical efficacy, adverse events and drug interactions of herbal remedies. Phytotherapy Research, 30(5), 691-700.
Moretti, M. E., Maxson, A., Hanna, F., & Koren, G. (January 01, 2009). Evaluating the safety of St. John’s Wort in human pregnancy. Reproductive Toxicology (elmsford, N.y.), 28, 1, 96-9.
Workman, M. L., & LaCharity, L. A. (2016). Understanding pharmacology: Essentials for medication safety.
