Hypericum perforatum: ¿una hierba más? / Hypericum perforatum: just another herb?

RESUMEN

Hypericum perforatum o hierba de San Juan se utilizó incialmente como antiinflamatorio (AI) en afecciones dérmicas. En la actualidad tiene múltiples usos (antidepresivo, tratamiento del insomnio, ansiolítico, antiinflamatorio, etc.), no todos oficialmente aceptados. • Respecto a la eficacia, existen ensayos clínicos publicados en los que se evidencia la superioridad frente a placebo de algunos extractos de hypericum en el tratamiento a corto plazo de la depresión leve a moderada. Otros ensayos también demuestran la no inferioridad de estos extractos frente a comparadores activos, aunque en otros no puede concluirse sobre dicha superioridad. • Los tratamientos actualmente disponibles para el tratamiento de la depresión presentan algunas limitaciones, no sólo en lo relativo a su eficacia sino en lo relacionado con su perfil de seguridad, el cual no siempre es bien aceptado. El problema fundamental del hypericum son sus múltiples interacciones farmacológicas. La Agencia Europea de Evaluación de Medicamentos (EMEA) recomienda evitar el uso concomitante de hypericum junto con antirretrovirales (inhibidores de la proteasa), digoxina, warfarina, ciclosporina, anticonceptivos orales y teofilina

ABSTRACT

Hypericum is one of the best known herbs in our setting. Hypericum perforatum (commonly called St John´s wort) was first used as an anti-inflammatory agent to treat skin lesions. At present, it has multiple uses (as an antidepressant, for insomnia, as an anti-anxiety drug, or as previously mentioned, an anti-inflammatory, etc.), not all of which are officially accepted. • As regards its efficacy, there are some published clinical trials showing the superiority of some hypericum extracts as compared to placebo in the short-term treatment of mild to moderate depression. Some clinical trials also demonstrate that these extracts are not inferior when compared against active comparators, although this point is a bit more controversial as there are other published clinical trials that are not conclusive of such superiority. • Currently available treatments for the treatment of depression present some limitations not only in what refers to their efficacy but also, and mainly, in what refers to their safety profile, which is not always well accepted. Within this context, the introduction of new therapeutic alternatives with a better safety profile, as suggested with hypericum, would be of great use. The fundamental problem of hypericum is its multiple pharmacological interactions. The Eupean Medical Evaluation Agency (EMEA) recommends not using hypericum concomitantly with antiretroviral drugs (protease inhibitors), digoxin, warfarin, cyclosporin, oral contraceptives and teofiline