Reduction of hyperbilirubinemia with hypericum extract (St. John's Wort) in a patient with Crigler‐Najjar syndrome type II

Aims

Crigler‐Najjar syndrome (CN) type II is a congenital disease with unconjugated hyperbilirubinemia due to a deficiency of uridine 5′‐diphospho‐glucuronosyltransferase 1A1. Since the currently proposed treatment with phenobarbital is associated with adverse reactions, we investigated the effect of hypericum extract.

Methods

Repetitive determination of total serum bilirubin in a female with CN type II before, during and after daily treatment with 900 mg hypericum extract on two occasions for 8 weeks. Confirmation of the enzyme‐inducing effect of hypericum using the cytochrome P450 3A4 probe drug i.v. midazolam.

Results

Hypericum reduced midazolam exposure by 42% and the total serum bilirubin concentration by 30 to 35%.

Conclusions

Hypericum extract is a potential alternative to phenobarbital in patients with CN type II.

DOI: 10.1111/bcp.12869

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