Effects of treatment with a commercially available St John's Wort product (Movina (R)) on cholesterol levels in patients with hypercholesterolemia treated with simvastatin

Objective. To assess the effect of treatment with a St John's Wort product ( Movina (R)) on cholesterol levels ( total cholesterol, LDL-cholesterol, and HDL-cholesterol) in patients with hypercholesterolemia on treatment with a stable dose of simvastatin. Design. Controlled, randomized, open, crossover pharmacodynamic study. Setting. Two primary healthcare centres. Intervention. Patients were treated with Movina (R) one tablet ( containing 300 mg of Hypericum perforatum) twice daily and control ( a commercially available multivitamin tablet, Vitamineral (R)). The trial started with a run-in period of 4 weeks. Then the treatment order between control and active treatment was decided ( randomization using sealed envelopes). The duration of each treatment period was 4 weeks and simvastatin treatment was kept unchanged during the whole study period ( 12 weeks). Subjects. Twenty-four patients with hypercholesterolemia treated with a stable dose of simvastatin ( 10-40 mg daily) for at least three months. Main outcome measures. Assessments of total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides were performed in the morning with the patients in a fasting condition. Results. All patients completed the study. LDL-cholesterol was significantly increased during active treatment compared with control. Thus, the mean LDL-cholesterol after 4 weeks' active treatment was 2.72 mmol/L compared with 2.30 mmol/L after treatment with control ( p<0.0001). An increase in total-cholesterol was also observed ( 5.08 mmol/L compared with 4.56 mmol/ L, p< 0.0001). Conclusion. Products containing St John's Wort should not be given to patients with hypercholesterolemia who are on treatment with simvastatin.