ST. John's Wort and Tyramine-Rich Foods Interaction: Hypertensive Crisis

A 41-year-old male patient was admitted to the emergency room for confusion and disorientation. Approximately 10 hours prior to admission, the patient ingested aged cheeses and a glass of red wine. The only medication taken was St. John’s Wort, which he had been taking for work-related stress for the past week. Upon emergency room arrival, the patient was tachycardic (115 beats per minute) and hypertensive (210/140 mm Hg) and had a respiratory rate of 16 breaths per minute. Speech and orientation were not within normal limits. Treatment included intravenous phentolamine and oral labetalol, resulting in decreased blood pressure (160/100 mm Hg) within two hours. Other symptoms also resolved gradually. Laboratory values were within normal limits. Urinary screenings were also within normal ranges. The authors concluded that this patient experienced a hypertensive crisis related to an interaction between St. John’s Wort and tyraminerich foods. They suggested that St. John’t Wort has monoamine oxidase inhibitor activity and thus interacted with tyramine. St. John’s Wort Patel S et al (Dept Internal Med, Southern Illinois Univ Sch Med, Springfield, IL) Hypertensive crisis associated with St. John’s wort. Am J Med 112:507–508 (Apr 15) 2002 Bleomycin (139) Ciprofloxacin (Ophthalmic)* (132) Copaltra Tea (140) Etanercept* (131) Ibuprofen (137) Leflunomide (136) Mango Fruit (133) Paroxetine (134) Pioglitazone (138) Pooled Plasma, Human (143) Rosiglitazone (138) Simvastatin (135) St. John’s Wort (129) Thalidomide (141, 142) Tissue Adhesive (130) Tyramine Foods (129) Warfarin (133)