リソース：抗うつ剤St.John's wort(Hypericum perforatum)セント・ジョーンズ・ワート（オトギリソウ）
■追加 ●BSC/ラジオ短波 -Medical Web Library BS病薬アワー - セントジョンズワートと薬物相互作用[2003.6.23, pdf,3p] by 昭和大学薬学部助教授 平井 康昭
【日本語版コメント1081】
St.John's Wort（オトギリソウ）はヨーロッパでは18年前から鬱の症状改善に愛用されている。ドイツでは1年間に300万もの処方箋が発行されている。これはプロザックの25倍の発行量である。 １９９７年度にはSt.John's Wortについての本が発行されてから米国でも人気に火がついた。米国の健康食品店では「カバ・ルート」「プレッグ」等が気分向上の補助剤として人気がある。[■St.John's Wortについて:ハーブにより気分を向上、安定させるSt.John's Wortについて（米ニューズウィーク誌5/5/97号より）]
学問的に臨床研究での検証もされ、効果も確認されている。(●St. John's wortは軽い抗うつ薬として有効[Medical Tribune 2000年4月13日 (VOL.33 NO.15) p.30] ●St. John's Wort Study Launched[NIH: Oct-1997])
最近では、相互作用の警告が出された。(●セント・ジョーンズ・ワート（セイヨウオトギリソウ）と医薬品の相互作用について[厚生省報道発表資料 平成１２年５月１０日])
【解説資料】
●FAQ - St. John's Wort
●Medscape drug researchで "St. John's wort"を検索すると医薬品集データが登録されている。
●St. John's Wort and the American Herbal Pharmocopoeia[July 1, 2000]
●NIH Factsheet: St. John's Wort[NIH - National Center for Complementary and Alternative Medicine (NCCAM)]は、FDAによりdietary supplementsとして承認された法制上経緯、臨床効果と副作用の概要、臨床試験結果、更に最近の医薬品相互作用についてもレビューした公式ファクトシート。 ドイツで最も使用され、1994年6600万日量が精神的愁訴に処方、Prozacの約20倍以上。 米国でも St. John's wortの使用が増加し現在数種類のブランドで販売され、1997年には植物製剤中の売上トップ、1998年には年間売上４億ドルと推定。
【ニュース・トピックス】
●Important Safety Information 2000: St John's Wort (hypericum perforatum)
●FDA Public Health Advisory - St. John's Wort
Summary: [Note: Parade Magazine, May 29, 2000, incorrectly stated that there is a complete list of 50 drugs that interact with St. John's Wort located at this address. In this study, concomitant administration of St. Johnｴs wort and indinavir substantially
●セント・ジョーンズ・ワート（セイヨウオトギリソウ）と医薬品の相互作用について[厚生省報道発表資料 平成１２年５月１０日]
１．セント・ジョーンズ・ワート（St John's Wort，和名：セイヨウオトギリソウ）を含有する製品を摂取することにより、薬物代謝酵素が誘導され、インジナビル（抗ＨＩＶ薬）、ジゴキシン（強心薬）、シクロスポリン（免疫抑制薬）、テオフィリン（気管支拡張薬）、ワルファリン（血液凝固防止薬）、経口避妊薬の効果が減少することが別記１のとおり報告されている。
２．我が国においても、最近、いわゆる健康食品としてセント・ジョーンズ・ワート含有食品（以下「ＳＪＷ含有食品」とする。）が流通しており、このような相互作用による健康被害の発生は現在まで報告されていないが、ＳＪＷ含有食品との併用により効果が減少するおそれの高い別記２の医薬品については、添付文書を改訂して、本剤投与時はＳＪＷ含有食品を摂取しないよう注意する旨を記載し、医師・薬剤師等の医療関係者に情報提供するよう当該医薬品の製造業者等に対して指示した。
●健康食品のBizest,Inc.
【リソース・オンライン雑誌】
●St. John's Wort [http://dir.yahoo.com/Health/Alternative_Medicine/Herbs/St__John_s_Wort/]
●St. John's Wort［http://uk.dir.yahoo.com/health/Alternative_Medicine/Herbs/St__John_s_Wort/]
●St. John's Wort and the Treatment of Depression［U.S. Pharmacist 1997.8月号］
●GO Network:St. John's Wort
●解説 ■St.John's Wortについて
ハーブにより気分を向上、安定させるSt.John's Wortについて
（米ニューズウィーク誌5/5/97号より）
カリン・テーラーの暗いムードは不眠症、無気力感からきていた。去年の夏は最悪で、生も死もどうでもよかった。彼女の主治医は向精神薬をすすめたが、薬は避けたかった。幸運なことに彼女の場合、友人の紹介によりハーブの1種St.John's Wortと巡り会った。服用後3週間程でテイラーは鬱（うつ）から立ち直った。トロントでアカウンタントして働く彼女は今も1日2カプセルの服用を続けている。「私は立ち直った」
黄色い花のSt.John's Wortはラテン語でHypericum perforatumといい、2000年にわたり愛用されてきた。起源はギリシャ時代に体内の悪魔払いとして使用されてから、と言われている。
ヨーロッパでは15年前から鬱の症状改善に愛用されている。ドイツでは1年間に300万もの処方箋が発行されている。これはプロザックの25倍の発行量であるSt.John's Wortについての本が発行されてから米国でも人気に火がついた。米国の健康食品店では「カバ・ルート」「プレッグ」等が気分向上の補助剤として人気がある。が「St.John's Wortが1番効果的」とハーブ研究所のマカレブは言う。
効果の実証は？
1994に権威ある老人精神学・脳神経学ジャーナルでは17の論文すべてがSt.John's Wortの論文だった。ある実験では3,250人中80％の軽～中程度の鬱患者に効果が認められた（服用4週間）。昨年の8月発行のBritishMedicalジャーナルでは合計1,757人の軽～中程度の鬱患者を対象に23種類の実験をした。米国とドイツの実験ではSt.John's Wortの効果はプレスボ（偽薬）より3倍効果的だった。テキサス大学のマーロウ博士はいう。「ハーブは確かに効果的だ」。
効果は実証されているが、まだメカニズムの大半が解明されていない。長期の使用後の副作用についてもわかっていないし、重度の鬱患者に有効かもわかっていない。
適量として0.3％のHypericum抽出成分を含む300mgのカプセルを1日3回が奨められている。効果が現れるまで数週間かかる。
多くの医師はハーブより薬（プロザック等）の処方を好むがエール大学の医師ブルームフィールド博士（Hypericum&Deperessionの著者）のようにSt.John's Wortを好む医師もいる。昨秋に彼の本が発売されてからは多くの医師から問い合わせを受けている。半年前には数十人だったSt.John's Wortを鬱治療に使用する医師の数は数百人に増えている。
グラミー賞にノミネートもされたジャズ歌手ジャネット・ローソンは長年鬱に悩まされていたが、処方薬は服用したくなかった。St.John's Wortとカバ・ルート等をミックスしたハーブを健康食品店で購入し症状もすっかり改善された。カリフォルニア州在住の48才エリザベス・ダンテもSt.John's Wortを愛用してから鬱症状が改善された
St.John's Wortはビタミンのように服用してよいのか？数百万人のドイツ人が服用しているが「死亡」は報告されていない。3,250人の鬱患者を対象にした実験では2.4％のみが軽いアレルギー、不快感等の軽い副作用を報告した。パーヂュ大学のハーブ研究家バロ・タイラーによれば「プロザックは不眠症、体重減少等の重い副作用があるが、St.John's Wortにはそれがない」
一番の心配点はハーブが「日光アレルギー」を引き起こす可能性があることだ。
St.John's Wortを大量服用した羊は太陽を浴びた後病気になり、死んだ。
人間の場合そのような報告例はまだない。しかしブルームフィールドはその危険も忘れぬよう警告する。日光に敏感な者、それを引き起こす可能性のある薬を服用中の者は特に気をつけるべきである。米NIHのような機関ではこれから研究が始まろうとしている。
●St. John's wortは軽い抗うつ薬として有効
[Medical Tribune 2000年4月13日 (VOL.33 NO.15) p.30]
〔ニューヨーク〕 St. John's wort（オトギリソウ科の草本）からつくられたヒペリカム抽出物は，処方薬であるイミプラミンと同じように中等度のうつ病の治療に有効であることがわかった，とドイツ・ランツフート地区病院精神科のMichael Philipp博士らはBritish Medical Journal（319：1534-1539，1999）に報告している。この研究では，中等度のうつ病患者263例を対象に，ヒペリカム抽出物の効果と安全性を，使用頻度が高い三環系抗うつ薬であるイミプラミンおよびプラセボと比較した。投与期間は 8 週間である。
その結果，ヒペリカム抽出物は．プラセボよりもうつ改善効果が優れ，イミプラミンと同程度の効果を示した。国際的に認知された質問票を用いて評価したところ，精神的，身体的QOL指標はヒペリカム抽出物の服用によって改善した。副作用はヒペリカム抽出物投与群，イミプラミン投与群とも重篤なものはなく，前者でより少なかった。
Philipp博士は「全般的に見て，最も頻度の高かった副作用は口渇であった（イミプラミン投与群38％）。ヒペリカム抽出物投与群で最も頻度が高かった副作用は嘔気（ 8 ％）であった。また，ヒペリカム抽出物の副作用が，QOLの重要項目を損なうことはなかった」と述べている。
米国立精神保健研究所（メリーランド州ベセズダ）の精神科医，Ben Vitiello博士によると，イミプラミンの副作用としてはほかに便秘，眠気，体重増加がある。また，ドイツなどではイミプラミンがうつ病の治療に最もよく使われるが，米国ではfluoxetine（Prozac，Lilly社），sertraline（Zoloft，Pfizer社），paroxetine（Paxil，SmithKleine Beecham社）などの新しい薬剤がよく使われているという。
ドイツの研究者は，多くのうつ病患者は，最初のうつ状態が続いた後は不十分な治療しか受けないかまたは無治療となるので，ヒペリカム抽出物は軽度～中等度のうつ病には第 1 選択の代替薬物になる可能性があるとしている。
「ヒペリカムの耐容性は三環系抗うつ薬よりも優れるので，患者の服薬コンプライアンスを改善し，長期治療に適した薬剤になるだろう」とドイツの研究者らは結論で述べている。「St. John's wortのような薬草療法はいくつかの理由から次第に広く用いられるようになってきた」と言うのは，非営利の薬草療法に関する研究教育機関である米国植物性医薬品審議会（テキサス州オースチン）の創立者で会長のMark Blumenthal氏。薬剤使用者は，薬草療法は処方薬よりも安全で安価であると感じている。しかも薬草療法は，消費者が予防的な意味で自らの健康に対して自ら学習し積極的に責任を取ることを可能にし，より強化する。しかし，「われわれは決して患者が医師に相談なく自己治療するのを推奨しているわけではない」と同氏は述べている。
Vitiello博士は薬草療法の危険性について使用者に次のように注意している。「瓶の中身について品質の保証はない。この臨床試験はSt. John's wortのある特定のタイプの抽出物について検討したものであり，この成績が他のSt. John's wort抽出物にも当てはまるとは限らない」
同博士は，研究は「よく計画され興味深い」が，「軽度～中等度のうつ病の治療に用いられる処方薬に比較して，St. John's wortの効力をもっと知る必要があるという現在の立場を基本的に変えるものではない」と述べている。
●データ FAQ - St. John's Wort
Medscape drug research
で "St. John's wort"を検索すると医薬品集データが登録されている。●NIH Factsheet: St. John's Wort
National Institutes of Health
National Center for Complementary and Alternative Medicine (NCCAM)
NCCAM Clearinghouse
FDAによりdietary supplementsとして承認された法制上経緯、臨床効果と副作用の概要、臨床試験結果、更に最近の医薬品相互作用についてもレビューした公式ファクトシート
[Other Versions] Adobe Acrobat , Text
★Introduction
St. John's wort (Hypericum perforatum) is a long-living, wild-growing herb with yellow flowers that has been used for centuries to treat mental disorders as well as nerve pain. In ancient times, doctors and herbalists (herb specialists) wrote about its use as a sedative and antimalarial agent as well as a balm for wounds, burns, and insect bites. Today, the herb is a popular treatment for mild to moderate depression; it also is used to treat anxiety, seasonal affective disorder, and sleep disorders.1
ドイツで最も使用され、1994年6600万日量が精神的愁訴に処方、Prozacの約20倍以上。 米国でも St. John's wortの使用が増加し現在数種類のブランドで販売され、1997年には植物製剤中の売上トップ、1998年には年間売上４億ドルと推定。
St. John's wort is most widely used in Germany, where doctors prescribed almost 66 million daily doses in 1994 for psychological complaints.2 In fact, German doctors prescribe St. John's wort about 20 times more often than Prozac, one of the most widely prescribed antidepressants in the United States.3
The use of St. John's wort is growing in the United States, and several brands now are available. Extracts of the plant are sold as a nutritional supplement after being prepared with a powder or an oil; the herb is available in capsule, tea, or tincture forms. St. John's wort was among the top-selling botanical products in the United States in 1997, with industry-estimated sales of $400 million in 1998.4
★FDA's Role
St. John's wort is 1 of 200 plant products approved by the U.S. Food and Drug Administration (FDA) for sale to the public as a dietary supplement. The FDA does not subject dietary supplements to an extensive premarket approval process, however, as it does new drugs.5 On the other hand, the Dietary Supplement Health and Education Act of 1994 permits the FDA to remove a supplement from the market if it determines the supplement is unsafe. Herbal products such as St. John's wort can be marketed without stating standards for dosage or evidence of safety. Often, information on specific products may be misleading or even inaccurate. For instance, when the Los Angeles Times, a newspaper in California, commissioned laboratory tests on 10 St. John's wort products, researchers found that the potency of the products varied dramatically from what their labels claimed.6
At the same time, a St. John's wort product stating the words "standardized extract" in its label may be more likely to contain the exact amount of the specific active ingredient needed to be effective. Standardized products generally are considered the highest-quality herbal products that a consumer can buy.7
★Treating Depression
Depression is a common illness that strikes perhaps 1 in 15 Americans each year. A person's mood, thoughts, physical health, and behavior all may be affected. Symptoms can include a persistent sad, anxious, or "empty" feeling; loss of energy, appetite, or sexual drive; and lack of interest in socializing, work, or hobbies.
Depression can be mild, moderate, or severe. Mild depression is characterized by difficulty in functioning normally, while moderate depression may involve impaired functioning at work or in social activities. Severe depression, which may involve delusions or hallucinations, markedly interferes with a person's ability to work or otherwise function and may lead to suicide. Genetic factors may put a person at risk for developing depression, and alcohol or drug use can make the problem worse.8 While the public misperception persists that depression is voluntary or a "character flaw," depression is a real condition that can be treated effectively by qualified professionals.9
Specific psychotherapies (such as interpersonal and cognitive-behavioral therapy) and antidepressant medications both have been found to be effective for patients with major depression. Major depression includes mild, moderate, or severe depression that is not characterized by manic-depressive mood swings or induced by a substance such as alcohol. Several antidepressant drugs have become more widely used in the past several years and been found to be effective. However, patients sometimes report unpleasant side effects such as a dry mouth, nausea, headache, diarrhea, or impaired sexual function or sleep.10
In part because of these types of drug side effects, many patients with depression are turning to herbal treatments such as St. John's wort. Researchers are studying it for possibly having fewer and less severe side effects than antidepressant drugs. St. John's wort also costs far less than antidepressant medication. In addition, St. John's wort does not require a prescription.11
St. John's wort is not completely free of side effects, however. Some users have complained of a dry mouth, dizziness, gastrointestinal symptoms, increased sensitivity to sunlight, and fatigue.12 In addition, herbal treatments often are not as potent or as quick to act as conventional treatments. Furthermore, herbal treatments may not produce the desired results and may not be as effective as conventional medicine. Still, some people turn to herbs because they prefer to use "natural" products.
Clinical depression is a serious medical disorder that, in many cases, can be treated. However, St. John's wort is not a proven therapy for clinical depression. Therefore, there is some risk in taking it to treat clinical depression.5
In any case, St. John's wort should not be mixed with other standard antidepressants because side effects may result. This is one reason why it is important to tell your doctor about all medications you are taking. Check with your doctor before taking St. John's wort or any other herb or medication. Your doctor can help you weigh the risks and benefits of a particular treatment so you can make informed health care decisions.
★How St. John's Wort Works
The major components in extracts of St. John's wort include flavonoids, kaempferol, luteolin, biapigenin, hyperforin, polycyclic phenols, hypericin, and pseudohypericin. Researchers believe the last three substances are the active ingredients.5 New research suggests that hyperforin also may play a large role in the herb's antidepressant effects. Some German manufacturers of St. John's wort have begun standardizing, not only to hypericin as most U.S. manufacturers do, but to hyperforin as well.13 Standardizing means that the manufacturer ensures that each individual supplement contains a uniform amount of a certain compound, in this case hypericin and hyperforin.
Recent research suggests a possible application of St. John's wort for alcoholism. Researchers from the University of North Carolina at Chapel Hill found that St. John's wort reduced alcohol intake in laboratory animals.14
Several mechanisms of action of St. John's wort have been proposed, including the following:
Inhibition of monoamine (serotonin, dopamine, and norepinephrine) re-uptake: St. John's wort appears to reduce the rate at which brain cells reabsorb serotonin (an important neurotransmitter or chemical that aids communication between nerve cells). Low levels of serotonin in the body are associated with depression.15,16
Modulation of interleukin-6 (IL-6) activity: Raised levels of IL-6, a protein involved in the communication between cells in the body's immune (disease-fighting) system, may lead to increases in adrenal regulatory hormones, a hallmark of depression. St. John's wort may reduce levels of IL-6, and thus help treat depression.17
More research is needed to determine precisely the active ingredients in St. John's wort and to learn how the herb works.
★Clinical Trials
Clinical trials (studies of a treatment's safety and effectiveness in humans) have found a similar rate of response with St. John's wort as with standard, conventional antidepressants in treating mild to moderate depression.18,19 However, it is hard to interpret these studies as definite proof of the efficacy of St. John's wort because low doses of standard antidepressants were used and there was no placebo (a pharmacologically inactive substance) control. An analysis of 23 European clinical studies of St. John's wort that was published in the British Medical Journal in 1996 concluded that the herb has antidepressive effects in cases of mild to moderate depression (the dosage varied considerably among the studies).2 However, no studies of its long-term use have been conducted. More research is needed to explore the long-term effects and optimum safe dosage of the extract.
★A new study funded by the National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM), Office of Dietary Supplements, and the National Institute of Mental Health will provide more information about St. John's wort. This study, which is in progress, is the first large-scale controlled clinical trial in the United States to assess whether the herb has a significant therapeutic effect in patients with clinical depression.
The $4.3 million study will involve 336 patients with major depression. The Duke University Medical Center in Durham, North Carolina, is coordinating the 3-year study, which has 13 clinical sites around the country.
There are three different treatment groups in the trial. One group will receive an initial dose of 900 mg per day of St. John's wort; a second will receive a placebo; and the third will receive Zoloft (a commonly used antidepressant). Patients who respond positively to their randomly assigned treatment will be continued on it for another 4 months.
★For More Information
For more information about depression, contact the National Institute of Mental Health toll-free at 1-800-421-4211. For more information about St. John's wort, contact the American Botanical Council at 512-926-4900 or the Herb Research Foundation at 303-449-2265. For more information about complementary and alternative medicine, contact the NCCAM Clearinghouse at 1-888-644-6226.
★References
American Herbal Pharmacopoeia and Therapeutic Compendium. "St. John's Wort (Hypericum perforatum) Monograph." Herbalgram. The Journal of the American Botanical Council and the Herb Research Foundation. 1997. (40):1-16.
[略]
★Drug Interaction Advisory
NIH Clinical Center research shows that St. John’s wort may reduce the effectiveness of several drugs by speeding up activity in a key pathway responsible for their breakdown. The end result is that blood levels of these drugs decrease because the body breaks them down faster. St. John’s wort especially affects Crixivan (indinavir) and other protease inhibitors used to treat HIV infection. It also may affect cyclosporine, a drug used to help prevent organ transplant rejection, and other immunosuppressant drugs; and other medications that work through the same pathway, including birth control pills, cholesterol-lowering medications such as Mevacor (lovastatin), cancer medications, seizure drugs, and blood thinners such as Coumadin (warfarin). Doctors and patients should be aware of these negative drug interactions that could interfere with the proper functioning of these drugs. For more information, visit NCCAM’s Web site http://nccam.nih.gov; or the Food and Drug Administration (FDA) Center for Drug Evaluation and Research’s Web site http://www.fda.gov/cder/drug/advisory/stjwort.htm; or call the FDA Center for Food Safety and Applied Nutrition at 201-800-332-4010.
This publication is not copyrighted and is in the public domain.
Duplication is encouraged.
Please send requests for information about complementary or alternative medicine to:
NCCAM Clearinghouse
P.O. Box 8218
Silver Spring, MD 20907-8218
1-888-644-6226 (1-888-NIH-NCAM) (Toll-Free, TTY/TDY, Fax-On-Demand)
1-301-495-4957 (Fax)
nccamc@altmedinfo.org (E-Mail)
http://nccam.nih.gov (NCCAM Web Site)
Inclusion of a treatment or resource in this fact sheet does not imply endorsement by the National Center for Complementary and Alternative Medicine, National Institutes of Health, or U.S. Public Health Service.
●臨床ガイドラインなど ●St. John's Wort and the American Herbal Pharmocopoeia
July 1, 2000
★The Herb of St. John
It has been known as goatweed, klamath weed and tipton weed. It has a rich folkloric tradition and a history of use that began with the ancient Greeks and has continued to the present. It grows and is used throughout Europe, North America and elsewhere. It has been celebrated for its magical qualities and blasted as a "noxious weed." The herb is St. John's wort (Hypericum perforatum).
St. John's wort ("wort" is an Anglo-Saxon word meaning herb) is named after John the Baptist. The red oil glands that dot the herb's leaves were once believed to be drops of blood, a reminder of the day the saint was beheaded. Some traditionalists believe that the best day to harvest St. John's herb is on June 24, the Feast of St. John. Interestingly, that harvest date often does yield optimal potency in the herb.
★A Hardy Immigrant
This shrubby perennial is found in dry soils, fields and sunny places. Though it was originally introduced to America from Europe, St. John's wort now thrives throughout much of eastern and pacific coastal North America. It's related to Rose of Sharon (Hypericum calycinum), a cultivated ornamental plant. St. John's wort has a pale brown stem and oblong leaves that grow in pairs. The leaves contain many translucent oil glands that look like holes (hence the species name perforatum, which describes the apparent perforations). The bright red color in these glands is produced by the pigment hypericin. The plant produces clusters of yellow flowers from June to September. Each of these flowers has five petals with black dots at the edges. These petals produce the same dark red pigment, hyper-icin, if you crush thembetween your fingers. The herb has a strong acrid flavor and an aroma reminiscent of turpentine.
Because it's relatively common and has been known to cause photo- sensitivity in grazing animals (this photosensitivity may in turn produce skin problems in animals who are exposed to extensive direct sunlight), St. John's wort is regarded among some ranchers and others as a nuisance and a noxious weed. Others cherish the colorful perennial, whose green leaves and bright yellow flowers make for a stunning splash of summer color. Those who cultivate the herb typically germinate and plant the seeds in early May or late April.
It is the bright red pigment, hypericin, that is regarded as the key constituent in St. John's wort, though there are dozens of other active constituents. Hypericin may be found throughout the plant, but is typically found in greatest concentration in the yellow flowers. Hypericin concentration is typically highest when the flower buds are full but not quite open. At Frontier Natural Products Co-op, we bring the plant in whole, then cut and sift it, using the potent flowering tops with a significant proportion of buds. We test the herb for the levels of hypericin, using HPLC (High Performance Liquid Chromatography). You can evaluate the quality of your St. John's wort without HPLC equipment by immersing the herb in olive oil (yielding a simple flower oil appropriate as a supportive skin dressing). As a rule of thumb, the redder the oil becomes, the more potent the herb.
★A Magical Wort
St. John's wort has long been associated with magic, and it was regarded as having power over evil spirits. The genus name Hypericum is derived from two Greek words - hyper and eikon, meaning "over" and "apparition." Early Christians and pre-Christians saw power in the bright, sun yellow flowers and stamens - the power, as they saw it, to ward off encroaching darkness and evil apparitions. Herbalist, author and educator Rosemary Gladstar notes that in pre-Christian religious practices in England, St. John's wort was used in many of the ceremonies and rituals. Bringing the flowers into the house on mid-summers eve would protect against the evil eye; and sleeping with a sprig of the plant under one's pillow on St. John's Eve would ensure a vision of the saint and his blessing.
★A Tradition of Healing
St. John's wort has been used as a health enhancer since the time of the ancient Greeks. It was favored by both Galen and Paracelsus, two of the great Greek healers and scientists, for purposes still employed today. Externally, the oil of St. John's wort may be used as a reinforcing balm for the skin. Internally, St. John's wort is a specific for the nervous system, and it is used to support nerve tissues throughout the body. The herb induces hypotension in blood vessels, thereby increasing blood flow. It is often used by those who are experiencing high degrees of stress or mental burnout. It is also used as a general support to the nervous system. It is not generally appropriate for those who suffer from severe depression.
Caution: St. John's wort has been known to induce photosensitivity in grazing animals, particularly cattle, sheep, horses and goats. While its potential to induce similar photosensitivity in humans is not well documented, it is generally advisable, when using the herb internally, to keep the doses small. Furthermore, people who are consuming St. John's wort should avoid extended exposure to direct sunlight, since they may be more susceptible to sunburn, rashes and other skin conditions.
★Conclusion
As a magical charm, a nurturing skin balm and a nervous system support, St. John's wort is the herb par excellence. The next step for us at Frontier in our relationship with this herb is to develop a good organic source that we can bring in direct from the grower and that meets our stringent quality targets.
Copyright c 1996-2000 by Frontier Natural Products Co-op All rights reserved.
●総説記事・文献 ●St. John's Wort Study Launched[NIH: Oct-1997]
NATIONAL INSTITUTES OF HEALTH
National Institute of Mental Health
Office of Alternative Medicine
--------------------------------------------------------------------------------
FOR IMMEDIATE RELEASE
Wednesday, October 1, 1997
Elaine Baldwin, NIMH (301) 443-4536
Anita Greene, OAM (301) 496-7790
Bethesda, MD--The National Institutes of Health (NIH) is launching the first U.S. clinical trial of St. John's wort, an herb widely used in Europe to treat depression.
The three-year study, sponsored by NIH's Office of Alternative Medicine (OAM), the National Institute of Mental Health (NIMH) and the Office of Dietary Supplements (ODS), will include 336 patients with major depression who will be randomly assigned to one of three treatment arms for an eight-week trial. One-third of the patients will receive a uniform dose of St. John's wort, another third will be given placebo, and the final third will take a selective serotonin reuptake inhibitor (SSRI), a type of antidepressant commonly prescribed for depression.
"This study will give us definitive answers about whether St. John's wort works for clinical depression," said NIMH Director Steven E. Hyman, M.D. "The study will be the first rigorous clinical trial of the herb that will be large enough and long enough to fully assess whether it produces a therapeutic effect."
"The compilation of research done thus far, although encouraging, still leaves some unanswered questions about exactly how the herb works," said Wayne B. Jonas, M.D., director of OAM, which is funding the study. "The interest and collaboration among these three NIH components in this clinical trial will provide the scientific expertise and clinical guidance to rigorously investigate this herb's benefit or risk in the treatment of depression."
In Germany, where physicians routinely prescribe herbs for a variety of medical illnesses, millions of doses of St. John's wort, known also by its botanical name, Hypericum perforatum, are used daily. However, no studies of long-term use have been conducted and published studies have used several different doses. This study will use a standardized preparation containing a 900 mg daily dose of the herb. In addition, study participants who respond positively will be followed for another 18 weeks. The goal of the followup is to determine if patients given St. John's wort have fewer relapses than patients given placebo.
Depression, a brain disorder that affects more than 17 million adult Americans each year, costs the nation up to $44 billion in treatment, disability, and lost productivity-a figure comparable to the cost of heart disease. Worldwide, depression is also a leading cause of disability. The illness, often chronic or recurrent, affects mood, thoughts, body and behavior. Common symptoms include sadness, loss of interests, decreased energy, disturbed sleep and hopelessness. When severe, depression can lead to suicide.
"Depression is a serious and sometimes fatal medical illness and we must be sure that the treatments people receive have been proven to be effective," said Dr. Hyman.
An overview of 23 clinical studies in Europe, published August 3, 1996, in the British Medical Journal, found that the herb may be useful in cases of mild to moderate depression. The NIH study will examine patients with the moderate form of the disorder.
NIH officials said the clinical trial will be coordinated by Jonathan Davidson, M.D., at Duke University Medical Center, which has received a three-year contract to conduct the $4.3 million study. Patient enrollment is expected to start next spring.
■St. John's Wort Study Launched●うつ病に使われるSt. John's Wort（オトギリソウ）の初の臨床研究が発表
●この記事は既に削除
The NIH is launching the first US clinical trial of St. John's wort, an herb widely used in Europe to treat depression.
The 3-year study, sponsored by NIH's Office of Alternative Medicine (OAM), the National Institute of Mental Health, and the Office of Dietary Supplements, will include 336 patients with major depression who will be randomly assigned to 1 of 3 treatment arms for an 8-week trial. One third of the patients will receive a uniform dose of St. John's wort, another third will be given placebo, and the final third will take a selective serotonin reuptake inhibitor, a type of antidepressant commonly prescribed for depression.
"The compilation of research done thus far, although encouraging, still leaves some unanswered questions about exactly how the herb works," said Wayne B. Jonas, MD, Director of OAM, which is funding the study.
In Germany, where physicians routinely prescribe herbs for a variety of medical illnesses, millions of doses of St. John's wort (botanical name, Hypericum perforatum) are used daily. However, no studies of long-term use have been conducted, and published studies have used several different dosages. This study will use a standardized preparation containing a 900-mg daily dose of the herb. In addition, study participants who respond positively will be followed for another 18 weeks. The goal of the follow-up is to determine if patients given St. John's wort have fewer relapses than patients given placebo.
An overview of 23 clinical studies in Europe, published August 3, 1996, in the British Medical Journal, found that the herb may be useful in cases of mild-to-moderate depression. The NIH study will examine patients with the moderate form of the disorder.
The clinical trial will be coordinated by Jonathan Davidson, MD, at Duke University Medical Center, which has received a 3-year contract to conduct the $4.3 million study. Patient enrollment is expected to start next spring.
Scientists Study How Light Activates St. John's Wort Chemical
St. John's Wortの科学的検証 AMES, IA -- December 4, 1997 -- A team of scientists has made progress in determining how hypericin, a chemical found naturally in the herbal remedy plant St. John's wort, becomes super-toxic to viruses and cancer cells when exposed to light. The results were published in yesterday's Journal of the American Chemical Society by chemists from Iowa State University and the United States Department of Energy's Brookhaven National Laboratory in Upton, N.Y. The research shows that when light strikes the hypericin molecule, it triggers a chemical reaction called a double proton transfer. This discovery raises the possibility that hypericin -- and similar light-activated molecules -- could be used in therapies to treat AIDS, hepatitis, brain tumors and other diseases. Hypericin's disease-fighting properties are not yet clinically proven, but are now being evaluated in clinical trials. Work at Iowa State includes development of the molecular flashlight, a method of turning on the disease fighting characteristics of certain compounds once they are deep inside the body. We are studying the excited state of the hypericin molecule and working out its mechanics, said Iowa State graduate student Doug English. The Iowa State team was led by Jacob Petrich, associate professor of chemistry, and included English, ISU postdoctoral fellow Kaustav Das, and scientists Kyle Ashby and Jaehun Park. They were joined by Edward Castner, a chemist at Brookhaven. The Iowa State team has long been investigating how hypericin and related chemicals kill viruses when exposed to light, Castner said. Through our collaboration with them, we now have verified their hypothesis about the mechanism for that effect. Knowing this may be an important step toward harnessing hypericin's power for more effective disease treatment. The study of hypericin traces its roots back to the mystery of cows that became sick after grazing on the yellow-flowered plant on sunny days, but recovered when moved to a dark barn. The animals were suffering from hypericism, or extreme sensitivity to light, caused by the hypericin in the St. John's wort. In 1991, Iowa State scientists demonstrated that hypericin must be exposed to light in order to kill viruses. The ISU experiments showed that hypericin was effective in killing many kinds of lentiviruses, especially the equine infectious anemia virus (EIAV), a retrovirus genetically related to the human AIDS virus, HIV. These Iowa State studies -- which included Petrich, ISU chemistry department chair George Kraus and Susan Carpenter, an ISU professor of microbiology, immunology and preventive medicine -- led to early interest in hypericin as an anti-AIDS drug. Even as more clinical trials began, Iowa State chemists tried to find out how hypericin works. Early results showed that light exposure caused hypericin to transfer energy to nearby oxygen molecules, producing a damaging product called singlet oxygen that is highly toxic to viruses and bacteria. But later experiments showed that hypericin was still toxic even when no nearby oxygen was available. Continued work suggested that another light-driven chemical process, called a proton transfer reaction, might be responsible for the toxic effect. In hypericin, proton transfer reactions occur when a proton, or positively charged hydrogen atom, moves a short distance of less than two angstroms (eight billionths of an inch) between neighboring oxygen atoms on a molecule. Using very short bursts of laser light, the Iowa State group led by Petrich developed a theory in which light causes hypericin to undergo two of the proton transfer reactions at the same time, one on either side of a molecule. To arrive at that hypothesis, Petrich and the Iowa State team had to capture the fleeting light emission given off by hypericin after it absorbed a light pulse lasting less than 100 femtoseconds (quadrillionths of a second). They were able to observe the signal caused by the proton-transfer reaction as it occurred -- lasting only seven picoseconds (trillionths of a second). Sometimes the proton completely leaves the molecule and is absorbed in the water surrounding the hypericin, English said. This proton ejection, which causes the surrounding area to become more acidic, may be important to hypericin's toxicity to viruses. A control experiment showed that the process didn't occur in a chemically modified form of hypericin in which all the protons that would have transferred had been replaced by methyl groups. The Brookhaven experiment that confirmed the theory is called fluorescence upconversion spectroscopy. It uses a laser to produce the light pulses and turn on the chemical reaction. The apparatus allows the scientists to watch this proton transfer evolve by carefully recording the intensity and color of the light emitted from the hypericin over time after the light burst. The apparatus is now being duplicated at Iowa State. Related work at Iowa State is focusing on the molecular flashlight, a technique to combat diseases such as AIDS. The molecular flashlight is a method in which molecules are turned on deep inside the body where they combat disease. This work is headed by George Kraus and Susan Carpenter. The new hypericin research is one more step along the pathway to developing this promising technique, Kraus said. There still are several things that have to be worked out as we move forward. Other tests on hypericin include work by a Delaware-based biotechnology firm VIMRX which is testing a synthetic form of hypericin in clinical trials for use against HIV, hepatitis C and glioblastoma, a highly malignant brain tumor. In October, the University of Pennsylvania began a VIMRX-sponsored trial of topically-applied hypericin for skin diseases including psoriasis, cutaneous T-cell lymphoma and warts.
●セント・ジョーンズ・ワート（セイヨウオトギリソウ）と医薬品の相互作用について
厚生省報道発表資料 平成１２年５月１０日
１．セント・ジョーンズ・ワート（St John's Wort，和名：セイヨウオトギリソウ）を含有する製品を摂取することにより、薬物代謝酵素が誘導され、インジナビル（抗ＨＩＶ薬）、ジゴキシン（強心薬）、シクロスポリン（免疫抑制薬）、テオフィリン（気管支拡張薬）、ワルファリン（血液凝固防止薬）、経口避妊薬の効果が減少することが別記１のとおり報告されている。
２．我が国においても、最近、いわゆる健康食品としてセント・ジョーンズ・ワート含有食品（以下「ＳＪＷ含有食品」とする。）が流通しており、このような相互作用による健康被害の発生は現在まで報告されていないが、ＳＪＷ含有食品との併用により効果が減少するおそれの高い別記２の医薬品については、添付文書を改訂して、本剤投与時はＳＪＷ含有食品を摂取しないよう注意する旨を記載し、医師・薬剤師等の医療関係者に情報提供するよう当該医薬品の製造業者等に対して指示した。
３．また、ＳＪＷ含有食品の表示や説明書において、セント・ジョーンズ・ワートを含む旨を明示するとともに、医薬品を服用する場合には本品の摂取を控えるなどの注意を表示するよう、各都道府県、各検疫所、関係団体を通じ、関係営業者等に周知、指導した。
４．別記２の医薬品を服用中でＳＪＷ含有食品を摂取している患者は、ＳＪＷ含有食品の急な摂取中止により好ましくない症状が現れるおそれがあるので、十分な注意を払いつつＳＪＷ含有食品の摂取を中止する必要がある。
また、別記２以外の医薬品についてもＳＪＷ含有食品の薬物代謝酵素誘導により影響を受ける可能性があることから、医薬品を服用する際にはＳＪＷ含有食品を摂取しないことが望ましい。
５．なお、以上の情報については厚生省ホームページ（http://www.mhw.go.jp)においても掲載している。
--------------------------------------------------------------------------------
（別記１）
セント・ジョーンズ・ワートと医薬品との相互作用について
セント・ジョーンズ・ワート（学名：Hypericum perforatum，和名：セイヨウオトギリソウ）は、主にヨーロッパから中央アジアにかけて分布している多年生植物である。これを含有する製品（ＳＪＷ含有製品）は米国や欧州で広く流通しているが、これらを摂取することにより薬物代謝酵素であるチトクロームP450、特にサブタイプであるCYP3A4及びCYP1A2が誘導されることが知られており、医薬品との相互作用について次のような報告がある。
（１）インジナビル（抗HIV薬）との相互作用について１）
インジナビルは主にCYP3A4で代謝を受ける薬物であり、ＳＪＷ含有製品との併用により血中濃度が低下することが、米国国立衛生研究所（ＮＩＨ）の研究によって報告されている。本報告によると、18歳以上の健常者8人にインジナビルを投与し、投与開始３日目から、ＳＪＷ含有製品（抽出物300mg含有）を１日３回摂取した結果、ＳＪＷ含有製品摂取開始２週間後のインジナビルの血中濃度が、非併用時に比べてAUC(0～8)は平均43%低下し、Cmaxは平均28％低下していた。
また、本報告においては、ＨＩＶ感染者においては血中濃度の低下により耐性が生じる危険性があることから、インジナビルの投与を受けている場合にはＳＪＷ含有製品を摂取すべきではなく、CYP3A4で代謝される他のHIVプロテアーゼ阻害薬、非核酸系逆転写酵素阻害薬投与時においてもＳＪＷ含有製品の摂取を避けることが適当であると言及されている。
（２）ジゴキシン（強心薬）との相互作用について2)
ジゴキシンは主にCYP3A4で代謝を受ける薬物であり、ＳＪＷ含有製品との併用により血中濃度が低下することが、ドイツでの研究によって報告されている。本報告によると、健常者25人をプラセボ群（12人）とＳＪＷ含有製品摂取群（13人）に分け、ジゴキシンを５日間投与してジゴキシンの血中濃度が定常状態となったところで、プラセボ又は市販のＳＪＷ含有製品（抽出物300mg含有）を１日３回摂取した結果、ＳＪＷ含有製品摂取開始10日後のジゴキシンの血中濃度が、プラセボ群に比べＳＪＷ含有製品摂取群ではAUC(0～24)は平均25%低下し、Cmaxは平均26％低下していた。
（３）シクロスポリン（免疫抑制薬）との相互作用について3)
シクロスポリンはCYP3A4で代謝を受ける薬物であり、ＳＪＷ含有製品との併用により血中濃度が低下した臨床例がスイスで２例報告されている。
一例は末期虚血性心疾患のため11ヶ月前に心移植した61歳男性で、もう一例は末期虚血性心疾患のため20ヶ月前に心移植した63歳男性の例である。いずれの症例においても、移植後、シクロスポリン、アザチオプリン等の免疫抑制剤の投与でコントロールされ、シクロスポリン濃度は安定していたが、市販のＳＪＷ含有製品（抽出物300mg含有）を１日３回摂取したところ、摂取開始３週間後にシクロスポリンの血中濃度の低下が見られ、生検の結果、急性拒絶反応が観察された。両症例とも拒絶反応を疑わせる他の要因は見あたらず、ＳＪＷ含有製品の摂取を中止したところ、シクロスポリンの血中濃度は回復した。
（４）その他の医薬品との相互作用について4)
いずれも海外における研究であるが、主にCYP3A4及びCYP1A2で代謝されるワルファリン、主にCYP3A4で代謝される経口避妊薬、主にCYP1A2で代謝されるテオフィリンについて、ＳＪＷ含有製品との併用により血中濃度の低下又は作用の減弱が見られた症例が報告されている。
（参考文献）
1) Piscitelli SC, Burstein AH, Chaitt D, Alfaro RM and Falloon J. Indinavir concentrations and St John's wort. Lancet 2000; 355: 547- 548.
2) Johne A., Brockmoller J, Bauer S, Maurer A, Matthias L and Roots I. Pharmacokinetic interaction of digoxin with an herbal extract from St John's wort (Hypericum perforatum). Clin. Pharmacol. Ther. 1999; 66 (4): 338-345.
3) Ruschitzka F, Meler PJ, Turina M, Luscher TF, Noll G. Acute heart transplant rejection due to Saint John's wort. Lancet 2000; 355: 548-549.
4)E Ernst. Second thoughts about safety of St Jphn's wort. Lancet 1999; 354: 2014- 2015.
-------------------------------------------------------------------------------- （別記２） 成分名 商品名 薬効分類 硫酸インジナビルエタノール付加物 クリキシバンカプセル（萬有製薬） 抗ＨＩＶ薬 メシル酸サキナビル インビラーゼカプセル（日本ロシュ） 抗ＨＩＶ薬 メシル酸ネルフィナビル ビラセプト錠（日本たばこ産業） 抗ＨＩＶ薬 リトナビル ノービア・カプセル100mg（ダイナボット）他 抗ＨＩＶ薬 アンプレナビル プローゼカプセル（キッセイ薬品工業） 抗ＨＩＶ薬 エファビレンツ ストックリンカプセル200（萬有製薬） 抗ＨＩＶ薬 ネビラピン ビラミューン錠200（日本ベーリンガーインゲルハイム） 抗ＨＩＶ薬 メシル酸デラビルジン レスクリプタ錠200mg（ワーナー・ランバート） 抗ＨＩＶ薬 ワルファリンカリウム ワーファリン錠1mg（エーザイ）他 血液凝固防止薬 シクロスポリン サンディミュンカプセル25mg（日本チバガイギー） サンディミュン注射液（日本チバガイギー）他 免疫抑制薬 タクロリムス水和物 プログラフカプセル0.5mg（藤沢薬品工業） プログラフ注射液5mg（藤沢薬品工業）他 免疫抑制薬 エチニルエストラジオール・ノルエチステロン エリオット21（明治製菓） シンフェーズT28（日本モンサント） ノリニールT28（科研製薬） オーソM-21（ヤンセン協和） オーソ777-28（ヤンセン協和）他 経口避妊薬 エチニルエストラジオール・レボノルゲストレル トリキュラー21（日本シエーリング） リビアン28（山之内製薬） トライディオール21（日本ワイスレダリー） アンジュ28（帝国臓器製薬）他 経口避妊薬 エチニルエストラジオール・デソゲストレル マーベロン28（日本オルガノン）他 経口避妊薬 ジゴキシン ジゴシン錠（中外製薬）他 強心薬 ジギトキシン ジギトキシン錠「シオノギ」0.1mg（塩野義製薬）他 強心薬 メチルジゴキシン ラニラピッド錠（日本ロシュ）他 強心薬 テオフィリン テオドール錠50（三菱東京製薬）他 気管支拡張薬 アミノフィリン ネオフィリン錠（サンノーバ） ネオフィリン注（エーザイ）他 気管支拡張薬 コリンテオフィリン テオコリン錠（サンノーバ）他 気管支拡張薬 フェニトイン、フェニトインナトリウム及びフェニトイン配合剤 アレビアチン細粒（大日本製薬）他 抗てんかん薬 カルバマゼピン テグレトール細粒（日本チバガイギー）他 抗てんかん薬 フェノバルビタール及びフェノバルビタールナトリウム フェノバール10倍散（藤永製薬）ルピアール坐剤50（エスエス製薬）他 抗てんかん薬 ジソピラミド及びリン酸ジソピラミド リスモダン（アベンティスファーマ）他 抗不整脈薬 リドカイン 静注用キシロカイン2%（藤沢薬品）他 抗不整脈薬 塩酸アミオダロン アンカロン錠100（大正製薬） 抗不整脈薬 硫酸キニジン 硫酸キニジン錠（日研化学）他 抗不整脈薬 塩酸プロパフェノン プロノン錠100mg（山之内製薬）他 抗不整脈薬 （照会先） 医薬安全局安全対策課 担当：近藤、大西 03-3503-1711(内)2753,2756 生活衛生局食品保健課新開発食品保健対策室 室長 大木 担当 森田 （内）2458
●Important Safety Information 2000: St John's Wort (hypericum perforatum)
Health professionals are notified of the risk of drug interactions with St. John's Wort, Indinavir and other drugs.
[February 10, 2000 (Public Health Advisory) - FDA.]
●FDA Public Health Advisory - St. John's Wort
Summary: [Note: Parade Magazine, May 29, 2000, incorrectly stated that there is a complete list of 50 drugs that interact with St. John's Wort located at this address. In this study, concomitant administration of St. Johnｴs wort and indinavir substantially
[Note: Parade Magazine, May 29, 2000, incorrectly stated that there is a complete list of 50 drugs that interact with St. John's Wort located at this address. This list does not exist because the clinical research necessary to make this claim has not been done. What might be helpful, however, is a brief article from Dr. Jane Henney, FDA Commissioner, that appears in JAMA (Journal of the American Medical Association), "Risk of Drug Interactions With St John's Wort," Apr 5, 2000, vol. 283, no.13. It essentially restates the advisory below and provides some additional drug examples. ]
FDA PUBLIC HEALTH ADVISORY
February 10, 2000
Subject: RISK OF DRUG INTERACTIONS WITH ST JOHN’S WORT AND INDINAVIR AND OTHER DRUGS
Dear Health Care Professional:
The Food and Drug Administration would like to inform you about results from a study conducted by The National Institutes of Health (NIH) that showed a significant drug interaction between St John's wort (hypericum perforatum), an herbal product sold as a dietary supplement, and indinavir, a protease inhibitor used to treat HIV infection. In this study, concomitant administration of St. John’s wort and indinavir substantially decreased indinavir plasma concentrations, potentially due to induction of the cytochrome P450 metabolic pathway. For additional information on this study please refer to the February 12, 2000 Lancet publication (Piscitelli, et al).
RECOMMENDATIONS:
Indinavir and other antiretroviral agents
At this time, pharmacokinetic data are available only for concomitant administration of indinavir with St. John’s wort. However, based on these results, it is expected that St John’s wort may significantly decrease blood concentrations of all of the currently marketed HIV protease inhibitors (PIs) and possibly other drugs (to varying degrees) that are similarly metabolized, including the nonnucleoside reverse transcriptase inhibitors (NNRTIs). Consequently, concomitant use of St John’s wort with PIs or NNRTIs is not recommended because this may result in suboptimal antiretroviral drug concentrations, leading to loss of virologic response and development of resistance or class cross-resistance.
Because herbal products are widely used in the United States and are available in various forms such as combination products and teas, it is important that health care professionals ask patients about concomitant use of products that could contain St. John’s wort (hypericum perforatum).
In addition, FDA is working closely with drug manufacturers to ensure that product labeling of antiretrovirals is revised to highlight the potential for drug interactions with St. John’s wort.
Other drugs
Based on this study and reports in the medical literature, St. John’s wort appears to be an inducer of an important metabolic pathway, cytochrome P450. As many prescription drugs used to treat conditions such as heart disease, depression, seizures, certain cancers or to prevent conditions such as transplant rejection or pregnancy (oral contraceptives) are metabolized via this pathway, health care providers should alert patients about these potential drug interactions to prevent loss of therapeutic effect of any drug metabolized via the cytochrome P450 pathway.
All health care professionals are encouraged to report any serious adverse event associated with the concomitant use of prescription drugs and St. John’s wort products to the FDA’s MedWatch program at 1-800-FDA-1088 (fax 1-800-FDA-0178).
Sincerely yours,
Murray M. Lumpkin, M.D
Deputy Center Director (Review Management)
Center for Drug Evaluation and Research Susan Alpert, Ph.D., M.D.
Director of Food Safety
Center for Food Safety and Applied Nutrition
-----------------------------------------------------------------------------
FDA/Center for Drug Evaluation and Research
Last Updated:June 09, 2000
●ニュース・トピックス ■健康食品のBizest,Inc.
最高級メラトニン・DHEA St.John's wort・ロゲイン、他、販売中 「わたしの健康」（主婦の友社発行）、「ゆほびか」（マキノ出版）等でも紹介された信用・実績ある会社です アメリカからの直販ならではの値段・サービス・品揃えをご提供しています。 多数の医師・薬剤師が認めるブランドのみをお取り扱いいたしております。 気分の向上、安定にSt.John's wortを プロザックは処方薬ですがSt.John's wortはハーブが主成分。 どなたでも購入可能です ワインの良い効果をアルコール抜きで得られるGrape Seed Extract（グレープの種） 不眠症・免疫力の増強・老化予防・若返り・癌の予防 その他60種類以上の成人病予防にメラトニンを、 元気の復活に DHEA・DHEAクリームを、 若い頃の冴え、記憶力が減退したと感じ始めたら PREGNENOLONE（プレグネノロン）を 効率の良いダイエットにシステム6を、 「飲む化粧品」といわれているPycnogenol 毎日の健康にマルチビタミン・パックを、 風邪にZINC（亜鉛） 甦る頭髪にロゲイン（ミノキシジル2％配合）をお奨めします。 その他多数の品揃え商品説明目次・プライスリスト ・商品説明・写真をご覧になりたい方は各「品名」をクリックして下さい。 メーカー 品名 プライス HORIZON社 メラトニン1mg・100錠 $25 HORIZON社 メラトニン3.0mg（ビタミンB6入り）・90錠 $30 BRECKENRIDGE-PHARM社 DHEA25mg・60錠$25 AlvinLast社 DHEAクリーム・56.7g $30 Schiff社 Pregnenolone10mg・30錠 $30ビタミン・ミネラル・ハーブ GNC社 ZINC(亜鉛)50mg・250錠 $30 GNC社 セレニウム200mcg・100錠 $30 BAYER社 One Day Maximum・（マルチビタミン）60錠 $30 TraderDarwin's社 マルチビタミン・30パック $55 GNC社 Solotron(マルチビタミン)・250錠 $110 PNC社 ピクノゼノール50mg・30カプセル $38 Niagara Sun社 Grape Seed Extract50mg・30カプセル $38 Horizon社 St.John's wort300mg/0.3％Hypericin・90錠（約30日分） $50簡単ダイエット IRWIN NATURALS社 システム6・120カプセル $60 URC社・貼るだけダイエット マジックスリムシール28枚（28日分） $60関節炎にサメの軟骨 カーティレイト社 最高級サメの軟骨740mg・180カプセル $120 SuperHealth社 ゲルマニウム30mg・200カプセル（約2カ月分） $220究極の育毛剤ロゲイン/ミノキシジル Moore社 育毛剤4本組・ミノキシジル2％配合（60mlx4） $100 UPJOHN社 ロゲイン4本組・ミノキシジル２％配合（60mlx4） $160 ＊送料は全商品無料です。 ご注文は1個から受け付けております。お気軽にお問い合わせ・ご注文下さいませ。 1週間～10日以内に確実に届けます！ クレジットカード（VISA/MASTERCARD）、又は日本国内銀行口座へ振り込みでお支払い。 問い合わせは日本語でe-mail/FAX（24時間）又はお電話で直接どうぞ（日本時間:AM9-PM7） お電話で問い合わせの場合折り返しお電話しますので電話代の心配はありません。 |ORDER| ご意見・ご質問はbizest@bizest.comまでお気軽に。 Page Created By Bizest,Inc./July,1997 Bizest,inc. P.O.Box6510, BeverlyHills,Ca,90212-6510 (Bizest,inc.Group：Amble,Inc.,& ZEST, Inc.) TEL:(001-1)310-842-9693 FAX:(001-1)310-202-6362
■From: brook006@mc.duke.edu Newsgroups: misc.kids.info,soc.sup
port.pregnancy.loss,misc.answers,soc.answers,news.answers Subject: misc.kids FAQ on Miscarriage, Part 2/3 Date: 29 Jun 1997 08:14:09 GMT Approved: news-answers-request@mit.e ... From: brook006@mc.duke.edu Newsgroups: misc.kids.info,soc.support.pregnancy.loss,misc.answers,soc.answers,news.answers Subject: misc.kids FAQ on Miscarriage, Part 2/3 Date: 28 Oct 1997 10:55:58 GMT Approved: news-answers-request@mit.edu,kids-info-request@ai.mit.edu Message-ID: misc-kids/miscarriage/part2_878035927@rtfm.mit.edu Archive-name: misc-kids/miscarriage/part2 Posting-Frequency: monthly Misc.kids Frequently Asked Questions Miscarriage Part 2 of 3 --------------------------------------------------------------------------- It has been my experience that the miscarriage process has not been adequately covered by books or by doctors, especially, the emotional distress afterwards. Besides the understandable grieving process, I think that there is also a hormonal aspect that has caused me to experience "PMS times 10" for a month after each miscarriage. I had never had a PMS problem before I had the miscarriages, so I was not prepared for the emotional rollercoaster that followed. While some of it was natural mourning, and therefore a process that is necessary, even spiritually beneficial, to undergo, some of it was simply distressing and non-productive. I am starting to research literature on reducing PMS symptoms to see if it would also reduce the post-miscarrage syndrome. While I have not found much on herbal or vitamin recommendations for post miscarriage there are several for the traditional PMS. The whole B complex - especially B-6 has been shown to be useful for alleviating symptoms. Folic acid is also recommended. Supposedly, one of the reasons for the chocolate cravings that occur with PMS is a need for magnesium, which should be taken with calcium. I don't even like chocolate that much but I found myself wolfing down candy bars after each miscarriage. Herbal treatments include:● St. John's Wort for depression, Valerian for anxiety and Dong Quai (there are numerous spellings) for disorientation. From the readings, I gather that Valerian should only be taken before bedtime, but the other two can be taken during the day. In fact, St.John's Wort not only has an immediate soothing effect, but supposedly has some enzyme-like positive effects that can only be felt after a few months of usage. Please research these before taking there are some medications that can't be taken with St. John's Wort, like asthma medicine. I took it during my pregnancy, along with Skullcap, to help sleep. There is a book that mentions these herbs called "Relief from PMS" by Pamela Patrick Novotory, published by Dell. I hope this helps. Deborah Pastor DAnnPastor@aol.com
●リンク＆リソース ●本ページ収録以外の文献 St. John's Wort [http://dir.yahoo.com/Health/Alternative_Medicine/Herbs/St__John_s_Wort/] St. John's Wort［http://uk.dir.yahoo.com/health/Alternative_Medicine/Herbs/St__John_s_Wort/] St. John's Wort and the Treatment of Depression［U.S. Pharmacist 1997.8月号］
■GO Network:St. John's Wort
Health>Drugs>Health supplements > St. John's Wort St. John's Wort Web sites 1~7 of 7 reviewed Web sites SORT BY:rating commerce All About St. John's Wort Consumer experiences and information on St. John's Wort. http://www.nutritionalsupplements.com/prozac.html Last reviewed by Stacie1228 Herbal Remedies: Saint-John's-Wort Explanation of its uses, how it works, and related information. http://www.healthyideas.com/healing/herb/rem/stjoh... St Johns Wort From Excel Nutrition commerce Product and ordering information. http://www.excelnutrition.co.uk/herbal/jonswort.ht... Last reviewed by zzaius St. John's Wort Information on usage, taxonomy, chemistry, and other areas. http://www.healthy.net/library/articles/hobbs/hype... St. John's Wort Information about side effects. http://www.quackwatch.com/01QuackeryRelatedTopics/... St. John's Wort Information about side effects and dosages. http://www.goaskalice.columbia.edu/1348.html St. John's Wort Study Launched An article about the National Institutes of Health (NIH) launching the first U.S. clinical trial of St. John's wort. http://www.thebody.com/nih/stjohnswort.html
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