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Supplement Use With Hepatitis C Treatment

TC is a 46-year-old Caucasian female who presents to your pharmacy requesting a refill on telaprevir. She plans to do some shopping while waiting for the prescription. Before her name is called, TC presents to the consultation counter to speak with you about a product she plans to purchase. TC shows you the product, St. John’s wort. TC shares that her friend told her it treats symptoms of depression, and she wants to know if it is safe for her to take.

You inquire about her need for the product and TC replies, “I started hepatitis C treatment 4 weeks ago and am doing really well with the medications. I never miss a dose, and I take telaprevir with some type of fatty food!” She goes on to share that she was excited to start hepatitis C treatment; however, over the past month, she noticed a change in her mood. TC offers, “I was diagnosed with depression 2 years ago after my divorce. I am taking a medication every day for my depression, and prior to last month, I felt like myself again.” She questions the reason for this change and offers that she would like to try St. John’s wort to improve her mood.

Her current medication profile includes: telaprevir 750 mg PO TID, Pegasys 180 mcg injection subcutaneously once weekly, ribavirin 600 mg PO BID, escitalopram 10 mg PO daily, hydrochlorothiazide 12.5 mg PO daily, and cetirizine 10 mg PO daily.

How would you advise TC on the use of St. John’s wort in light of her current therapy?

Marissa C. Salvo, PharmD
Assistant Clinical Professor
University of Connecticut School of Pharmacy
Storrs, Connecticut

Click here... Send your input to casestudychallenge@uspharmacist.com by October 18, 2012, and include the words "Case Study" and the date of this email in the subject line (or simply use the Click Here button to the left). Please include your last name and first initial along with your pharmacy degrees and city and state, or let us know if you would like to remain anonymous in the event we choose your answer for the follow-up email.