The authors observed that St. John's wort had lowered the patients' plasma cyclosporine levels. Biopsy revealed acute heart transplant rejection, and withdrawal of St. John's wort resulted in a return to normal cyclosporine levels. No further rejection episodes occurred. Patients and health care professionals need to be aware of this interaction. All the participants showed a marked drop in blood levels of indinavir after taking St. John's wort.
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