The short answer
Review St John’s wort with the clinician managing your aripiprazole lauroxil injections. Induction can affect the active aripiprazole formed from the prodrug, and maintenance and initiation products have different rules.
What this answer covers
Oral Hypericum perforatum with long-acting intramuscular aripiprazole lauroxil; ARISTADA maintenance and ARISTADA INITIO distinguished.
- Supplement or preparation
- Hypericum perforatum
- Medication ingredient
- aripiprazole lauroxil
The active drug is formed after injection
Aripiprazole lauroxil is converted to aripiprazole, which is cleared through CYP3A4 and CYP2D6. Its label explicitly uses oral aripiprazole interaction evidence; the injected prodrug is not being absorbed from the gut.
Original clinical evidence used another inducer
Carbamazepine lowered exposure to oral aripiprazole and its active metabolite. St John’s wort can induce CYP3A activity, but extract studies vary; no exact lauroxil-herb effect size is available.
Duration and injection product change the plan
Maintenance ARISTADA labeling distinguishes CYP-modifier use for less than two weeks from use longer than two weeks, with dose-specific instructions. INITIO instead advises avoiding strong CYP3A4 inducers because its dose cannot be modified.
Do not manage this by shifting the supplement hour
Bring the herb’s extract, amount, start date and injection details to the clinician. A short time gap cannot be assumed to resolve a prolonged metabolism interaction; do not change injection or oral initiation doses yourself.
Evidence and practical considerations
Side effects & toxicity
Conditional concern for reduced active-drug exposure through a label-supported prodrug/metabolism bridge; not impaired intestinal absorption of the injection.
- Exact scope
- Oral Hypericum perforatum with long-acting intramuscular aripiprazole lauroxil; ARISTADA maintenance and ARISTADA INITIO distinguished. with Exact aripiprazole lauroxil long-acting intramuscular suspension. Exact RxNorm IN1673265, ester prodrug, not oral aripiprazole. ARISTADA maintenance injection and ARISTADA INITIO initiation product distinguished; oral aripiprazole clinical findings require explicit active-metabolite bridge.
- Medication form and route
- intramuscular
- Timing or duration
- Source-specific single-dose, repeated-dose and observational exposures distinguished.
What remains uncertain
- No direct lauroxil-SJW study. Extract strength, inducer classification, duration and injection regimen determine applicability.
Factors that may matter: preparation and plant part; clinical indication; dose; other medicines; baseline alertness.
Read the supporting source summaries
Source 1: current product label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: People prescribed aripiprazole lauroxil.
Prodrug hydrolyzed to active aripiprazole; long-acting injection, cognitive/motor and orthostatic precautions; duration-dependent CYP3A4 inducer instructions.
How this applies: Exact RxNorm IN1673265, ester prodrug, not oral aripiprazole. ARISTADA maintenance injection and ARISTADA INITIO initiation product distinguished; oral aripiprazole clinical findings require explicit active-metabolite bridge.
No supplement-specific event rate, universal timing rule or untested route/preparation equivalence.
Source 2: original human study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Nine male patients enrolled; six completed.
Aripiprazole and dehydroaripiprazole exposure decreased substantially with carbamazepine.
How this applies: Only the named drug, preparation, route and measured endpoints apply.
Oral active drug, not injected lauroxil, and carbamazepine rather than St John’s wort. Original oral dose advice is not an injection instruction.
Source 3: official product label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Adults initiating or reinitiating ARISTADA for schizophrenia.
Avoid strong CYP3A4 inducers because INITIO dosage cannot be modified; interaction evidence is derived from oral aripiprazole.
How this applies: Same prodrug but distinct initiation formulation and instructions.
No specific INITIO interaction study; oral active-drug and supplement bridging must be explicit.
Source 4: original human study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Twelve healthy volunteers in an open-label fixed-order crossover.
Alprazolam exposure fell about one-half and clearance increased; elimination half-life shortened.
How this applies: Preparation-specific original evidence; no untested antidepressant or route transfer.
Single extract and short exposure, healthy volunteers; no anxiety-treatment failure endpoint. Does not imply reduced gut absorption or transfer to predominantly conjugated benzodiazepines.
Source 5: original human study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Healthy participants in randomized placebo-controlled studies.
Changes in probe exposures were small and judged clinically irrelevant; hyperforin levels were below quantification.
How this applies: Preparation-specific original evidence; no untested antidepressant or route transfer.
Preparation-specific result, not permission to assume all retail products are low-hyperforin or all doses safe.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Research summary published | |
| Article prepared | |
| Current exact available claims adjudicated using original captures and explicit identity and comparator limits. |
Article revision: 3db0e404723b9296
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.