The short answer
Do not use St. John’s wort with the labeled atazanavir regimen. The current product information contraindicates the combination because enzyme induction can lower antiviral exposure and compromise treatment.
What this answer covers
Oral atazanavir in the specified labeled antiretroviral regimen with Hypericum perforatum products. Boosters and combination partners remain part of the treatment identity.
- Supplement or preparation
- Hypericum perforatum
- Medication ingredient
- atazanavir
Check the exact medicine and regimen
This review concerns oral atazanavir, supplied as atazanavir sulfate in products such as REYATAZ. Capsule and powder instructions and the use of a booster must match the prescription. An unboosted study does not establish the same exposure change in every boosted combination.
Why treatment can be affected
The product information identifies St. John’s wort as an enzyme inducer that can lower exposure to the antiviral or relevant combination components. This is not simply binding in the stomach. Reduced exposure can threaten viral control and permit resistance.
Product variability does not remove the restriction
A human probe study found different degrees of enzyme induction among Hypericum preparations with different hyperforin exposure. It did not test atazanavir, and its percentages cannot predict an individual’s antiviral level. The exact regimen’s contraindication still applies.
Coordinate starting or stopping
Tell the HIV care team promptly if you use St. John’s wort, including mood or sleep blends. They can arrange an alternative and decide whether treatment monitoring is needed. Do not alter the antiretroviral dose or rely on a few hours of separation to address enzyme induction.
Evidence and practical considerations
Absorption & effectiveness
The exact regimen label contraindicates Hypericum; spacing doses does not replace avoidance of enzyme induction.
- Exact scope
- Oral atazanavir in the specified labeled antiretroviral regimen with Hypericum perforatum products. Boosters and combination partners remain part of the treatment identity. with RxNorm 343047 IN atazanavir. REYATAZ sulfate capsules/powder with base-equivalent strengths; boosted and unboosted regimens explicitly differ. Other protease inhibitors not treated as equivalent.
- Medication form and route
- Oral
What remains uncertain
- Exact labeled regimen contraindication plus indirect human probe evidence. No precise botanical effect size, same-milligram product equivalence or validated spacing.
Factors that may matter: Exact oral regimen and formulation; Booster or fixed-combination context; Mineral preparation and dosing order; Food requirements.
Read the supporting source summaries
Source 1: Current original prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Patients prescribed the specified oral regimen.
Administer atazanavir two hours before or one hour after antacids/buffered medicines. Hypericum contraindicated; gastric acidity and CYP3A susceptibility matter.
How this applies: RxNorm 343047 IN atazanavir. REYATAZ sulfate capsules/powder with base-equivalent strengths; boosted and unboosted regimens explicitly differ. Other protease inhibitors not treated as equivalent.
High-dose PPI research is not an antacid effect size. Garlic studies with other protease inhibitors and target inaccessible case remain distinguished.
Source 2: Original clinical research
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: 42 healthy men receiving six different Hypericum preparations.
Midazolam exposure decreased, with greater induction at higher hyperforin exposure.
How this applies: Exact reported regimen, preparation and endpoints only; other drugs or forms remain indirect.
Abstract-only probe evidence, not atazanavir co-use or a transferable percentage; current exact label independently contraindicates Hypericum.
Source 3: Medication terminology
rxnav.nlm.nih.gov · Source check Sep 10, 2026
Population: Terminology.
atazanavir is IN.
How this applies: Exact ingredient.
Not clinical evidence.
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 | |
| Sources checked and article drafted. |
Article revision: 2ca6d5f9a81a93c1
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.