The short answer
St. John’s wort can induce the pathway that clears bedaquiline, so co-use needs to be avoided when the product acts as a moderate or strong CYP3A4 inducer. The exact effect size for this herbal combination has not been measured.
What this answer covers
Hypericum perforatum preparations with variable hyperforin content and enzyme-inducing potential.
- Supplement or preparation
- Hypericum perforatum
- Medication ingredient
- bedaquiline
The current label directs avoiding inducers
SIRTURO labeling directs avoiding strong or moderate CYP3A4 inducers because they may reduce systemic bedaquiline exposure. This concerns drug clearance and effectiveness, not proven reduced intestinal absorption.
Human herb studies support the pathway indirectly
Repeated St. John’s wort altered midazolam exposure in human studies. These establish preparation-dependent induction, but did not measure bedaquiline or tuberculosis outcomes and cannot supply this pair’s effect size.
A weak preparation result is not blanket permission
A low-hyperforin preparation had a smaller probe effect than other products. An unidentified herbal extract cannot be assumed to match it, and current bedaquiline labeling should guide the clinical decision.
Coordinate any change with the TB team
Tell the prescriber about the exact product before starting or stopping it. Do not raise the antibiotic dose to compensate or assume dose spacing prevents enzyme induction. The complete multidrug regimen needs review.
Evidence and practical considerations
Absorption & effectiveness
Conditional reduced exposure/effectiveness via CYP3A4 induction from current bedaquiline label and indirect human St John’s wort studies. Avoid moderate/strong inducing products; no exact herbal effect size, gut-absorption proof or timing workaround.
- Exact scope
- Hypericum perforatum preparations with variable hyperforin content and enzyme-inducing potential. with Bedaquiline fumarate oral SIRTURO tablets, strength expressed as bedaquiline.
- Medication form and route
- oral medication; oral supplement
What remains uncertain
- No unmeasured pair incidence, blanket class transfer or arbitrary spacing interval.
Factors that may matter: Preparation; Dose; Other medicines; Organ function.
Read the supporting source summaries
Source 1: current product label
dailymed.nlm.nih.gov · Source check Sep 11, 2026
Population: People prescribed bedaquiline
QT prolongation; assess and correct low potassium/calcium/magnesium. Avoid other hepatotoxic exposures; monitor liver function. Avoid strong/moderate CYP3A4 inducers.
How this applies: Exact bedaquiline RxCUI 1364504 IN, with stated salt/formulation/route bridge.
Exact route and formulation apply. Label precautions do not quantify untested botanical pairs or support arbitrary supplement doses.
Source 2: original human study
pubmed.ncbi.nlm.nih.gov · Source check Sep 11, 2026
Population: 12 healthy adults.
Short-term dosing had no measured CYP effect; repeated use reduced oral midazolam AUC more than IV AUC.
How this applies: Original source interpreted for bedaquiline only within the stated preparation and endpoint limits.
Not a direct bedaquiline combination trial; original preparation, dose and endpoint limits apply. No exact-pair adverse-event rate or protective spacing established.
Source 3: original human study
pubmed.ncbi.nlm.nih.gov · Source check Sep 11, 2026
Population: 20 healthy men.
Small AUC decrease considered not clinically relevant by authors; no significant Cmax or half-life change.
How this applies: Original source interpreted for bedaquiline only within the stated preparation and endpoint limits.
Not a direct bedaquiline combination trial; original preparation, dose and endpoint limits apply. No exact-pair adverse-event rate or protective spacing established.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Research summary published | |
| Editorial update | |
| Corrected missing spaces between numbers and units or words in the copy before registration; evidence and conclusions unchanged. | |
| Article prepared | |
| Prepared exact bedaquiline article with formulation-specific evidence and uncertainty. |
Article revision: 2207368bce37f5a4
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.