The short answer
St John’s wort may lower canagliflozin exposure and weaken glucose control. The concern is loss of effect, rather than proven increased canagliflozin toxicity.
What this answer covers
Oral Hypericum perforatum preparations with enzyme-inducing potential; product constituent amounts vary.
- Supplement or preparation
- Hypericum perforatum
- Medication ingredient
- canagliflozin
The product information names the herb
European Invokana product information explicitly lists St John’s wort among enzyme inducers that may decrease canagliflozin exposure and efficacy.
The mechanism is not a CYP3A-only assumption
Canagliflozin is mainly cleared through UGT glucuronidation. Its labels describe inducer effects; rifampicin data support that mechanism, but the measured rifampicin effect must not be assigned to a herbal product.
Product strength and changes matter
Different St John’s wort preparations may have different inducing potential. Starting or stopping use should be reviewed with the diabetes team, without assuming a predictable percentage change in drug levels.
Monitor response without self-adjustment
Follow the clinician’s plan for glucose monitoring and treatment review. Renal function affects prescribing decisions. Do not change the canagliflozin dose yourself or assume a short spacing gap prevents enzyme induction.
Evidence and practical considerations
Side effects & toxicity
Exact European product information names Hypericum as potentially lowering exposure/efficacy; broad safety statement narrowed to impaired glucose control, not increased drug toxicity.
- Exact scope
- Oral Hypericum perforatum preparations with enzyme-inducing potential; product constituent amounts vary. with Oral canagliflozin RxCUI1373458 IN; agent-specific renal and metabolic mechanisms.
- Medication form and route
- oral medication; oral supplement
What remains uncertain
- No arbitrary interval, class-only metabolism assumption or unmeasured pair-event rate.
Factors that may matter: Preparation; Dose; Kidney function; Volume status; Other diabetes treatment.
Read the supporting source summaries
Source 1: current product label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Patients prescribed oral canagliflozin
SGLT2 inhibition increases urinary glucose. Volume contraction can cause hypotension or acute kidney injury, with risk modifiers. UGT inducers may lower drug exposure and effectiveness. Insulin/secretagogue co-use increases hypoglycemia risk.
How this applies: Exact single-ingredient canagliflozin, not all SGLT2 agents or combination products.
Warnings do not establish every botanical interaction or routine sodium supplementation. Renal function and whole regimen matter.
Source 2: current product information
ema.europa.eu · Source check Sep 10, 2026
Population: Patients prescribed canagliflozin
St John’s wort may decrease canagliflozin exposure and efficacy. Rifampicin study supports inducer mechanism. Metabolism primarily UGT1A9/UGT2B4; review glycemic response during co-use.
How this applies: Exact medication label names the herb; ingredient/preparation variability remains.
Rifampicin magnitude is not a measured St John’s wort effect. National dosing recommendations differ; no patient-specific dose change or protective gap inferred.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Prepared exact canagliflozin article separating volume effects, metabolic exposure and intrinsic supplement risks. | |
| Research summary published |
Article revision: 41e62cc570682954
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.