The short answer
Do not use St. John’s wort with the labeled elvitegravir regimen. The current product information contraindicates the combination because enzyme induction can lower antiviral exposure and compromise treatment.
What this answer covers
Oral elvitegravir 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
- elvitegravir
Check the exact medicine and regimen
This review concerns oral elvitegravir in GENVOYA, a combination with cobicistat, emtricitabine and tenofovir alafenamide. Some original experiments used ritonavir-boosted elvitegravir instead. These regimens are not interchangeable, and the whole prescribed combination must stay intact.
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 elvitegravir, 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 elvitegravir in the specified labeled antiretroviral regimen with Hypericum perforatum products. Boosters and combination partners remain part of the treatment identity. with RxNorm 1306286 IN elvitegravir. Current source is GENVOYA fixed combination elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide; not an unboosted standalone regimen. Original ritonavir-boosted experimental exposure explicitly distinguished.
- 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.
Separate named polyvalent-cation products by at least two hours. Hypericum is contraindicated because induction may lower component exposure and cause loss of response/resistance.
How this applies: RxNorm 1306286 IN elvitegravir. Current source is GENVOYA fixed combination elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide; not an unboosted standalone regimen. Original ritonavir-boosted experimental exposure explicitly distinguished.
Cannot assign all fixed-combination findings to isolated unboosted elvitegravir. Preparation, dose and booster context matter.
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 elvitegravir 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.
elvitegravir 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: ba3361e0c18d97c0
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.