The short answer
A clinically important St. John’s wort effect on prasugrel is uncertain; its induction data differ from those of some other antiplatelet drugs. Review the full regimen.
What this answer covers
Oral Hypericum perforatum preparations with oral prasugrel hydrochloride tablets. Hyperforin content, repeated exposure and the exact drug matter.
- Supplement or preparation
- Hypericum perforatum
- Medication ingredient
- prasugrel
The exact drug changes the interpretation
A rifampin study found no change in prasugrel’s active-metabolite exposure. It did observe modest differences in platelet inhibition, which the authors did not attribute to enzyme induction. This does not support automatically predicting lower prasugrel exposure from St. John’s wort.
St. John’s wort products vary
A human midazolam-probe study found that CYP3A induction differed between St. John’s wort products and tracked with hyperforin dose. This establishes a product-dependent enzyme effect, not a universal percentage change for every medicine. Bring the extract, daily dose and duration to the pharmacist.
Do not rely on a few hours of separation
There is no validated spacing interval for this pair, and the available evidence does not establish a routine prasugrel dose change. Ask for a review of the full regimen before starting or stopping the herb.
Know when to get help
Seek urgent care for bleeding that will not stop, vomiting blood or black, tarry stools. Tell your prescriber about the full supplement and medicine list. Do not stop prescribed antiplatelet treatment on your own to accommodate a supplement; ask the treating team to make a plan.
Evidence and practical considerations
Absorption & effectiveness
A clinically important St. John’s wort effect on prasugrel exposure is not established.
- Exact scope
- Oral Hypericum perforatum preparations with oral prasugrel hydrochloride tablets. Hyperforin content, repeated exposure and the exact drug matter. with Exact prasugrel RxCUI613391 IN. Current label identifies racemic hydrochloride tablets expressing5/10mg prasugrel-equivalent doses; active metabolite exposure is distinguished from parent ingredient.
- Medication form and route
- Oral
What remains uncertain
- No exact herb/drug trial inspected. Prasugrel active-metabolite formation was unaffected by rifampin; ticagrelor exposure was substantially reduced. Hyperforin-dependent induction is a conditional bridge, not identical effect across drugs or products.
Factors that may matter: Exact preparation and dose; Fasting versus fed dosing; Bleeding and ulcer history; Other medicines.
Read the supporting source summaries
Source 1: Current prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Prescription oral oral prasugrel hydrochloride tablets users; short human pharmacology studies where described.
Serious bleeding risk; premature discontinuation may increase stent thrombosis, MI or death. Rifampin did not change active-metabolite exposure; label expects no important CYP-induction effect.
How this applies: Exact current product label. Exact prasugrel RxCUI613391 IN. Current label identifies racemic hydrochloride tablets expressing5/10mg prasugrel-equivalent doses; active metabolite exposure is distinguished from parent ingredient.
Exact salt-to-IN bridge from product label; no herb-specific bleeding rate. Original rifampin study retained modest platelet differences beyond simplified label summary.
Source 2: Original clinical research
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Healthy male volunteers in an open-label sequential study.
Active-metabolite exposure was unchanged. Modest reductions in platelet inhibition occurred, attributed by post hoc work to a possible receptor-level rifampin effect rather than induction.
How this applies: Exact prasugrel counterevidence to a generic induction claim; no exact herb trial.
Abstract-only; no St. John’s wort arm. The label summarizes no clinically significant induction effect, but the original pharmacodynamic differences are retained.
Source 3: Original clinical research
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: 42 healthy men randomized to six St. John’s wort preparations.
CYP3A induction varied with hyperforin dose; midazolam exposure fell most with the high-hyperforin extract.
How this applies: Indirect for oral prasugrel hydrochloride tablets co-use; exact preparation and endpoint retained.
Abstract-only; midazolam probe, not an antiplatelet drug. Product-dependent induction does not establish identical effects with every medicine.
Source 4: Medication terminology
rxnav.nlm.nih.gov · Source check Sep 10, 2026
Population: Terminology.
prasugrel is IN.
How this applies: Exact identity.
Not clinical evidence.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Sources checked and article drafted. | |
| Research summary published |
Article revision: 41d88c5755e398fa
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.