The short answer
Do not use St. John’s wort with the labeled rilpivirine regimen. The current product information contraindicates the combination because enzyme induction can lower antiviral exposure and compromise treatment.
What this answer covers
Oral rilpivirine in the specified labeled antiretroviral regimen with Hypericum perforatum products. This concerns the prescribed oral rilpivirine product or combination; a booster is not intrinsic to rilpivirine treatment.
- Supplement or preparation
- Hypericum perforatum
- Medication ingredient
- rilpivirine
Check the exact medicine and regimen
This review applies to oral rilpivirine products such as EDURANT. The adult tablet and pediatric dispersible tablets have different instructions and cannot simply be swapped by milligram amount. Long-acting injections do not share this stomach-absorption exposure. Keep the prescribed combination and meal plan.
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 rilpivirine, 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 rilpivirine in the specified labeled antiretroviral regimen with Hypericum perforatum products. This concerns the prescribed oral rilpivirine product or combination; a booster is not intrinsic to rilpivirine treatment. with RxNorm 1102270 IN rilpivirine. Oral hydrochloride EDURANT 25 mg tablets and separately dosed EDURANT PED suspension tablets; not long-acting injectable rilpivirine or automatic fixed-combination substitution.
- 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.
Antacids at least two hours before or four hours after oral rilpivirine. Hypericum contraindicated. Protein drink/yogurt alone does not substitute for meal.
How this applies: RxNorm 1102270 IN rilpivirine. Oral hydrochloride EDURANT 25 mg tablets and separately dosed EDURANT PED suspension tablets; not long-acting injectable rilpivirine or automatic fixed-combination substitution.
Oral pH/food instructions do not apply automatically to injection. Mineral antacid activity, not elemental name alone, is relevant.
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 rilpivirine 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.
rilpivirine 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: 1693987ed13d99e9
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.