The short answer
St. John’s wort products that induce CYP3A may reduce ticagrelor exposure. Ask your prescriber about avoiding the combination; a few hours of spacing is not an established solution.
What this answer covers
Oral Hypericum perforatum preparations with oral ticagrelor tablets. Hyperforin content, repeated exposure and the exact drug matter.
- Supplement or preparation
- Hypericum perforatum
- Medication ingredient
- ticagrelor
The exact drug changes the interpretation
The ticagrelor label advises avoiding strong CYP3A inducers. A healthy-volunteer study with rifampicin substantially lowered ticagrelor exposure and shortened the duration of platelet inhibition. That study did not measure the effect of St. John’s wort itself.
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
Repeated enzyme induction is not a same-time stomach interaction, so taking the products a few hours apart is not an established solution. Ask the prescriber about an alternative to the inducing herb and a plan if you are already using it.
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
Enzyme-inducing St. John’s wort products may reduce ticagrelor exposure and should be reviewed for avoidance.
- Exact scope
- Oral Hypericum perforatum preparations with oral ticagrelor tablets. Hyperforin content, repeated exposure and the exact drug matter. with Exact ticagrelor RxCUI1116632 IN. Oral parent drug and active metabolite have antiplatelet activity; other P2Y12 drugs are not interchangeable.
- 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 ticagrelor tablets users; short human pharmacology studies where described.
Significant bleeding risk; stopping treatment raises cardiovascular risk. Strong CYP3A inducers lower exposure and efficacy and should be avoided.
How this applies: Exact current product label. Exact ticagrelor RxCUI1116632 IN. Oral parent drug and active metabolite have antiplatelet activity; other P2Y12 drugs are not interchangeable.
No exact botanical bleeding rate. Rifampin exposure changes are not an effect size for St. John’s wort.
Source 2: Original clinical research
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: 14 healthy volunteers.
Ticagrelor peak concentration and AUC fell 73% and 86%; platelet inhibition wore off faster.
How this applies: Exact ticagrelor inducer study; quantitative rifampin results are not assigned to Hypericum.
Abstract-only; rifampicin, not St. John’s wort. No herb-specific effect size or cardiovascular event trial.
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 ticagrelor 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.
ticagrelor 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: 12cab4ac17e68860
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.