The short answer
An added GI-injury risk from St. John’s wort with tolmetin is uncertain. Review the product and other medicines, and take tolmetin’s own GI warning seriously.
What this answer covers
Oral Hypericum perforatum preparations with oral tolmetin sodium capsules. Other medicines and preparations require separate review.
- Supplement or preparation
- Hypericum perforatum
- Medication ingredient
- tolmetin
The available study does not answer the GI question
A small healthy-volunteer study found no significant platelet-function change with the tested St. John’s wort course. Platelet testing does not measure stomach lining injury, and tolmetin was not the tested combination. It cannot prove or disprove the claimed GI interaction.
Tolmetin itself has GI risks
The inspected capsules contain tolmetin sodium, expressed as a tolmetin-equivalent dose. Tolmetin carries serious GI bleeding and ulcer warnings. These effects make persistent symptoms important to assess, but do not establish that a particular botanical adds to the risk. An antacid should not be used to conceal ongoing pain.
Bring the full medicine list
Record the St. John’s wort preparation, dose and other ingredients, and have the pharmacist review the full regimen. Evidence from one short commercial-herb study cannot establish the behavior of every extract. This article does not establish safety with your other medicines.
Know when to get help
oral tolmetin sodium capsules can cause serious GI bleeding even without a supplement. Seek urgent care for vomiting blood or black, tarry stools, and report persistent stomach pain or unusual bleeding. Tell your prescriber about other pain medicines, aspirin and anticoagulants. A few hours of separation has not been shown to prevent an added bleeding effect.
Evidence and practical considerations
Side effects & toxicity
Increased GI injury specifically from St. John’s wort with tolmetin is not established.
- Exact scope
- Oral Hypericum perforatum preparations with oral tolmetin sodium capsules. Other medicines and preparations require separate review. with Exact tolmetin IN 10636 linked by current RxNorm to tolmetin sodium PIN 42935. Capsules contain 246 mg sodium dihydrate equivalent to 200 mg tolmetin. Other NSAIDs are not interchangeable.
- Medication form and route
- Oral
What remains uncertain
- Small platelet-function study did not assess GI mucosal injury or tolmetin co-use. No exact interaction rate or protective timing interval.
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 tolmetin sodium capsules users; short human pharmacology studies where described.
Serious GI injury and bleeding warnings. Label recommends antacids other than sodium bicarbonate; aluminum/magnesium hydroxide did not change absorption in the cited study.
How this applies: Exact current product label. Exact tolmetin IN 10636 linked by current RxNorm to tolmetin sodium PIN 42935. Capsules contain 246 mg sodium dihydrate equivalent to 200 mg tolmetin. Other NSAIDs are not interchangeable.
Exact oral product label; no measured botanical co-use incidence. Ingredient, route, preparation and comparator differences must be retained.
Source 2: Original clinical research
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Ten healthy adults in the experimental component.
No significant PFA-100 platelet-function change in the tested herbal courses.
How this applies: Indirect for oral tolmetin sodium capsules co-use; exact preparation and endpoint retained.
Abstract-only; platelet testing cannot assess GI mucosal injury, rare bleeding, exact tolmetin co-use or every formulation.
Source 3: Medication terminology
rxnav.nlm.nih.gov · Source check Sep 10, 2026
Population: Terminology.
tolmetin is IN. Exact tolmetin IN 10636 linked by current RxNorm to tolmetin sodium PIN 42935. Capsules contain 246 mg sodium dihydrate equivalent to 200 mg tolmetin. Other NSAIDs are not interchangeable.
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: d275746cb7a4412d
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.