The short answer
Avoid taking St. John’s wort with dolutegravir. Current prescribing information and NIH guidance advise against the combination because the herb may lower drug concentrations. Taking the products at different times is not an established solution.
What this answer covers
Oral Hypericum perforatum products with dolutegravir. Botanical strength can vary, but no extract-specific exemption from the current avoidance advice is established here.
- Supplement or preparation
- St. John’s wort
- Medication ingredient
- dolutegravir
Why is this different from a mineral interaction?
The concern is that St. John’s wort can affect pathways involved in clearing medicines, rather than simply bind a tablet in the intestine. Dolutegravir labeling describes lower concentrations with enzyme or transporter inducers and specifically lists this herb among combinations to avoid.
Has treatment failure been shown for every user?
No. The recommendation does not mean every person will lose viral suppression. One observational cohort included a single St. John’s wort user with an undetectable viral load before and after dolutegravir. The duration of herb exposure was unknown and drug concentrations were not measured.
Does that reassuring observation change the advice?
One person cannot establish safety across extracts, doses or HIV treatment histories. Current labeling states that evidence is insufficient to recommend an adjusted dolutegravir dose for this combination. NIH guidance also says not to coadminister it, so a two-hour separation should not be offered as a workaround.
What if I am already taking both?
Contact your HIV clinician or pharmacist promptly with the herb’s exact name, dose and start date. Keep taking prescribed HIV therapy as directed while getting advice. The clinician can assess the supplement and treatment monitoring; do not change the antiretroviral dose yourself.
Evidence and practical considerations
Absorption & effectiveness
Avoid taking St. John’s wort with dolutegravir. Current prescribing information and NIH guidance advise against the combination because the herb may lower drug concentrations. Taking the products at different times is not an established solution.
- Exact scope
- Oral Hypericum perforatum products with dolutegravir. Botanical strength can vary, but no extract-specific exemption from the current avoidance advice is established here. with Dolutegravir, exact RxCUI 1433868, IN. TIVICAY contains dolutegravir sodium expressed as dolutegravir active-moiety strength in its label. This provides the explicit salt-to-IN bridge. Oral tablets are the primary scope; no automatic extrapolation to another integrase inhibitor or a different combination regimen. TIVICAY PD is not interchangeable milligram for milligram.
- Medication form and route
- oral
What remains uncertain
- Avoidance is directly supported by current labeling and guidance, while exact-product clinical effect sizes remain poorly established. A single uncontrolled observation with unknown herb duration cannot refute the precaution.
Factors that may matter: exact preparation and dose; food and administration order; complete antiretroviral regimen.
Read the supporting source summaries
Source 1: regulatory prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: People prescribed oral dolutegravir, including tablet and pediatric suspension formulations with separate dosing instructions.
Specifies dolutegravir two hours before or six hours after named mineral products; calcium/iron supplements have a simultaneous-with-food exception for TIVICAY. St. John’s wort co-use is to be avoided because a dosing recommendation cannot be established.
How this applies: Restricted to the preparation and conditions described in this article.
The table includes both measured and predicted interactions. It does not quantify every mineral salt, product or botanical extract. Formulations and combination tablets require their own instructions.
Source 2: government clinical guideline
clinicalinfo.hiv.gov · Source check Sep 10, 2026
Population: Adults and adolescents receiving antiretroviral therapy.
Supports product-specific spacing and the calcium/iron food exception; says not to coadminister St. John’s wort with dolutegravir.
How this applies: Restricted to the preparation and conditions described in this article.
Clinical guidance combines measured and predicted effects. The DTG supplement instructions specifically discuss calcium and iron; the zinc heading is not a zinc-only human experiment.
Source 3: primary observational clinical research
panafrican-med-journal.com · Source check Sep 10, 2026
Population: A 461-person HIV cohort, including one person reporting St. John’s wort.
The one person reporting St. John’s wort had undetectable viral load before and after dolutegravir and no reported side effects or treatment discontinuation.
How this applies: Restricted to the preparation and conditions described in this article.
Exposure duration was unknown, drug concentrations were not measured, data were missing, and a single observation cannot refute the labeled interaction or show all extracts are safe.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Current prescribing instructions and original research checked. Article written with product-specific timing and explicit limits of the evidence. | |
| Research summary published |
Article revision: 4e94689bfeb0bf20
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.