NutriStack
Aripiprazole and St. John's Wort, a conflict.
St. John's Wort induces CYP3A4 and CYP2D6, both of which metabolize aripiprazole. This can reduce aripiprazole levels by 50% or more, potentially causing psychotic relapse.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Aripiprazole and St. John's Wort
- Pair type
- Conflict
- Evidence (highest tier)
- Strong
- Source citations
- 2 sources
- Stack Score effect
- −10 to your Stack Score (per scored conflict row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Conflict · Strong evidence
Conflict
What is happening. St. John's Wort induces CYP3A4 and CYP2D6, both of which metabolize aripiprazole. This can reduce aripiprazole levels by 50% or more, potentially causing psychotic relapse.
Mechanism. Aripiprazole is metabolized by CYP3A4 and CYP2D6. St. John's Wort induces CYP3A4, significantly increasing aripiprazole clearance and reducing therapeutic levels.
Recommendation. Avoid St. John's Wort with aripiprazole. The FDA prescribing information lists strong CYP3A4 inducers as requiring dose adjustment.
Sources (2)
- Markowitz JS, Donovan JL, DeVane CL, et al. Effect of St John's wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. JAMA. 2003;290(11):1500-1504. PMID 13129991
- Belmonte C, Ochoa D, Roman M, et al. Influence of CYP2D6, CYP3A4, CYP3A5 and ABCB1 Polymorphisms on Pharmacokinetics and Safety of Aripiprazole in Healthy Volunteers. Basic Clin Pharmacol Toxicol. 2018;122(6):596-605. PMID 29325225
Stack Score
How this pair moves the number.
Effect on the composite score
If both Aripiprazole and St. John's Wort are in the same stack, this pair applies −10 to your Stack Score (per scored conflict row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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