NutriStack
Atorvastatin and St. John's Wort, a conflict.
St. John's Wort is a potent CYP3A4 inducer that significantly increases atorvastatin metabolism, reducing its plasma levels and cholesterol-lowering efficacy. Studies have shown up to 50% reduction in statin AUC with concurrent St. John's Wort use.
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
- Atorvastatin and St. John's Wort
- Pair type
- Conflict
- Evidence (highest tier)
- Strong
- Source citations
- 1 source
- 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 is a potent CYP3A4 inducer that significantly increases atorvastatin metabolism, reducing its plasma levels and cholesterol-lowering efficacy. Studies have shown up to 50% reduction in statin AUC with concurrent St. John's Wort use.
Mechanism. Hyperforin in St. John's Wort activates PXR, leading to upregulation of CYP3A4 and P-glycoprotein. Atorvastatin is extensively metabolized by CYP3A4, so enzyme induction dramatically accelerates its clearance and reduces therapeutic plasma concentrations.
Recommendation. Avoid combining St. John's Wort with atorvastatin. If mood support is needed, discuss alternative options with your prescriber that do not induce CYP3A4.
Stack Score
How this pair moves the number.
Effect on the composite score
If both Atorvastatin 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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