From the databaseWhat the row says.
Every entry follows the same shape: what is happening, the mechanism, and the recommendation.
Scope
Supplement × Prescription
Last verified
June 4, 2026
ConflictEmerging evidence
What is happening. St. John's Wort can induce CYP3A4 and may reduce cinacalcet exposure, destabilizing calcium and PTH control.
Mechanism. CYP3A4 induction can lower cinacalcet concentrations.
Recommendation. Avoid unsupervised use; recheck labs if any enzyme-inducing supplement is started or stopped.
Stack Score
How it moves the number.
Effect on the composite score
If both Cinacalcet 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 at /methodology/stack-score.
SourcesSources, by evidence tier.
Every claim on this page is cited. PMIDs link straight to PubMed.
Reference material
1- 1U.S. National Library of Medicine. Cinacalcet Tablets US Prescribing Information. 2026.Needs sourceNo link