Supplement × Prescription·a conflict·Emerging evidence

Cinacalcet + St. John's Wort

Conflict Emerging evidence

St. John's Wort can induce CYP3A4 and may reduce cinacalcet exposure, destabilizing calcium and PTH control.

From the database

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Pair type
Conflict
Evidence
Emerging
Source citations
1
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.

Sources

Sources, 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

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