Rifampin and St. John's Wort: what the published research says
PubMed indexes 4 records that name Rifampin and St. John's Wort together, either in the title or in an interaction, co-administration, or pharmacokinetic context. Each one is listed below with its study design and, where the abstract states one, the authors’ own conclusion, quoted and linked. This page reports that literature. It does not tell you whether to combine them.
Every statement below is attributed to a named, dated, linked source.
This page lists published research relevant to Rifampin and St. John's Wort. It deliberately does not state whether the combination is safe, whether it interacts, in which direction, at what dose, or how far apart to take them.
A study appearing here is not proof that an interaction exists. Two substances can be named together in a paper that never tested them in combination, and a source listed as background may cover only one of them.
Findings are quoted from each abstract as the authors wrote them. NutriStack has not re-analysed, pooled, or reconciled them, and they may disagree with each other.
NutriStack’s own interaction assessment for this pair is not published here. It has not completed qualified-human clinical review, so it is withheld from search. See the publication gate.
Nothing here is medical advice. Decisions about prescription medication and supplements belong with your prescriber or pharmacist, who can see your full regimen.
The research
4 studies naming Rifampin and St. John's Wort.
Strongest relevance first: papers naming both substances in the title, then human trials and systematic reviews.
Clinical and translational science · 2024 · PMID 39152679
Human subjects
“These results show that rifampin significantly enhances the induction of the highest SJW doses both hepatically and overall and suggest that these metabolic effects occur predominantly in the gut. These findings also suggest that in drug interactions involving strong and moderate enzyme inducers, the perpetrator effects of the strong inducer are decisive for the interaction.”
Names both Rifampin and St. John's Wort in its title.
Journal of clinical pharmacy and therapeutics · 2017 · PMID 28177134
Systematic ReviewHuman subjects
“To conclude, the combination use of high-dose efavirenz, high-dose ritonavir, St John's wort, rifampin, phenobarbital, or carbamazepine with voriconazole is contraindicated as instructed in the drug label. Low-dose efavirenz, low-dose ritonavir, rifabutin and phenytoin may be used together with voriconazole provided TDM and dose adjustment of voriconazole.”
Names Rifampin and St. John's Wort together in an interaction, co-administration, or pharmacokinetic context.
The Journal of antimicrobial chemotherapy · 2014 · PMID 24554646
Meta-AnalysisHuman subjects
“Current dosing regimens for voriconazole result in subtherapeutic exposure in many patients without CYP2C19 LoF alleles, suggesting the need for higher doses, whereas these regimens result in supratherapeutic exposure in a high proportion of patients with reduced CYP2C19 activity. These findings support the essential role of therapeutic drug monitoring in ensuring efficacious and safe voriconazole exposure.”
Names Rifampin and St. John's Wort together in an interaction, co-administration, or pharmacokinetic context.
“John's wort-induced neuropathy. The risk to develop this adverse effect is almost exclusively present in women.”
Names Rifampin and St. John's Wort together in an interaction, co-administration, or pharmacokinetic context.
Limitations
What this evidence cannot tell you.
Search-based evidence indexes have real limits, and it is worth being explicit about them:
Selection. These records were found by searching PubMed titles and abstracts for both substance names alongside interaction and pharmacokinetic terms. Relevant work that phrases things differently, or is not indexed in PubMed, will be missing.
No effect size. The quoted conclusions are the authors’ words about their own study. We have not extracted effect direction or magnitude, and a single study’s conclusion is not a consensus.
Population mismatch. Findings in healthy volunteers, animals, or a specific patient group may not transfer to you, your dose, or your formulation.
Absence is not safety. Few published studies means the combination is under-studied, which is not the same as established as safe.
Nearby evidence
Other pairs with published research.
Pages covering Rifampin or St. John's Wort alongside a different substance.
NutriStack is a free iPhone app for organising a supplement routine: what you take, when, and what the published record says about it. Its exploratory interaction checker covers Rifampin, St. John's Wort, and several hundred other substances.
The checker is a research and organisation tool, not a clinical decision aid, and its per-pair assessments are excluded from search until they pass claim-level review.
NutriStack is an informational and organizational tool, not a medical service, and not a substitute for professional advice. Always consult a qualified healthcare professional before starting, stopping, or changing any supplement or medication.
