Coadministration has not been studied and is contraindicated in the product labels for Biktarvy as St John’s wort may substantially decrease bictegravir and tenofovir alafenamide plasma concentrations which may result in loss of therapeutic effect and development of resistance. However, a recent study suggests a low risk of a clinically relevant pharmacokinetic interaction with low-hyperforin formulations (<1 mg/day) of St John’s Wort (hyperforin is the constituent responsible for induction of CYPs and P-gp). Coadministration may be considered with St John’s Wort formulations that clearly state the hyperforin content and which have a total daily hyperforin dose of 1 mg or less. No interaction is expected with emtricitabine.