cyclosporine
4 interactions related to cyclosporine
cyclosporine + st. john's wort
St. John's wort is a potent inducer of CYP3A4 and P-glycoprotein, the enzyme and transporter that clear cyclosporine. Taking the two together markedly lowers cyclosporine blood levels, which can render the drug subtherapeutic. This has caused documented acute organ rejection in transplant recipients, making the combination a contraindication.
seville orange + cyclosporine
Seville orange (bitter orange, Citrus aurantium) contains furanocoumarins that inhibit intestinal CYP3A4, the enzyme that breaks down cyclosporine in the gut wall. Unlike grapefruit, however, a controlled human study found that Seville orange juice did not meaningfully raise cyclosporine blood levels, because cyclosporine absorption also depends on intestinal P-glycoprotein, which Seville orange spares. Most transplant teams still advise avoiding bitter orange products as a precaution given variable furanocoumarin content and the high stakes of altered immunosuppressant levels.
cyclosporine + grapefruit
Grapefruit contains furanocoumarins that irreversibly inhibit intestinal CYP3A4, the enzyme that normally breaks down cyclosporine before it is absorbed. This meaningfully raises cyclosporine blood levels and, because cyclosporine has a narrow safety margin, increases the risk of kidney injury, high blood pressure, and neurological side effects. The effect persists for about a day or longer after a single serving.
cyclosporine + echinacea
Echinacea is marketed as an immune stimulant, and laboratory studies suggest it can activate parts of the immune system. Cyclosporine works in the opposite direction, suppressing immune activity to prevent transplant rejection and control autoimmune disease. The two therefore have opposing pharmacology, so combining them is generally discouraged. The real-world clinical importance is uncertain — there are no solid human reports of rejection caused by echinacea alone — but the theoretical conflict is enough to warrant caution.