Distil ← Back to home
Class landing · Immunosuppressants

Supplements and immunosuppressants.

Tacrolimus, ciclosporin, sirolimus, everolimus and the CYP3A4 substrates that put transplant patients at risk.

Transplant immunosuppressants (tacrolimus, ciclosporin, sirolimus, everolimus) have very narrow therapeutic windows. They are metabolised by CYP3A4. Any supplement that inhibits or induces CYP3A4 shifts blood levels in a way that risks either toxicity or graft rejection. This is the highest-stakes category in our database.

Hard exclusions: curcumin, quercetin, resveratrol, schisandra, and St John’s Wort all act on CYP3A4 and are off the table on these drugs. Immune-stimulating supplements (echinacea, andrographis, elderberry, astragalus, cordyceps) are also avoided in transplant patients because they may counteract the deliberate immunosuppression. Anything you consider should go through the transplant team first.

Loading database stats…
For adults over 18. This tool gives evidence-graded information, not medical advice. Always discuss changes with your GP, especially if you take any medication, are pregnant, breastfeeding, or have a serious health condition.
Type the supplement name. Click each match to add it.
Brand or generic name works. Click each match to add it.

Something missing?

If a supplement or medication you take isn't in our autocomplete, tell us and we'll add it in the next quarterly update.

Distil's interactions database is reviewed and updated every quarter. We grade evidence transparently and publish our methodology, including every database change, at /about/methodology. This tool is information, not a substitute for clinical judgement. If you take medication and supplements together, your GP or pharmacist can review your full regimen against your medical history.