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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, berberine, bergamot, boswellia and St John’s Wort all act on CYP3A4 and are off the table on tacrolimus, ciclosporin, sirolimus and everolimus. Potassium is off the table on ciclosporin and tacrolimus too, because both make the body hold on to potassium. Immune-active supplements (echinacea, andrographis, elderberry, astragalus, cordyceps) are also avoided in transplant patients: some may push against the deliberate immunosuppression, and cordyceps, which has been studied as an add-on to it, can change how much anti-rejection medicine you need. Anything you consider should go through the transplant team first.

Database last updated 2026-09-23. Free for everyone. No account, no paywall. · Browse coverage A-Z

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For adults over 18. This tool gives evidence-graded information, not medical advice. Always discuss changes with your GP or pharmacist, especially if you take any medication, are pregnant, breastfeeding, or have a serious health condition.
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How we decide

How we grade severity, choose what's in scope, and what we exclude.

Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.

Read the full methodology
The full report

A full supplement review, built around you, not a generic stack.

The free checker answers one interaction question at a time. A Distil report reviews the bigger picture: your goals, diet, medications, current supplements and any blood results you provide, then shows what appears worth keeping, changing, adding or leaving out.

  • what your diet already covers, so you are not adding a capsule for something food is already handling
  • which evidence-graded compounds are worth considering for your goals, and which were considered but left out
  • what to keep, change or stop from what you already take, plus the order to introduce anything new
  • how your medications and complete supplement stack fit together, with daily timing and a clear point for reassessment

The interaction check is one section of the full report. You also get the reasoning behind each recommendation and the evidence references used.

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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. If you want a full personalised stack reasoned against this same database, the Distil report is the next step up.