Supplements and Ciclosporin.
Ciclosporin, sold under the brand names Neoral, Sandimmun, Gengraf, is a calcineurin inhibitor used as a post-transplant immunosuppressant. The therapeutic window is narrow and CYP3A4-substrate-driven.
Ciclosporin is a calcineurin inhibitor immunosuppressant. UK prescribing covers organ transplantation, severe psoriasis, severe atopic dermatitis, and some autoimmune conditions. Mechanism mirrors tacrolimus, but the side effect profile differs. More gum hypertrophy. More hirsutism. Slightly less diabetogenic. The therapeutic window is narrow and the CYP3A4 dependence is just as strong. The same supplement exclusion list applies. Curcumin, quercetin at high doses, resveratrol, schisandra, St John's Wort, and bergamot extract all change plasma ciclosporin levels in measurable ways. Grapefruit and Seville orange are textbook exclusions; the BNF and MHRA both list them. Immune-stimulating supplements (echinacea, andrographis, elderberry, cordyceps, astragalus) work against the drug and are also excluded. The combination with NSAIDs (ibuprofen, naproxen) adds renal stress on top of ciclosporin's own nephrotoxicity. Any supplement decision belongs with the transplant or dermatology team rather than at the OTC counter.
Below are the 23 documented pairs we have explicitly assessed against Ciclosporin in the Distil database: 9 red and 14 amber. The pairs cluster around 7 mechanisms: Additive hyperkalaemia (raised potassium), CYP induction, CYP3A4 inhibition, Immune-stimulant vs immunosuppressant (precautionary), Reduced immunosuppressant level, Immunosuppression caution, and Nrf2 + CYP modulation. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not on this list is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by supplement, and the missing-item form at the bottom of the page routes any uncatalogued supplement into our next curation pass.
Documented interactions
Last reviewed 13 August 2026. Each interaction below lists the evidence its assessment drew on: some rest on studies of the exact pair, others on mechanism evidence, where a citation may support one part of the reasoning rather than the exact combination. The evidence line on each entry says which.
Additive hyperkalaemia (raised potassium)
Red Does Potassium interact with ?
Ciclosporin tends to raise blood potassium because it reduces how much potassium the kidneys pass out. A potassium supplement adds more potassium on top, and together they can push potassium high enough to affect the heart rhythm, which can be dangerous. People on ciclosporin are usually under specialist or transplant follow-up with regular blood tests, so do not start a potassium supplement unless that team has specifically advised it and is checking your blood potassium.
Evidence: Well established across multiple human studies or interaction references.
CYP induction
Red Does St John's Wort interact with ?
St John's Wort can cause your body to clear ciclosporin too quickly, dropping its level below the protective range and raising rejection risk. Do not combine.
Evidence: Supported by human study data.
CYP3A4 inhibition
Red Does Berberine interact with ?
Berberine raises ciclosporin blood levels by slowing how the body clears it. A trial in transplant patients showed roughly a 30 percent rise in ciclosporin levels, which can push the drug into the toxic range. We treat this as a do-not-combine pair outside direct transplant-team supervision.
Evidence: Supported by human study data.
Red Does Bergamot Extract (BPF / Bergavit40) interact with ?
Bergamot is grapefruit-family citrus and can raise ciclosporin blood levels by slowing its clearance. We treat this as a do-not-combine pair outside direct transplant-team supervision.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Red Does Boswellia interact with ?
Boswellia may slow how the body clears ciclosporin and raise its blood levels, though one laboratory study suggests the opposite effect. Because the direction is unsettled and ciclosporin has to stay within a narrow range, we treat this as a do-not-combine pair outside direct transplant-team supervision.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Red Does Curcumin interact with ?
Curcumin can slow how the body clears ciclosporin, which may push ciclosporin blood levels higher than intended. We treat this as a do-not-combine pair outside direct transplant-team supervision.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Red Does Quercetin interact with ?
Quercetin can slow how the body clears ciclosporin, which may push ciclosporin blood levels higher than intended. We treat this as a do-not-combine pair outside direct transplant-team supervision.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Red Does Resveratrol interact with ?
Resveratrol can slow how the body clears ciclosporin, which may push ciclosporin blood levels higher than intended. We treat this as a do-not-combine pair outside direct transplant-team supervision.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Red Does Schisandra interact with ?
Schisandra can slow how the body clears ciclosporin and push ciclosporin blood levels higher than intended, which risks toxicity. Do not combine the two outside direct transplant-team supervision.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Immune-stimulant vs immunosuppressant (precautionary)
Amber Does Ashwagandha interact with ?
Ciclosporin works by calming the immune system down, which is what stops your body rejecting a transplant or quietens an autoimmune condition. Ashwagandha has been reported to do the opposite and gently stimulate the immune system. There is no proof the two clash in people, but because the stakes with a transplant or autoimmune disease are high, it is safer not to start ashwagandha while you take ciclosporin without first talking to your transplant or specialist team.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Beta-Glucan interact with ?
Ciclosporin works by calming the immune system down, which is what stops your body rejecting a transplant or quietens an autoimmune condition. Beta-glucan from mushrooms or yeast does the opposite and gently stimulates the immune system. There is no proof the two clash in people, but because the stakes with a transplant or autoimmune disease are high, it is safer not to start beta-glucan while you take ciclosporin without first talking to your transplant or specialist team.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Elderberry interact with ?
Ciclosporin works by calming the immune system down, which is what stops your body rejecting a transplant or quietens an autoimmune condition. Elderberry is taken to support the immune system and has been shown to stimulate it. There is no proof the two clash in people, but because the stakes with a transplant or autoimmune disease are high, it is safer not to start elderberry while you take ciclosporin without first talking to your transplant or specialist team.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Eleuthero interact with ?
Eleuthero (Siberian ginseng) is taken to stimulate the immune system, which in theory works against a medicine like ciclosporin that is meant to calm it. This has not been tested in people taking immune-suppressing medicines, so it is a cautious flag rather than a strong warning. If you take ciclosporin after a transplant or for an autoimmune condition, check with your specialist before starting eleuthero.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Melatonin interact with ?
Melatonin can stimulate parts of the immune system, which in theory works against medicines like ciclosporin that are deliberately suppressing it, for example after a transplant. There is no direct study of the two together, but because the stakes are high it is best not to start melatonin without clearing it with the team that manages your ciclosporin.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Spirulina interact with ?
Ciclosporin works by calming the immune system down, which is what stops your body rejecting a transplant or quietens an autoimmune condition. Spirulina has a genuine immune-stimulating effect, which in theory pulls in the opposite direction. There is no study of the two together, but because the stakes with a transplant or autoimmune disease are high, it is safer not to start spirulina while you take ciclosporin without first checking with your specialist team.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Reduced immunosuppressant level
Amber Does Collagen Precursors interact with ?
The 1,000 mg of vitamin C in this collagen precursor blend may cause a modest fall in ciclosporin blood levels, which matters because ciclosporin needs to stay within a tight range; in transplant patients, high-dose antioxidant vitamins have been linked to this. If you take ciclosporin, do not start this blend without asking your transplant team, who may want to check your ciclosporin levels.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Vitamin C interact with ?
There is a report that vitamin C, taken together with vitamin E, lowered ciclosporin blood levels in heart transplant patients by around a third. Ciclosporin has to stay within a tight range to stop the body rejecting a transplant, so a drop like that matters. If you have a transplant or take ciclosporin for another reason, do not start a vitamin C supplement without talking to your transplant team, who can check your ciclosporin level if anything changes. The same report found no effect on tacrolimus.
Evidence: Limited human data, based on case reports and a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Immunosuppression caution
Amber Does Akkermansia muciniphila (pasteurised) interact with ?
If you take a medicine that suppresses your immune system, check with your specialist before starting any probiotic. The pasteurised (non-living) form used here lowers the usual concern, but immune data are incomplete, so a quick word with your team is the safe route.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Andrographis interact with ?
Andrographis is taken to stimulate the immune system, which in theory works against a medicine like ciclosporin that is meant to calm it. There is also a separate concern that andrographis may slow how the body clears ciclosporin and push its blood levels up. The human evidence for both effects is thin, so for a narrow-window transplant medicine the safe route is to check with your transplant team before starting.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Bifidobacterium longum 1714 interact with ?
If you take ciclosporin, check with your specialist team before starting this strain: ciclosporin strongly dampens the immune system, usually after a transplant or for a serious autoimmune condition, and in people whose defences are this weakened there have been rare cases of a probiotic organism getting into the bloodstream and causing an infection. Avoid any probiotic, including this strain, if you are seriously unwell in hospital or have a central line or drip. Bifidobacterium longum 1714 is a live bacterium, and the evidence that probiotics are safe for most people comes from studies of people who were not significantly immunosuppressed, so on ciclosporin let your specialist team's advice decide.
Evidence: Supported by human study data.
Amber Does Cordyceps interact with ?
Cordyceps is often taken to support the immune system, but in transplant studies it actually adds to immune suppression rather than working against it, and patients needed less ciclosporin to reach the same blood levels. Because ciclosporin has a narrow safe range, starting or stopping cordyceps on your own could shift your levels without anyone watching. Do not change your cordyceps use without your transplant team, who can adjust monitoring if needed.
Evidence: Limited human data, based on case reports and a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Probiotics interact with ?
If you take ciclosporin, check with your specialist team before starting a probiotic: ciclosporin strongly dampens the immune system, usually after a transplant or for a serious autoimmune condition, and in people whose defences are this weakened there have been rare cases of the probiotic organism getting into the bloodstream and causing an infection. Avoid any probiotic if you are seriously unwell in hospital or have a central line or drip. Probiotics are live bacteria or yeast, and the evidence that they are safe for most people comes from studies of people who were not significantly immunosuppressed, so on ciclosporin let your specialist team's advice decide.
Evidence: Supported by human study data.
Nrf2 + CYP modulation
Amber Does Sulforaphane (Broccoli Sprout Extract) interact with ?
Sulforaphane activates a body-wide antioxidant pathway (Nrf2) that can also subtly affect liver enzymes responsible for clearing ciclosporin. The effect at supplement doses is uncertain, but for a narrow-window drug like ciclosporin the cautious path is to discuss with your transplant team before starting.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope (food-supplement interactions only; for drug-drug interactions, the BNF is authoritative). Use the checker below to surface any supplement, and submit a missing item if you take something we have not catalogued.
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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.
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