Supplements and Sirolimus.
Sirolimus, sold under the brand name Rapamune, is an mTOR inhibitor used as a post-transplant immunosuppressant. The therapeutic window is narrow and CYP3A4-driven.
Sirolimus is an mTOR inhibitor immunosuppressant. The class includes sirolimus and everolimus. Mechanism differs from calcineurin inhibitors, but the therapeutic window is just as narrow and the CYP3A4 dependence is just as strong. Trough plasma levels are monitored after transplantation, or in the specific oncology indications. The same CYP3A4-active supplement exclusion list applies. Curcumin, quercetin at higher doses, resveratrol, schisandra, St John's Wort, and bergamot extract all change plasma mTOR inhibitor levels in measurable ways. Grapefruit and Seville orange are textbook exclusions and are listed in the BNF and product literature. Immune-stimulating supplements (echinacea, andrographis, elderberry, cordyceps, astragalus) work against the drug and are excluded too. Use in cancer overlaps further with the active cancer context flag in our checker, since several supplements that are otherwise lower risk become exclusions during active oncology care.
Below are the 12 documented pairs we have explicitly assessed against Sirolimus in the Distil database: 7 red and 5 amber. The pairs cluster around 3 mechanisms: CYP3A4 inhibition, 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.
CYP3A4 inhibition
Red Does Berberine interact with ?
Berberine can slow how the body clears sirolimus, which may push sirolimus 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 Bergamot Extract (BPF / Bergavit40) interact with ?
Bergamot is grapefruit-family citrus and can raise sirolimus 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 sirolimus and raise its blood levels, with one laboratory study pointing the other way. Because the direction is unsettled and sirolimus 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 sirolimus, which may push sirolimus 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 sirolimus, which may push sirolimus 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 sirolimus, which may push sirolimus 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 slows how the body clears sirolimus and can roughly double sirolimus blood levels, which risks toxicity. Do not combine the two outside direct transplant-team supervision.
Evidence: Supported by human study data.
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 Bifidobacterium longum 1714 interact with ?
If you take sirolimus, check with your specialist team before starting this strain: sirolimus strongly dampens the immune system, usually after a transplant, 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 sirolimus let your specialist team's advice decide.
Evidence: Supported by human study data.
Amber Does Cordyceps interact with ?
Cordyceps is taken to support the immune system, but in transplant studies it adds to immune suppression rather than opposing it. Sirolimus is a narrow-range transplant medicine, so taking cordyceps on your own could shift the balance without anyone watching. Do not start or stop cordyceps without your transplant 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 Probiotics interact with ?
If you take sirolimus, check with your specialist team before starting a probiotic: sirolimus strongly dampens the immune system, usually after a transplant, 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 sirolimus 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 sirolimus. The effect at supplement doses is uncertain, but for a narrow-window drug like sirolimus 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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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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