DangerousContraindicated
St. John's Wort
St. John's Wort can markedly reduce cyclosporine concentrations and has been associated with transplant rejection.
Recommendation: Avoid completely unless a transplant specialist explicitly directs otherwise.
Cyclosporine
Prescription ·Strong evidence ·Reviewed May 2026
Cyclosporine is a calcineurin inhibitor used to prevent organ transplant rejection and to treat selected autoimmune or inflammatory diseases. It has a narrow therapeutic index and major safety issues including nephrotoxicity, hypertension, serious infections, malignancy, hyperkalemia, hypomagnesemia, neurotoxicity, and extensive CYP3A4/P-glycoprotein interactions.
What it's good for
The bottom line
Evidence rating strong. Most-documented uses: prevention of kidney, liver, and heart transplant rejection, treatment of severe rheumatoid arthritis when other therapies fail, treatment of severe plaque psoriasis in selected patients. 3 sources indexed (1989–2026), with 5 interaction records on file.
The science
How it works, mechanistically.
Core mechanism
Cyclosporine binds cyclophilin to form a complex that inhibits calcineurin phosphatase activity in T cells. This prevents dephosphorylation and nuclear translocation of NFAT, reducing interleukin-2 transcription and T-cell activation. Renal vasoconstriction, tubular effects, and CYP3A4/P-glycoprotein metabolism underlie nephrotoxicity, electrolyte changes, and many interactions.3,2
Class
Calcineurin inhibitor immunosuppressant
Absorption
Fat-soluble; take with food
Dosing
Dosing & protocol.
Common range
Highly individualized by indication, formulation, trough concentration, kidney function, and interacting drugs. Modified and non-modified formulations are not interchangeable and transplant dosing is titrated by therapeutic drug monitoring.
Recommended form
Oral capsule or solution using the exact prescribed formulation; intravenous use only in supervised settings
Take consistently with regard to meals and formulation. Avoid grapefruit products and do not switch brands or modified/non-modified formulations without prescriber supervision.
Depletions
What it depletes.
Nutrients this medication can lower over time, and what to replace.
Magnesium
SignificantCalcineurin inhibitors can cause renal magnesium wasting and hypomagnesemia.
Replace Magnesium GlycinateMonitor Serum magnesiumOnset Weeks to months, sometimes early after transplant
Safety
Full safety detail.
Side effects
- Nephrotoxicity
- Hypertension
- Tremor
- Headache
- Hyperkalemia
- Hypomagnesemia
- Gingival hyperplasia
- Hirsutism
- Hepatotoxicity
- Serious infections
- Lymphoma and skin cancers
- Thrombotic microangiopathy rarely
Contraindications
- Known hypersensitivity to cyclosporine or formulation components3,2
- Uncontrolled hypertension or abnormal renal function for non-transplant autoimmune indications3
- Concomitant PUVA or UVB therapy, methotrexate, coal tar, or radiation therapy in psoriasis labeling contexts
- Use only under clinicians experienced with immunosuppression and therapeutic drug monitoring2
Interactions
Interaction records.
SeriousCaution
Potassium
Cyclosporine can cause hyperkalemia; potassium supplements or salt substitutes can make it dangerous.
Recommendation: Avoid potassium supplementation unless prescribed and monitored with serum potassium and kidney function.
InfoSynergy
Magnesium Glycinate
Magnesium may help correct cyclosporine-associated hypomagnesemia, but kidney function and levels must guide dosing.
Recommendation: Supplement only with clinician guidance and monitor serum magnesium, diarrhea, and kidney function.
SeriousCaution
Quercetin
Quercetin may inhibit CYP3A4 or P-glycoprotein and could increase cyclosporine exposure and nephrotoxicity.
Recommendation: Avoid high-dose quercetin unless transplant clinicians monitor trough levels and kidney function.
SeriousCaution
Berberine
Berberine may affect P-glycoprotein and CYP3A pathways and could alter cyclosporine levels.
Recommendation: Avoid unsupervised berberine; check trough levels if started or stopped.
Sources
Sources, by evidence tier.
Numbered references. Citations throughout the page link here.
Reviews & position papers
2- 1KDIGO Clinical Practice Guideline for the Care of Kidney Transplant RecipientsNeeds reviewNo linkKidney Disease: Improving Global Outcomes · American Journal of Transplantation · 2009
Guideline supports monitoring calcineurin inhibitor exposure, kidney function, blood pressure, and metabolic complications.
- 2Cyclosporine in clinical organ transplantationNeeds reviewNo linkKahan BD · New England Journal of Medicine · 1989
Review describes efficacy, nephrotoxicity, and therapeutic monitoring principles.
Reference material
1- 3Cyclosporine Capsules Modified US Prescribing InformationNeeds reviewURLU.S. National Library of Medicine · DailyMed · 2026
Labeling describes transplant and autoimmune uses, therapeutic monitoring, nephrotoxicity, hypertension, infection and malignancy warnings, and CYP3A/P-gp interactions.
Keep exploring
Deep dives & adjacent profiles.
This page is educational. Do not start, stop, or change a supplement or medication based on it without checking with a qualified healthcare professional.
Use this with your stack
Cyclosporine in NutriStack.
Add it to your stack, see how it interacts with everything else you take, and get a Stack Score that updates the moment it does.