Food and medicine interaction
Grapefruit and grapefruit juice and cyclosporine (Neoral, Sandimmune) and tacrolimus (Prograf)
EstablishedEvidence level: established. Shown in drug labeling or in controlled studies in people.
Last reviewed
What can happen
Grapefruit can raise blood levels of these anti-rejection drugs. FDA lists cyclosporine among drugs grapefruit affects, and MedlinePlus tells people on either drug to avoid grapefruit, since too much drug in the blood can mean more side effects.
- Why it happens
- Grapefruit blocks the CYP3A4 enzyme in the small intestine that normally breaks down part of each dose before it is absorbed.
- At ordinary food amounts
- Ordinary servings matter here: MedlinePlus says to avoid grapefruit and its juice altogether with cyclosporine and with tacrolimus in any amount.
What to do
MedlinePlus advises avoiding grapefruit and grapefruit juice with both drugs. If you have had grapefruit, tell your transplant team or pharmacist, and never stop or adjust an anti-rejection medicine on your own.
Never stop or change a prescribed medicine without talking to the prescriber.
Common questions
Can I have grapefruit and grapefruit juice while taking transplant immunosuppressants?
MedlinePlus advises avoiding grapefruit and grapefruit juice with both drugs. If you have had grapefruit, tell your transplant team or pharmacist, and never stop or adjust an anti-rejection medicine on your own. Ordinary servings matter here: MedlinePlus says to avoid grapefruit and its juice altogether with cyclosporine and with tacrolimus in any amount.
Sources
- U.S. Food and Drug Administration. Grapefruit Juice and Some Drugs Don't Mix (consumer update).
- MedlinePlus (U.S. National Library of Medicine). Cyclosporine: drug information.
- MedlinePlus (U.S. National Library of Medicine). Tacrolimus: drug information.
- Bailey DG, Dresser G, Arnold JM. Grapefruit-medication interactions: forbidden fruit or avoidable consequences? CMAJ. 2013. PMID 23184849.
Related
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