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Cyclosporine helps prevent rejection of a transplanted organ by suppressing the immune system.
Grapefruit juice slows the body's normal breakdown of several drugs, including cyclosporine, allowing it to build up to potentially excessive levels in the blood. 1 A recent study indicates this effect can last for three days or more following the last glass of juice. 2If you take cyclosporine, the safest approach is to avoid grapefruit juice altogether.
St. John's Wort The herb St. John's wort (Hypericum perforatum) is primarily used to treat mild to moderate depression. St. John's wort has the potential to accelerate the body's normal breakdown of certain drugs 3,4 including cyclosporine, resulting in lower blood levels of these drugs. This interaction appears to have occurred in two heart transplant patients taking cyclosporine, leading to heart transplant rejection. 5 These individuals had been doing well after transplantation while taking standard immunosuppressive therapy that included cyclosporine. After starting St. John's wort for depression, however, they began experiencing problems and their blood levels of cyclosporine were found to have dipped below the therapeutic range. After St. John's wort was discontinued, cyclosporine levels returned to normal and no further episodes of rejection occurred. Numerous cases of transplant rejection episodes involving the heart, kidney, and liver have also been reported in people using the herb. 6,7Based on this evidence, if you are taking cyclosporine, you should not take St. John's wort.