The short answer
CBD warrants a medication review and cyclosporine-level monitoring. A cyclosporine interaction has been reported, but the accessible human evidence does not establish a reliable direction or size of change. An earlier small series found stable cyclosporine levels, so a rise should not be presented as inevitable.
What this answer covers
Cannabidiol used with systemic cyclosporine, with oral products the practical focus. CBD composition and dose need confirmation. Findings are not automatically applicable to topical products, THC-containing mixtures or another transplant medicine.
- Supplement or preparation
- Cannabidiol
- Medication ingredient
- cyclosporine
What direct evidence is available?
A 2024 report describes an interaction in a kidney transplant recipient taking CBD, cyclosporine and mycophenolate mofetil. Its available abstract does not give the CBD dose or the direction and size of the cyclosporine change. It supports taking the possibility seriously without supplying a percentage that can guide your dose.
What did the earlier patient series find?
In a three-week series of seven kidney transplant recipients, CBD was increased from 50 mg twice daily toward 150 mg twice daily. Cyclosporine levels remained stable in the patients receiving it. The report is too small and short, with insufficient product detail, to show that all CBD products can be used without monitoring.
Why do regulators recommend monitoring?
European safety guidance specifically advises caution when CBD is used with systemic cyclosporine and recommends close trough-level monitoring. Its explanation includes reports involving another calcineurin inhibitor. That precaution is relevant to cyclosporine, but the other medicine’s measured changes cannot be copied over as cyclosporine results.
How should changes be handled?
Tell the prescribing team about the CBD brand, amount, route and any planned change. They can decide when to check drug levels and kidney function. The sources do not establish a protective spacing interval. Do not compensate by changing cyclosporine yourself or assume a low-dose retail product has been tested.
Evidence and practical considerations
Absorption & effectiveness
CBD warrants a medication review and cyclosporine-level monitoring. A cyclosporine interaction has been reported, but the accessible human evidence does not establish a reliable direction or size of change. An earlier small series found stable cyclosporine levels, so a rise should not be presented as inevitable.
- Exact scope
- Cannabidiol used with systemic cyclosporine, with oral products the practical focus. CBD composition and dose need confirmation. Findings are not automatically applicable to topical products, THC-containing mixtures or another transplant medicine. with Cyclosporine, RxCUI 3008, IN, systemic oral use. Neoral modified microemulsion and conventional Sandimmune are distinguished; neither is automatically dose-equivalent to the other. The Neoral label identifies cyclosporine as the active ingredient and basis of strength. Intravenous reference experiments are identified separately; ophthalmic and topical use are excluded.
- Medication form and route
- oral
- Timing or duration
- Only the durations described in the sources are established; no untested persistence or dose-spacing interval is inferred.
What remains uncertain
- One case without accessible full details, one very small short series, variable CBD exposure and indirect basis for part of the regulatory signal. No verified general direction, threshold or timing remedy.
Factors that may matter: CBD dose and route; product composition; other immunosuppressants; cyclosporine trough levels; kidney function.
Read the supporting source summaries
Source 1: regulatory prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Patients prescribed systemic oral cyclosporine, including transplant recipients.
Requires clinical and blood-level monitoring, recognizes nephrotoxicity and hyperkalemia, cautions with potassium-containing drugs and explicitly advises avoiding grapefruit and grapefruit juice. Neoral and Sandimmune are not bioequivalent.
How this applies: Direct exact-medication identity and oral monitoring guidance. Pair-specific applicability is restricted to the named food or potassium-containing products; other supplements require their own evidence.
A regulatory label does not quantify each supplement interaction. Botanical effects and absolute event rates cannot be inferred from cyclosporine toxicity alone. Formulation-specific findings must be retained.
Source 2: primary case report
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: One kidney transplant recipient with a history of end-stage kidney disease.
The authors report a pharmacokinetic interaction and recommend drug-level monitoring, but the abstract provides no numerical cyclosporine result or direction of change.
How this applies: Confirms an exact cyclosporine/CBD case has been reported, without supporting a quantified effect or extrapolation to every CBD route.
Abstract only. Mixed immunosuppressive regimen; magnitude, direction, product and clinical outcome cannot be verified. Enzyme discussion does not supply missing patient results.
Source 3: primary uncontrolled clinical series
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Seven kidney transplant recipients, age 58-75 years, with differing immunosuppressants.
Cyclosporine concentrations remained stable in patients receiving it. The abstract reports no severe adverse effects during this short monitored series.
How this applies: Contrary direct clinical observation that prevents describing a rise in cyclosporine as inevitable. Tacrolimus findings are not transferred to cyclosporine.
Abstract only. The number receiving cyclosporine and exact CBD formulation are not specified. Small uncontrolled series and short duration cannot exclude interactions with other doses or products.
Source 4: official regulatory safety recommendation
ema.europa.eu · Source check Sep 10, 2026
Population: People receiving systemic ciclosporin who also use cannabidiol.
Recommends caution, monitoring for effects and close whole-blood trough monitoring, with dose adjustment if needed. The rationale mentions increased levels of another calcineurin inhibitor.
How this applies: Supports supervised co-use and monitoring for the exact named systemic drug. Does not supply an oral dose threshold or extend to topical CBD.
A regulatory precaution naming cyclosporine, not a cyclosporine clinical trial. The underlying other-drug signal cannot establish a cyclosporine-specific effect size or direction in an individual.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Original studies and regulatory sources checked; a new article prepared with exact formulation and access limits. No independent clinical review is recorded. | |
| Research summary published |
Article revision: f19f2f286ac02661
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.