The short answer
Avoid grapefruit and grapefruit juice while taking oral cyclosporine, as its prescribing information advises. Juice can increase the amount of cyclosporine reaching the bloodstream, but the effect varies with the patient, formulation and measure used. Do not use grapefruit to boost your medicine or reduce its dose.
What this answer covers
Citrus paradisi, grapefruit, with oral cyclosporine. The original clinical studies tested juice; the cyclosporine label also names whole grapefruit. Seed extracts, peel extracts, pomelo and other citrus are distinct exposures and are not assigned the juice studies’ percentages.
- Supplement or preparation
- Citrus paradisi
- Medication ingredient
- cyclosporine
What did the juice studies measure?
In 12 healthy volunteers, grapefruit juice increased the bioavailability of microemulsion cyclosporine by 45%. Bioavailability describes how much of an oral dose reaches the circulation. This was a short juice experiment, and that percentage should not be used to predict an individual patient’s concentration or toxicity risk.
Why does the formulation matter?
A study in six children with kidney transplants found a trough-level increase with conventional cyclosporine solution but no significant change with microemulsion. That small null result does not override the label’s avoidance advice. Modified and conventional cyclosporine also are not interchangeable at the same dose without medical supervision.
Does every blood measurement rise?
Not necessarily. In another study of kidney transplant recipients, grapefruit juice increased the peak cyclosporine concentration while total exposure and the trough did not significantly change. These differences help explain why a single reassuring result or a percentage from another patient cannot settle whether the combination is acceptable for you.
What should you do about accidental intake?
Contact your transplant team or prescriber for advice about the amount consumed and whether testing is needed. Keep the cyclosporine dose unchanged unless they instruct you otherwise. The label advises avoidance; these studies do not establish a safe juice amount or a number of hours that reliably prevents the interaction.
Evidence and practical considerations
Absorption & effectiveness
Avoid grapefruit and grapefruit juice while taking oral cyclosporine, as its prescribing information advises. Juice can increase the amount of cyclosporine reaching the bloodstream, but the effect varies with the patient, formulation and measure used. Do not use grapefruit to boost your medicine or reduce its dose.
- Exact scope
- Citrus paradisi, grapefruit, with oral cyclosporine. The original clinical studies tested juice; the cyclosporine label also names whole grapefruit. Seed extracts, peel extracts, pomelo and other citrus are distinct exposures and are not assigned the juice studies’ percentages. 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
- Small short human studies, abstract-only original access and varied formulations; juice studies do not directly quantify whole fruit or concentrated botanical extracts.
Factors that may matter: juice versus fruit or extract; cyclosporine formulation; amount and frequency; transplant population; timing of level measurement.
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 human crossover pharmacokinetic study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Twelve healthy volunteers.
Grapefruit juice significantly increased peak concentration and AUC; absolute oral bioavailability increased 45% compared with water.
How this applies: Direct grapefruit juice evidence for oral microemulsion cyclosporine. Not a measured flesh, seed, peel or extract result.
Abstract only; exact juice volume and oral dose are not supplied. Healthy volunteers and short sampling do not quantify chronic toxicity. Juice exposure cannot be relabeled as a whole-fruit trial.
Source 3: primary pediatric crossover pharmacokinetic study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Six stable pediatric renal transplant recipients in an open-label, four-period crossover study.
Juice increased the 12-hour trough and reduced elimination rate with conventional solution. No pharmacokinetic difference was detected with microemulsion in this small group.
How this applies: Shows why the direction and magnitude of changes cannot be reduced to a single percentage for every patient or oral formulation.
Abstract only, six patients, unresolved juice volume and no whole-fruit exposure. A microemulsion null result differs from the healthy-volunteer positive result and is not proof that grapefruit is safe with that formulation.
Source 4: primary clinical pharmacokinetic study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Twelve stable kidney transplant recipients.
Cyclosporine peak concentration increased by 185 ng/mL (95% CI 60-310; P=0.008), while AUC and trough did not significantly change.
How this applies: Prevents conflating a higher peak with a consistent rise in every measure of exposure. Concerns juice, not isolated fruit flesh.
Abstract only. The small sample and short repeated-juice regimen do not establish toxicity frequency or a safe amount; formulation details are not resolved here.
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: 2491c1808640f441
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.