Cyclosporine and Herbal Supplement Interactions

Table 1

A summary of commonly used herbal extracts, effect of herbal extract-cyclosporine A (CyA) interaction, and the mechanisms involved if known.

Herbal supplement or extract	Effect of interaction on CyA bioavailability	Mechanism of interaction	Studies
St John’s wort	Decreased	Hypericin: P-gp; Hyperforin: induces intestinal and hepatic CYP3A4, CYP2B6, and P-gp	Human
Grapefruit juice	Increased (oral only)	Inhibits intestinal CYP3A4	Human
Ginger	Decreased (oral only)	Reduces gastrointestinal motility	Animal
Cannabidiol	Increased	Inhibits hepatic CYP3A4	Animal
Chamomile	Increased	Inhibits CYP3A4	Human (case report)
Liquorice	Decreased (oral only)	Induced P-gp and CYP3A4	Animal
Scutellariae radix	Decreased (oral only)	Induces CYP3A4 and intestinal P-gp	Animal
Quercetin	Decreased (oral only)	Induces CYP3A4 and intestinal P-gp	Animal
Resveratrol	Increased	Induces CYP3A4	Animal
Serenoa repens	Increased (speculative)	Potent inhibitor of CYP3A4, 2D6, and 2C9	In-vitro
Echinacea	Increased (speculative)	Possible inhibitor of CYP (data inconclusive)	In-vitro
Berberine	Increased	Inhibits CYP3A4 and intestinal P-gp	Human