Supplements and Immunosuppressants

St. John's wort can cause transplant rejection. It lowers blood levels of cyclosporine and tacrolimus. Never combine.

Ashwagandha may stimulate the immune system. It could counteract immunosuppressive drugs. Avoid unless your doctor approves.

Berberine can raise cyclosporine levels. In kidney-transplant patients, berberine increased cyclosporine blood concentrations. Don't combine without your transplant team.

Live microbes with a suppressed immune system. Rare but serious infections from probiotic organisms have been reported in immunocompromised people.

Red yeast rice has statin-type drug interactions. Products with significant monacolin K can interact with the same medicines statins do; drugs such as cyclosporine raise statin levels and muscle-damage risk. Check with your prescriber.

Licorice interacts with corticosteroids. Interactions between licorice and corticosteroids have been reported. Check with your prescriber.

Echinacea may work against immunosuppressants. It's taken to stimulate the immune system, and NIH notes theoretical reasons it might interact with immunosuppressants. Avoid unless your doctor agrees.