Cyclosporine

Cyclosporine has been associated with low blood magnesium levels and undesirable side effects. Some doctors suggest monitoring the level of magnesium in red blood cells, rather than in serum, as the red blood cell test may be more sensitive for evaluating magnesium status.

Ginkgo was reported to protect liver cells from damage caused by cyclosporine in a test tube experiment. A Ginkgo biloba extract partially reversed cyclosporine-induced reduced kidney function in a study of isolated rat kidneys. Human trials have not studied the actions of ginkgo to prevent or reduce the side effects of cyclosporine.

Several studies have shown that in organ transplant patients treated with cyclosporine, addition of 4–6 grams per day of omega-3 fatty acids from fish oil helped reduce high blood pressure, though not every study has found fish oil helpful. It remains unclear to what extent fish oil supplementation will help people with high blood pressure taking cyclosporine following organ transplant.

Twenty-six liver transplant patients (both adults and children) unable to achieve or maintain therapeutic cyclosporine blood levels during the early post-transplant period were given water-soluble vitamin E in the amount of 6.25 IU/2.2 pounds of body weight two times per day. Addition of vitamin E in the early post-transplant period reduced the required amount of cyclosporine and the cost of cyclosporine therapy by 26%. These results imply that the addition of vitamin E to established cyclosporine therapy allows for a decrease in the amount of cyclosporine. Combining vitamin E and cyclosporine requires medical supervision to avoid cyclosporine toxicity.

In a study in rats, oral administration of Chinese scullcap at the same time as cyclosporine significantly reduced the absorption of cyclosporine. Chinese scullcap did not interfere with the availability of cyclosporine when cyclosporine was given intravenously. Because of the potential adverse interaction, people taking cyclosporine should not take Chinese scullcap.

Pharmacological research from Europe suggests that St. John’s wort (Hypericum perforatum)may reduce plasma levels of cyclosporine. Two case reports also describe heart transplant patients taking cyclosporine who showed signs of acute transplant rejection after taking St. John’s wort extract. In both cases, reduced plasma concentrations of cyclosporine were found. One report cites similar findings in three patients taking cyclosporine and St. John’s wort together. Finally, similar drops in cyclosporine blood levels were reported in 45 kidney or liver transplant patients who began taking St. John’s wort. Until more is known, people taking cyclosporine should avoid the use of St. John’s wort.

Cyclosporine can cause excess retention of potassium, potentially leading to dangerous levels of the mineral in the blood (hyperkalemia). Potassium supplements, potassium-containing salt substitutes (No Salt, Morton Salt Substitute, and others), and even high-potassium foods (primarily fruit) should be avoided by people taking cyclosporine, unless directed otherwise by their doctor.

In an animal study, oral administration of quercetin (50 mg per 2.2 pounds of body weight) at the same time as cyclosporine decreased the absorption of cyclosporine by 43%. However, in a study of healthy human volunteers, supplementing with quercetin along with cyclosporine significantly increased blood levels of cyclosporine, when compared with administering cyclosporine alone. Because the effect of quercetin supplementation on cyclosporine absorption or utilization appears to be unpredictable, individuals taking cyclosporine should not take quercetin without the supervision of a doctor.