Journal of Toxicology / 2014 / Article / Tab 1

Review Article

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 extractEffect of interaction on CyA bioavailabilityMechanism of interactionStudies

St John’s wortDecreasedHypericin: P-gp
Hyperforin: induces intestinal and hepatic CYP3A4, CYP2B6, and P-gp
Grapefruit juiceIncreased (oral only)Inhibits intestinal CYP3A4Human
GingerDecreased (oral only)Reduces gastrointestinal motilityAnimal
CannabidiolIncreasedInhibits hepatic CYP3A4Animal
ChamomileIncreasedInhibits CYP3A4Human (case report)
LiquoriceDecreased (oral only)Induced P-gp and CYP3A4Animal
Scutellariae radixDecreased (oral only)Induces CYP3A4 and intestinal P-gpAnimal
QuercetinDecreased (oral only)Induces CYP3A4 and intestinal P-gpAnimal
ResveratrolIncreasedInduces CYP3A4Animal
Serenoa repens Increased (speculative)Potent inhibitor of CYP3A4, 2D6, and 2C9In-vitro
Echinacea Increased (speculative)Possible inhibitor of CYP (data inconclusive)In-vitro
BerberineIncreasedInhibits CYP3A4 and intestinal P-gpHuman

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