Food increases the absorption of cyclosporine. A change in the timing of food and cyclosporine dosing may alter cyclosporine blood levels, requiring dose adjustment.
In a randomized study of nine adults with cyclosporine-treated autoimmune diseases, grapefruit juice (5 ounces two times per day with cyclosporine, for ten days) caused a significant increase in cyclosporine blood levels compared with cyclosporine with water. The rise in cyclosporine blood levels was associated with abdominal pain, lightheadedness, nausea, and tremor in one patient. A similar interaction between grapefruit juice and cyclosporine has been observed in healthy volunteers. Using grapefruit juice to reduce the amount of cyclosporine needed has not been sufficiently studied and cannot therefore be counted on to produce a predictable change in cyclosporine requirements. The same effects might be seen from eating grapefruit as from drinking its juice.
Pomegranate juice has been shown to inhibit the same enzyme that is inhibited by grapefruit juice. The degree of inhibition is about the same for each of these juices. Therefore, it would be reasonable to expect that pomegranate juice might interact with cyclosporine in the same way that grapefruit juice does.
Ingestion of red wine along with cyclosporine has been found to reduce blood levels of the drug. Individuals taking cyclosporine should, therefore, not consume red wine at the same time as they take the drug. It is not known whether red wine consumed at a different time of the day would affect the availability of cyclosporine. Until more is known, it seems prudent for people taking cyclosporine to avoid red wine altogether.
Mixing Sandimmune solution with room-temperature milk, chocolate milk, orange juice, or apple juice may improve its flavor.
Mixing Neoral solution with room temperature orange or apple juice may improve its flavor, but combining it with milk makes an unpalatable mix.