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AFTER TRANSPLANTWhy no grapefruit withanti-rejection drugs?1Tacrolimus, cyclosporine, sirolimus and everolimusare metabolised by the gut enzyme CYP3A4;grapefruit blocks it, so blood levels of the drugrise.2The effect can last 24–72 hours — so spacing it "afew hours apart" does not help.3Same risk: pomelo and Seville (bitter) orange,including marmalade. Regular sweet oranges, lemonsand limes are not a problem.4Ate some by accident? Do not reduce your doseyourself — contact your transplant team; an earlierdrug-level test may be needed.5Also: star fruit is neurotoxic in people withreduced kidney function — avoid it after transplanttoo.Drugs and doses differ from person to person — ask your transplantteam or pharmacist if in doubt.BBeyond CKDbeyondckd.com/en/cards/grapefruit-and-transplant-drugsSources: FDA · Bailey DG et al. Grapefruit–medication interactions · 2026-10-16Compiled from public clinical guidelines · General education, not individual medical advice
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After transplant

Why no grapefruit with anti-rejection drugs?

The most-asked question after a transplant — and the answer is not just "eat it a few hours apart".

  1. 1Tacrolimus, cyclosporine, sirolimus and everolimus are metabolised by the gut enzyme CYP3A4; grapefruit blocks it, so blood levels of the drug rise.
  2. 2The effect can last 24–72 hours — so spacing it "a few hours apart" does not help.
  3. 3Same risk: pomelo and Seville (bitter) orange, including marmalade. Regular sweet oranges, lemons and limes are not a problem.
  4. 4Ate some by accident? Do not reduce your dose yourself — contact your transplant team; an earlier drug-level test may be needed.
  5. 5Also: star fruit is neurotoxic in people with reduced kidney function — avoid it after transplant too.

Drugs and doses differ from person to person — ask your transplant team or pharmacist if in doubt.

Caption (ready to paste)

The most-asked question after a transplant — and the answer is not just "eat it a few hours apart".

1. Tacrolimus, cyclosporine, sirolimus and everolimus are metabolised by the gut enzyme CYP3A4; grapefruit blocks it, so blood levels of the drug rise.
2. The effect can last 24–72 hours — so spacing it "a few hours apart" does not help.
3. Same risk: pomelo and Seville (bitter) orange, including marmalade. Regular sweet oranges, lemons and limes are not a problem.
4. Ate some by accident? Do not reduce your dose yourself — contact your transplant team; an earlier drug-level test may be needed.
5. Also: star fruit is neurotoxic in people with reduced kidney function — avoid it after transplant too.

Drugs and doses differ from person to person — ask your transplant team or pharmacist if in doubt.

Sources: FDA — Prograf (tacrolimus) Prescribing Information §7 Drug Interactions (grapefruit); Bailey DG et al. Grapefruit–medication interactions — CMAJ 2013;185:309-316; Neto MM et al. Star fruit intoxication — Nephrol Dial Transplant 2003;18:120
Verified: 2026-10-16

Cards and scripts are general health education compiled from public clinical guidelines. They are not individual medical advice and do not replace assessment by your doctor, pharmacist or dietitian. Please keep the sources and this notice when sharing; this page holds the latest version.
https://beyondckd.com/en/cards/grapefruit-and-transplant-drugs
60-second short-video script

Shot list and voice-over. Vertical 9:16; put captions in the lower third. Every line maps to the sources on the left.

secScreenVoice-over
0–5Halved grapefruit + pill organiserThe most common question after a transplant: why exactly is grapefruit off the menu?
5–18Gut enzyme CYP3A4 "switched off", drug level curve risingAnti-rejection drugs like tacrolimus, cyclosporine and sirolimus are broken down by a gut enzyme called CYP3A4. Grapefruit switches that enzyme off, so more drug gets absorbed and blood levels shoot up.
18–28Clock turning 24 → 72 hAnd the effect lasts one to three days. So grapefruit in the morning and your tablet at night does not solve anything.
28–40Left: pomelo, Seville orange ✗; right: orange, lemon, lime ✓Pomelo and Seville orange carry the same risk. Regular oranges, lemons and limes are fine.
40–50Phone calling the transplant teamAte some by accident? Do not cut your dose yourself. Call your transplant team — they may ask for an earlier drug-level test.
50–60Star fruit ✗ + site logo + URL + QROne more: star fruit is neurotoxic when kidney function is reduced — avoid it too. More interaction lookups at Beyond CKD.

Sources (every point on the card maps to one)

Verified: 2026-10-16