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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".
- 1Tacrolimus, cyclosporine, sirolimus and everolimus are metabolised by the gut enzyme CYP3A4; grapefruit blocks it, so blood levels of the drug rise.
- 2The effect can last 24–72 hours — so spacing it "a few hours apart" does not help.
- 3Same risk: pomelo and Seville (bitter) orange, including marmalade. Regular sweet oranges, lemons and limes are not a problem.
- 4Ate some by accident? Do not reduce your dose yourself — contact your transplant team; an earlier drug-level test may be needed.
- 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.
Légende (prête à coller)
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 Vérifié le: 2026-10-16 Cartes et scripts sont des informations d'éducation à la santé issues de recommandations cliniques publiques. Ce ne sont pas des conseils médicaux individuels et ils ne remplacent pas l'évaluation de votre médecin, pharmacien ou diététicien. Conservez les sources et cet avertissement lors du partage ; cette page fait foi pour la version la plus récente. https://beyondckd.com/fr/cards/grapefruit-and-transplant-drugs
Script vidéo courte 60 s
Plans et voix off. Vertical 9:16 ; sous-titres dans le tiers inférieur. Chaque phrase renvoie aux sources à gauche.
| s | Image | Voix off |
|---|---|---|
| 0–5 | Halved grapefruit + pill organiser | The most common question after a transplant: why exactly is grapefruit off the menu? |
| 5–18 | Gut enzyme CYP3A4 "switched off", drug level curve rising | Anti-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. |
| 18–28 | Clock turning 24 → 72 h | And the effect lasts one to three days. So grapefruit in the morning and your tablet at night does not solve anything. |
| 28–40 | Left: pomelo, Seville orange ✗; right: orange, lemon, lime ✓ | Pomelo and Seville orange carry the same risk. Regular oranges, lemons and limes are fine. |
| 40–50 | Phone calling the transplant team | Ate some by accident? Do not cut your dose yourself. Call your transplant team — they may ask for an earlier drug-level test. |
| 50–60 | Star fruit ✗ + site logo + URL + QR | One more: star fruit is neurotoxic when kidney function is reduced — avoid it too. More interaction lookups at Beyond CKD. |
Sources (chaque point de la carte y renvoie)
- 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
Vérifié le: 2026-10-16
