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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.
Didascalia (pronta da incollare)
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. Fonti: 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 Verificato il: 2026-10-16 Schede e script sono informazione sanitaria generale tratta da linee guida cliniche pubbliche. Non sono consigli medici individuali e non sostituiscono la valutazione di medico, farmacista o dietista. Mantieni fonti e questa nota quando condividi; questa pagina contiene la versione più recente. https://beyondckd.com/it/cards/grapefruit-and-transplant-drugs
Script video breve 60 s
Inquadrature e voce fuori campo. Verticale 9:16; sottotitoli nel terzo inferiore. Ogni frase rimanda alle fonti a sinistra.
| s | Schermo | Voce |
|---|---|---|
| 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. |
Fonti (ogni punto della scheda vi corrisponde)
- 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
Verificato il: 2026-10-16
