Immunosuppressants (Anti-Rejection)

Immunosuppressants (Anti-Rejection) are medicines in the immune drug class and immunosuppressant family. They are used as anti-rejection medicines and include Cyclosporine (Neoral), Tacrolimus (Prograf), Sirolimus (Rapamune), Mycophenolate (CellCept), and Azathioprine (Imuran), among other immunosuppressive therapies and agents.

This page provides educational reference information about how supplements such as Black Elderberry, Reishi, and others may interact with common anti-rejection medicines. Anyone considering supplements alongside treatment should consult a clinician about their specific medical condition.

The most serious concern is Saccharomyces Boulardii. Because immunosuppression can impair clearance of this viable yeast, it has a documented risk of fungemia and systemic infection, particularly when intestinal barriers are disrupted or a central venous catheter is present. This combination warrants discussion with a prescriber or pharmacist before use.

Several other combinations involve possible opposition to the intended immune-suppressing effect. Ashwagandha, Astragalus, Echinacea, Lion's Mane, Melatonin, Panax Ginseng, Reishi, Spirulina, and Turkey Tail may stimulate or modulate immune function, while Black Elderberry, Cordyceps, and American Ginseng raise mainly theoretical concerns. The clinical importance is not established for every pair, but the issue is especially relevant to transplant recipients and people being treated for autoimmune disease. Tongkat Ali (Eurycoma) and Shilajit also raise concerns because immune-modulating or preclinical immune-activating effects could interfere with therapy; clinical interaction data for Shilajit are absent.

Some combinations call for monitoring rather than a demonstrated harmful outcome. Coenzyme Q10 may affect cyclosporine and tacrolimus levels. L-Leucine affects the mTOR pathway, creating a theoretical concern with sirolimus or everolimus, although a clinically proven interaction is not established. Glutathione and Selenium likewise have theoretical concerns without clinical evidence showing treatment failure, rejection, toxicity, or reduced immunosuppressive effects. No listed supplement is described as providing a useful combination with immunosuppressants. A clinician or pharmacist can help assess the specific immunosuppressive regimen and transplant or autoimmune context.