Immunosuppressants (Cyclosporine, Tacrolimus)
Common brand names: Neoral, Sandimmune, Prograf, Cellcept
Three nutrients listed against this medication. The most severe is marked critical.
At a glance
One of the three is marked well documented. The other two carry their own evidence levels.
At a glance
- MagnesiumCritical · Well documented
- Vitamin D3Moderate · Traditionally cited, limited evidence
- CoQ10Mild · Mechanism only, no human trial
Color shows how serious each listed effect is. The label beside it shows how strong the evidence is. The cards below explain each one and show its evidence.
Nutrients it can lower
Mechanism, Cyclosporine and tacrolimus cause renal magnesium wasting via inhibition of TRPM6 magnesium channels in renal tubules. Hypomagnesemia is common in transplant patients. Background figure, not from a trial cited on this record.
Common signs, Muscle cramps, tremor, seizures, cardiac arrhythmia, worsening nephrotoxicity
Navaneethan et al. (Transplant Proc, 2006; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 16797291): hypomagnesemia is common in transplant recipients on calcineurin inhibitors.
Magnesium glycinate was used at 300–600 mg daily, with serum magnesium monitored monthly; IV magnesium may be needed acutely.
Mechanism, Proposed mechanism: cyclosporine impairs mitochondrial function, and reduced CoQ10 synthesis has been suggested as one contributor to its kidney and heart toxicity. No human study shows cyclosporine or tacrolimus lowering CoQ10.
Common signs, Nephrotoxicity, cardiomyopathy, hypertension, fatigue
Mechanism only. No human study demonstrates that cyclosporine or tacrolimus depletes CoQ10. The supplementation literature that is usually cited here reports CoQ10 given alongside cyclosporine to mitigate cardiotoxicity, which is augmentation of an outcome and not evidence of a depletion. EBL states no depletion claim for this pair.
CoQ10 was used at 200–300 mg daily; drug levels are monitored when initiating, since CoQ10 can minimally affect cyclosporine levels.
Mechanism, Tacrolimus and cyclosporine impair renal 1-alpha hydroxylase, reducing conversion of 25-OH-D to active vitamin D. Vitamin D deficiency is highly prevalent in transplant patients. Background figure, not from a trial cited on this record.
Common signs, Osteoporosis (5–8% bone loss in first year post-transplant), fractures, immune dysregulation
Vitamin D deficiency is highly prevalent in transplant patients (Stein et al., 2011; PMID 21207011): an association reflecting illness and sun avoidance, not a demonstrated drug depletion.
Vitamin D3 2,000–5,000 IU plus K2 daily was used, with 25(OH)D tested quarterly; active D3 (calcitriol) may be needed where renal conversion is impaired.
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Disclosure
These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
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