Drug & supplement interaction

Vitamin E + Cyclosporine

Cyclosporine brand names: Neoral, Gengraf, Sandimmune, Ciclosporine, Cequa, and others.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Cyclosporine falls into 2 drug categories that Vitamin E can interact with; the most serious is rated moderate. Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Vitamin E and Cyclosporine

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Vitamin E interacts with whole categories of medication. Cyclosporine falls into 2 of those categories, so it can interact with Vitamin E in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

1 of 2

Why this applies to Cyclosporine

Cyclosporine falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group Vitamin E interacts with.

Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Vitamin E appears to bind with the nuclear receptor, pregnane X receptor (PXR), which results in increased expression of CYP3A4. Although the clinical significance of this is not known, use caution when considering concomitant use of vitamin E and other drugs affected by these enzymes.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the idea behind this pairing. Your body clears cyclosporine using a liver enzyme called CYP3A4. In lab studies, high-dose vitamin E may gently nudge that enzyme to work faster. If that happened in real life, your cyclosporine could get cleared a little quicker, which might lower its levels in your blood.

Why does that matter? Cyclosporine is a drug where the right blood level really counts. If levels dip too low after a transplant, there's a worry about organ rejection; for arthritis or psoriasis, your symptoms could creep back. Now, this is only a theoretical concern, not proven in people, and everyday food amounts of vitamin E shouldn't be an issue. Still, before starting high-dose vitamin E, please check with your transplant team or pharmacist.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Landes N, Pfluger P, Kluth D, et al. Vitamin E activates gene expression via the pregnane X receptor. Biochem Pharmacol 2003;65:269-73. . PubMed
  2. Brigelius-Flohe R. Vitamin E and drug metabolism. Biochem Biophys Res Commun 2003;305:737-40. PubMed
Moderate

CYCLOSPORINE (Neoral, Sandimmune)

2 of 2
A specific form of vitamin E might increase absorption and levels of cyclosporine.
There is some evidence that one specific formulation of vitamin E (D-alpha-tocopheryl-polyethylene glycol-1000 succinate, TPGS, tocophersolan, Liqui-E) might increase absorption of cyclosporine. This vitamin E formulation forms micelles which seems to increase absorption of cyclosporine by 40% to 72% in some patients. However, this interaction is unlikely to occur with the usual forms of vitamin E.
Severity Moderate Likelihood Unlikely Evidence B

Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the key thing to know: most everyday vitamin E supplements are not expected to interfere with your cyclosporine. The concern applies to one special water-soluble form called TPGS (tocophersolan, sometimes sold as Liqui-E). That particular form can help your gut absorb more cyclosporine, raising your blood levels by roughly 40% to 70% in some people.

Cyclosporine is a narrow-window medication, so higher levels can mean more side effects like kidney strain, high blood pressure, tremor, or extra gum growth. Since transplant teams adjust your dose based on exact blood levels, an unexpected bump matters. The good news is this is unlikely with regular vitamin E. Still, before starting any vitamin E product, please check with your transplant pharmacist or doctor so they can confirm it's a safe form and amount.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Chang T, Benet LZ, Hebert MF. The effect of water-soluble vitamin E on cyclosporine pharmacokinetics in healthy volunteers. Clin Pharmacol Ther 1996;59:297-303. PubMed
  2. Pan SH, Lopez RR Jr, Sher LS, et al. Enhanced oral cyclosporine absorption with water-soluble vitamin E early after liver transplantation. Pharmacother 1996;16:59-65. DOI
  3. Sokol RJ, Johnson KE, Karrer FM, et al. Improvement of cyclosporin absorption in children after liver transplantation by means of water-soluble vitamin E. Lancet 1991;338:212-4.. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Vitamin E Also Interacts With Other Medications

Vitamin E has 762 moderate, 1 minor known drug interactions in our database — the Cyclosporine one above is among them. If you take anything else, check it against the full list below.

Moderate 762 Minor 1 No known interaction 2,067 (incl. Cyclosporine)
Taking anything else?

Check Another of Your Medications Against Vitamin E

Covers the 2,830 medications we’ve checked against Vitamin E. Pick one to open its full report.

From our Q&A

Questions About Vitamin E or Cyclosporine

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Vitamin E or Cyclosporine, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Cyclosporine

This page covers Vitamin E only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Cyclosporine page lists 229 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Asarabacca (major), Beer (major), Berberine (major) and Grapefruit (major).

By severity: 9 major · 182 moderate · 38 minor.

From our pharmacist’s overview on the Cyclosporine page

“Cyclosporine (Neoral, Sandimmune, Gengraf) keeps a transplanted organ from being rejected, and small shifts in its blood level can tip you toward rejection on one side or toxicity on the other. So approach these 229 interacting supplements with real care.”

Reviewed by 2 · Jul 18, 2026

Open the Cyclosporine interaction page

One more smart check

Taking Vitamin E as Part of a Dietary Supplement Product? Check It for Interactions

We hold 22,182 real supplement products containing Vitamin E, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Vitamin E. Your product may carry other ingredients that interact with Cyclosporine too, on top of Vitamin E — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Vitamin E and Cyclosporine Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Vitamin E
Top 10

#10 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Cyclosporine
Top 25%

#633 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Vitamin E

What is Vitamin E?

Vitamin E
  • General antioxidant support
  • Skin and hair care
  • Heart health
  • Eye health (age-related conditions)
  • Immune support

Vitamin E is an essential fat-soluble vitamin and antioxidant that most people get in adequate amounts from a normal diet. Supplements can help correct a true deficiency, but high-dose vitamin E has not been clearly proven to prevent heart disease or cancer and may carry risks. Talk to your pharmacist or doctor before taking high doses.

Read the full Vitamin E monograph & all interactions
Medication

About Cyclosporine

What Is Cyclosporine Used For?

Brand names: Neoral, Gengraf, Sandimmune, Ciclosporine, Cequa, Verkazia, Vevye

Cyclosporine is prescribed to help prevent the body from rejecting a transplanted kidney, liver, or heart. It is often used alongside other immunosuppressive medicines as part of a full transplant care plan.

It is also used for adults with severe, active rheumatoid arthritis that hasn't responded well enough to methotrexate, and for adults with severe plaque psoriasis who haven't had success with other standard treatments.

See full Cyclosporine drug information
Keep checking

Other Drugs & Vitamin E

Browse every other medication we’ve checked against Vitamin E — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
762Moderate
1Minor
2,066No known interaction
762 Moderate 1 Minor 2,066 No interaction
Moderate

762 interactions

Showing 60 of 762 moderate interactions — see all 762 on the Vitamin E page.

Minor

1 interaction

No interaction 2,066 drugs checked — show the list

We also checked Vitamin E against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,066 medications checked with no known interaction — see the full Vitamin E list.

See the full Vitamin E interactions page
See every supplement checked against Cyclosporine, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Vitamin E monograph › Uses, safety, and every drug interaction in one place Cyclosporine supplement interactions › Every supplement checked against Cyclosporine, ranked by severity Cyclosporine drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Vitamin E and Cyclosporine Together: Common Questions

Can you take Vitamin E with Cyclosporine?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for Vitamin E and Cyclosporine?
Cyclosporine belongs to more than one drug category, and Vitamin E interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Vitamin E and Cyclosporine interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Cyclosporine and Vitamin E?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.