Background: It is still controversial whether pomegranate causes drug interactions.
Pomegranate juice has been shown to inhibit CYP3A in-vitro and animal studies. The coadministration
of pomegranate juice with cyclosporine, a narrow therapeutic drug that is the substrate
of CYP3A, might lead to drug toxicity. The objective of this study is to investigate the effect
of pomegranate juice on the pharmacokinetics of cyclosporine in healthy Thai volunteers.
Methods: The study design was an open-label, randomized, single dose, crossover study with a 2-
week washout period. Each fasting subject received 2 microemulsion tablets of 100 mg of cyclosporine
with 500 ml of pomegranate juice (test) or 500 ml of water (control). Serial blood samples
were collected up to 24 h after dosing, and blood samples were analyzed for cyclosporine concentrations
by using chemiluminescent microparticle immunoassay. Fourteen healthy volunteers
completed the study.
Results: The 90% confidence intervals for the test/control ratio using logarithmically transformed
data of area under the concentration-time curve (AUC) from time zero until the last measured concentration
(AUC0-t), AUC from time zero to infinity (AUC0-∞), and maximum concentration (Cmax)
were 91.6-105.6, 92.0-105.2 and 82.3-102.5, respectively. The results were within the accepted
bioequivalence range for narrow therapeutic index drugs (90-111% for AUC and 80-125% for
Cmax). There were no differences in adverse event between the groups.
Conclusion: Single dose administration of pomegranate juice with cyclosporine did not significantly
affect the oral bioavailability of cyclosporine. However, further work is needed to thoroughly
evaluate the effect of pomegranate on narrow therapeutic drugs.