Why Shouldn't You Take Medicine with Grapefruit Juice?
Grapefruit Juice and Heart Medications — Dangerous Combo?
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I have type 2 diabetes, high cholesterol, and high blood pressure, and am on medication for all. I know grapefruit can interfere with my meds, but is an occasional serving going to hurt me?
— Alan, Nevada
This is a question I am often asked by my patients, in particular those who are taking statins to help lower their high cholesterol. That’s because it has long been known that grapefruit and grapefruit juice, as well as some other juices, including sour Seville orange juice (often used in marmalade), can inhibit the metabolism of statin drugs such as Lipitor (atorvastatin), Zocor (simvastatin), and Mevacor (lovastatin), increasing their potency and causing potential side effects. (Please see my article, Hold the Grapefruit Juice, for more on this.) Interestingly, two other statins, Crestor (rosuvastatin ) and Pravachol (pravastatin) are not affected the same way by grapefruit or the juice.
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Less well known is that grapefruit can also affect blood pressure meds. I don’t know what you are taking for your blood pressure, but grapefruit juice can heighten the potency of the calcium channel blockers Nimotop (nimodipine), felodipine (Nitrendipine, Plendil), pranidipine, nisoldipine (Sular), nicardipine (Cardene), and verapamil (Verelan, Calan). This is important to be aware of, because if your blood pressure falls too low, you may get light-headed and pass out. While an occasional small glass of grapefruit juice probably won’t hurt you, it’s important to remember that its effects are not immediate and can persist for up to 24 hours. In other words, the grapefruit juice does not have to be taken at the same time as the medication for an interaction to occur. Studies have been done where double-strength grapefruit juice was administered multiple times daily in people taking lovastatin, and it increased concentrations of the drug more than tenfold. Single-strength grapefruit juice taken once daily, however, resulted in a twofold increase. The source of the juice and whether it’s reconstituted, frozen, canned, or fresh, can also factor into its effects. You should also beware of citrus juice blends that may contain grapefruit juice and dietary supplements that contain grapefruit bioflavonoids.
Interestingly, new evidence suggests that grapefruit and other common fruit juices, including possibly orange and apple, can also substantiallydecreasethe absorption of certain other drugs, potentially wiping out their beneficial effects. In a study presented in 2008 at the national meeting of the American Chemical Society, healthy volunteers took a dose of the antihistamine fexofenadine (Allegra, Telfast, and others) with water or juice. When the drug was taken with grapefruit juice, only half of the dose was absorbed into the bloodstream compared to when it was taken with water. Other drugs affected the same way are the chemotherapy drug etoposide; certain beta-blockers used to control high blood pressure; cyclosporine, which is used to prevent rejection of transplanted organs; and certain antibiotics. The researchers anticipate more drugs will be added to this list but also admit that more research is needed in this area.
Today, many drugs carry labels warning consumers against taking them with grapefruit juice or fresh grapefruit. But to be on the safe side, I would consult your own doctor about whether this is true for the specific medications you are on.
Video: Grapefruit Juice Has Serious Side Effects With Certain Medications
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