Grapefruit–drug interactions

Some fruit juices and fruits can interact with numerous drugs, in many cases causing adverse effects.[1] The effect is most studied with grapefruit and grapefruit juice,[1] but similar effects have been observed with certain other citrus fruits.[1][2][3][4]

One whole grapefruit, or a small glass (200 mL, 6.8 US fl oz) of grapefruit juice, can cause drug overdose toxicity in patients taking felodipine.[1] Fruit consumed three days before the medicine can still have an effect.[5] The relative risks of different types of citrus fruit have not been systematically studied.[1] Affected drugs typically have an auxiliary label saying "Do not take with grapefruit" on the container, and the interaction is elaborated upon in the package insert.[6] People are advised to ask their physician or pharmacist about drug interactions.[6] However, some experts believe that for the majority of patients, complete avoidance of grapefruit is unwarranted.[7]

Although a prospective cohort study of middle-aged women indicated that some flavonoid-rich foods are associated with a reduction in all-cause mortality, frequent grapefruit consumption was associated with a small increase in all-cause mortality, possibly because of the clinically significant drug interactions of the non-flavonoid components.[8]

  1. ^ a b c d e Bailey, D. G.; Dresser, G.; Arnold, J. M. O. (2013). "Grapefruit-medication interactions: Forbidden fruit or avoidable consequences?". Canadian Medical Association Journal. 185 (4): 309–316. doi:10.1503/cmaj.120951. PMC 3589309. PMID 23184849.
  2. ^ Bailey, D.G.; Dresser, G.K.; Bend, J.R. (June 2003). "Bergamottin, lime juice, and red wine as inhibitors of cytochrome P450 3a4 activity: comparison with grapefruit juice". Clinical Pharmacology & Therapeutics. 73 (6): 529–537. doi:10.1016/S0009-9236(03)00051-1. PMID 12811362. S2CID 45359353.
  3. ^ Gallagher, James (26 November 2012). "Grapefruit and pills mix warning". BBC News.
  4. ^ Chen, M.; Zhou, S. Y.; Fabriaga, E.; Zhang, P. H.; Zhou, Q. (April 2018). "Food–drug interactions precipitated by fruit juices other than grapefruit juice: An update review". J Food Drug Anal. 26 (2S): S61 – S71. doi:10.1016/j.jfda.2018.01.009. PMC 9326888. PMID 29703387.
  5. ^ Cite error: The named reference pmid12891222 was invoked but never defined (see the help page).
  6. ^ a b Mitchell, Steve (19 February 2016). "Why Grapefruit and Medication Can Be a Dangerous Mix". Consumer Reports. Retrieved 4 May 2016.
  7. ^ Cite error: The named reference pmid21254874 was invoked but never defined (see the help page).
  8. ^ Ivey KL, Jensen MK, Rimm EB (2017). "Association of flavonoid-rich foods and flavonoids with risk of all-cause mortality". British Journal of Nutrition. 117 (10): 470–1477. doi:10.1017/S0007114517001325. PMC 7233415. PMID 28606222.
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