Grapefruit and medicines: Can they mix?
The bottom line
At least 85 drugs are known or thought to interact with grapefruit. Grapefruit products can cause those drugs to stay in your system much longer than usual. The effects are like a drug overdose. They can include dangerous heart rhythms, kidney damage, muscle damage, respiratory depression, and bleeding from the stomach or intestines.
Prevention Tips
Look at your prescription medicine bottle. If there's a sticker warning you about grapefruit, don't eat or drink any grapefruit products.
If you're not sure, ask your doctor and pharmacist if it's safe to take grapefruit with your medicine.
This Really Happened
Case 1: A 52-year-old man was taking sertraline and bupropion for depression. One day, he drank a large amount of grapefruit juice. The following day, he developed a severe headache. He called his poison center because of his symptoms. There is a known drug interaction between sertraline and grapefruit juice; when they are taken together, there is an increased risk of side effects or toxicity from the sertraline. The man was advised to discontinue his sertraline for a few days. After doing so, his headache resolved.
Case 2: A 50-year-old woman was taking amlodipine, atenolol, and clonidine for high blood pressure. She drank about 6–8 ounces of grapefruit juice with every meal for 2 days. On the third day, she began experiencing lightheadedness, dizziness, and nausea. The grapefruit juice was interacting with her amlodipine, which made her blood pressure drop too low. Her poison center recommended that she stop drinking the grapefruit juice. She followed the poison center's directions, and her symptoms resolved in 3 days.
Can I drink grapefruit juice with my medicines?
While citrus fruits are often celebrated for their health-promoting effects, the consumption of certain citrus fruits can cause interactions with many prescription and over-the-counter medications. This phenomenon was initially reported in a 1989 study that investigated the potential interactions between ethanol and felodipine, a drug used to treat high blood pressure. In this study, participants took either a drink without ethanol (the placebo) or a drink that had ethanol mixed with grapefruit juice to mask the taste, followed by a dose of the blood pressure drug. Surprisingly, blood concentrations of felodipine were significantly higher in the people who consumed felodipine with the ethanol/grapefruit juice mixture than in those who took felodipine with the placebo drink. The people who drank ethanol or grapefruit juice also had lower blood pressures than the study participants who consumed placebo. The study authors concluded that this clinical effect was possibly due to an unexpected effect of the grapefruit juice. Since then, multiple other studies have evaluated the potential interactions between grapefruit juice and medications.
How does grapefruit juice interact with some medications?
Grapefruit contains multiple natural compounds, including flavonoids, organic acids, and carotenoids. Grapefruit is also our largest dietary source of furanocoumarins. Furanocoumarins are natural compounds that play a role in citrus plant defense mechanisms against insects and other stressors. In humans, the prominent furanocoumarins that are present in grapefruit are also known to block the activity of intestinal enzymes that assist in the breakdown of many medications. These enzymes, known as cytochrome P450 3A4, are involved in the metabolism of numerous prescription and over-the-counter drugs. When people who take these medications drink grapefruit juice or consume fresh grapefruit, the body might not break down the medications in a normal manner, and this can lead to unwanted side effects and toxicity in susceptible individuals. Grapefruit juice also affects the activity of p-glycoprotein, a protein system that helps transport drugs back and forth across cell membranes in our bodies. Grapefruit juice’s effects on p-glycoprotein can result in higher or lower concentrations of medications in the body, and this side effect of grapefruit juice can cause both adverse effects and decreased medication effectiveness, depending on the individual.
Since the actions of many medications within our bodies are affected by both p-glycoprotein and cytochrome P450 3A4, consumption of grapefruit juice can be harmful for some people. Because there is considerable variability in how our bodies process and metabolize medications, some people are more susceptible to drug interactions related to grapefruit juice consumption. Because of this, people should talk with their doctor and pharmacist about potential drug interactions, including the impact of drinking grapefruit juice, when starting any new medication. Fortunately, most people can safely consume other citrus juices, including orange juice, without experiencing similar drug interactions, although adverse drug reactions have rarely been reported in individuals who consume pomelo, noni, and cranberry juices.
What medicines should not be taken with grapefruit?
Interactions with grapefruit can occur with several different kinds of medications. Some examples of medications that should not be taken with grapefruit or grapefruit juice include (but are not limited to) felodipine (Plendil) and some other calcium channel blockers, certain statin cholesterol drugs such as atorvastatin (Lipitor), lovastatin, and simvastatin (Zocor), as well as clarithromycin (Biaxin), fexofenadine (Allegra), and buspirone (BuSpar). To find out if your medication interacts with grapefruit juice, read the package insert or label, or talk with your doctor and pharmacist. If there is an interaction present, you’ll want to avoid consumption of grapefruit and grapefruit juice, but you can likely still enjoy other fruits and fruit juices.
If you have questions about medicine interactions, contact Poison Control for expert advice. Help from Poison Control is available at www.poison.org and by phone at 1-800-222-1222. Both options are free, confidential, and available 24 hours a day.
