Dangers of Grapefruit

Did you know more than 85 drugs interfere badly with grapefruit, with 43 of them dangerously so?  The same problem can happen with limes, Seville oranges, & pomelos.  The interaction between grapefruit, whether in the form of the fruit or the juice, and certain medications can be significant. The interaction occurs because a substance in grapefruit interferes with the breakdown, or metabolism, of the medication. As a result, the patient ends up inadvertently taking more, or in the case of fexofenadine, less, than the prescribed amount.
What Drugs Interact With Grapefruit?
Cholesterol Medication The consumption of grapefruit (or grapefruit juice) increases the concentration of lovastatin, a cholesterol-lowering medication, in the bloodstream, resulting in potentially toxic levels of the drug. Antihistamines Unlike many of the other drugs that interact with grapefruit juice, according to a study out of the London Health Sciences Centre in Ontario, fexofenadine, an antihistamine, levels actually decrease with the consumption of normal quantities of grapefruit juice (300 ml, which is a little more than a cup of juice). According to Graedon's Guide to Grapefruit Interactions, published by The People's Pharmacy, grapefruit as a whole fruit & grapefruit juice have the same effect. Immunosuppressant Cyclosporine, sirolimus and tacrolimus, used by transplant patients, are immunosuppressants, which means they "turn down" the immune system. It is used after organ transplants to help prevent rejection by the transplant recipient, and for active rheumatoid arthritis. The list of potential side effects is a long one and includes a higher risk of infections (since the immune system is less able to fight off infections), headaches, high blood pressure, nausea, diarrhea, abnormal hairiness and tremor. Since grapefruit impacts the breakdown of cyclosporine, patients who eat grapefruit (or drink grapefruit juice) while on cyclosporine will have higher concentrations of the medication in their bloodstreams Calcium channel blockers Amlodipine is in a class of drugs called calcium channel blockers. The class as a whole may be used for a variety of conditions, but amlodipine is most often used to treat high blood pressure and to help patients who have angina (chest pain caused by a decreased blood supply to the heart). Levels of amlodipine will be higher than prescribed if patients consume grapefruit in any form (juice or whole fruit) while on this drug. Medications in this class that interact with grapefruit include felodipine, brand name Plendil, and nifedipine. Heart Rhythm Medications Quinidine & amiodarone, two drugs that are used to control abnormal heart rhythms, compete with grapefruit for metabolization by the CYP3A4 enzyme complex. Amiodarone may not be effective in treating heart rhythm abnormalities when taken with grapefruit. This drug is an anti-arrhythmic medication that works to normalize an irregular or fast heart rate. Hormones Oral contraceptives and agents used for hormone replacement therapy, such as estradiol, are among the drugs that are affected by grapefruit. As is the case with other medications, grapefruit increases your blood levels of these hormones, which raises the risk of side effects, such as blood clots, headaches, nausea and vomiting, breast tenderness and excessive vaginal bleeding. Statins Statins are drugs used to lower high cholesterol levels. MayoClinic.com lists several statins that interact with grapefruit, including simvastatin, lovastatin and atorvastatin. The consumption of grapefruit with a statin drug increases the likelihood of the usual side effects associated with statin use, which include liver damage, muscle injury and kidney failure. If you eat a lot of grapefruit or drink a lot of grapefruit juice, you may want to ask your physician about statins that will not interact with the fruit, like fluvastatin, pravastatin, or rosuvastatil, notes Harvard Medical School. Neurological and Psychological Medications Various medications used for neurological and psychological conditions, like anxiety or depression, also interact with grapefruit. These medications include benzodiazepines like diazepam and triazolam and antidepressants like buspirone and sertraline, says the Harvard School of Medicine. Anti-seizure medications like carbamazepine can also be affected by grapefruit, adds MayoClinic.com. Buspirone is a medication used to treat anxiety. Unfortunately, eating a grapefruit while taking buspirone can decrease its effectiveness. Medications that have little to no interaction with grapefruit include clonazepam, flurazepam, haloperidol and zolpidem. Sedatives and Anticonvulsants Among the sedatives and anti-anxiety medications affected by grapefruit are diazepam, zaleplon, buspirone and triazolam. Carbamazepine, a drug used to control seizures, interacts with grapefruit, too. Increased blood levels of these medications caused by ingestion of grapefruit will intensify their side effects. More MayoClinic.com lists other medications that may be affected by grapefruit, including certain antibiotics, the anti-arrhythmia drug amiodarone, the antihistamine fexofenadine, and several anti-retroviral drugs used to treat HIV & AIDS, including saquinavir, ritonavir, & indinavir. Researchers have found that grapefruit, orange & apple juices reduce absorption of the anticancer drug etoposide.  Dextromethorphan, an over-the-counter cough remedy, is also affected by grapefruit.
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