Some people have a lot of enzymes and others just a little. The effects of grapefruit on some medications are so far-reaching that the Food and Drug Administration (FDA) now requires some prescription and over-the-counter drugs taken by mouth to include warnings against drinking grapefruit juice or eating grapefruit while taking the drug. ][29][30], The location of the inhibition occurs in the lining of the intestines, not within the liver. Depending on growing and processing conditions, concentrations of the interacting polyphenol compounds can vary dramatically. [12] As a result, many drugs are impacted by consumption of citrus juice. [11] These chemicals inhibit key drug metabolizing enzymes, such as cytochrome P450 3A4 (CYP3A4). [43] When should you see a pulmonologist for a cough? So grapefruit juice may affect people differently even when they take the same drug. The effects of grapefruit on some medications are so far-reaching that the Food and Drug Administration (FDA) now requires some prescription and over-the-counter drugs … [1][3][4][5] One medical review advised patients to avoid all citrus.[6]. Pandit Introduction to Pharmaceutical Sciences, Jellin J.M., et al. Veronese ML, Gillen LP, Burke JP, Dorval EP, Hauck WW, Pequignot E, Waldman SA, Greenberg HE. “When there is too much drug in the blood, you may have more side effects.”. © Health24 2000 - 2020. Do not eat those fruits if your medicine interacts with grapefruit juice. Before sharing sensitive information, make sure you're on a federal government site. However, many of the citrus cultivars known to be problematic seem to be closely related. 7th ed. [34][35] These limes can also inhibit drug metabolism. [35][36] Bitter oranges (such as the Seville oranges often used in marmalade) can interfere with drugs[39] including etoposide, a chemotherapy drug, some beta blocker drugs used to treat high blood pressure, and cyclosporine, taken by transplant patients to prevent rejection of their new organs. CYP3A4 is a metabolizing enzyme for almost 50% of drugs, and is found in the liver and small intestinal epithelial cells. P-glycoprotein (Pgp) transports lipophilic molecules out of the enterocyte back into the intestinal lumen. Fruits are often sold as mandarin, tangerine, or satsuma (which may be synonyms[40]). Seville oranges (often used to make orange marmalade), pomelos, and tangelos (a cross between tangerines and grapefruit) may have the same effect as grapefruit juice. 10 ways to make yourself poop first thing in the morning, OPINION | Unpacking the legal and ethical aspects of South Africa’s Covid-19 track and trace app, Covid-19: No deal yet to access '90% effective' vaccine tested in South Africa, which claims your medical scheme doesn't have to pay, Yes, I've been living with it for a while, Cholesterol-lowering statin drugs, such as Zocor (simvastatin) and Lipitor (atorvastatin), High blood pressure drugs, such as Procardia and Adalat CC (both nifedipine). Consuming grapefruit, whether the whole fruit, its juice, or any product that contains it, the normal functioning of the CYP3A4 enzyme is blocked, causing a lower metabolization of the drugs. And, the severity of the interaction can differ depending on the person, the drug and the amount of grapefruit juice consumed, the FDA said. Exposure-dependent inhibition of intestinal and hepatic CYP3A4 in vivo by grapefruit juice. [9] The relative risks of different types of citrus fruit have not been systematically studied. This food and drug interaction can be a concern, says Shiew Mei Huang, PhD, of the U.S. Food and Drug Administration. According to a review done by the Canadian Medical Association, there is an increase in the number of potential drugs that can interact with grapefruit juice, and of the number of fruit types that can interact with those drugs. Talk to your doctor, pharmacist or other health care provider and read any information provided with your prescription or OTC drug to find out: With most drugs that interact with grapefruit juice, “the juice lets more of the drug enter the blood,” Huang says. [1] However, the effects on the CYP3A4 in the liver could in principle cause interactions with non-oral drugs,[citation needed] and non-CYP3A4-mediated effects also exist.[28]. CYP3A4 is a metabolizing enzyme for almost 50% of drugs, and is found in the liver and small intestinal epithelial cells. Many citrus cultivars are hybrids of a small number of ancestral species, which have now been fully genetically sequenced.[34][35]. [6] Effects have been observed with apple juice, but their clinical significance is not yet known. Grapefruit juice may, however, slightly reduce the body’s ability to absorb the drug, so if you often drink grapefruit juice, levothyroxine levels may be lower than normal, impairing treatment. [33][better source needed] The third approach is hampered by a paucity of knowledge of the genes in question. [13], The effect of grapefruit juice with regard to drug absorption was originally discovered in 1989. [58], Additional drugs found to be affected by grapefruit juice include, but are not limited to. Mixing grapefruit with meds could be deadly. [28], Apple juice, especially commercially produced products, interferes with the action of OATPs. The FDA has required that some prescription and over-the-counter (OTC) drugs taken by mouth include warnings against drinking grapefruit juice or eating grapefruit while taking the drug, Huang says. The discovery that flavonoids are responsible for some interactions make it plausible that other fruit and vegetables are affected. [1] The effect was first discovered accidentally, when a test of drug interactions with alcohol used grapefruit juice to hide the taste of the ethanol. [1][3][4][5] One medical review advises patients to avoid all citrus juices until further research clarifies the risks. [10] Conversely, if the medication is a prodrug, it needs to be metabolised to be converted to the active drug. [37], Common lemons are the product of orange/citron hybridization, and hence have pomelo ancestry, and although Key limes are papeda/citron hybrids, the more commercially prevalent Persian limes and similar varieties are crosses of the Key lime with lemons, and hence likewise have pomelo ancestry. [39] Other less-common citrus species also referred to as lemons or limes are genetically distinct from the more common varieties, with different proportions of pomelo ancestry.[34]. Intestinal enzyme inhibition will only affect the potency of orally administrated drugs. [7][medical citation needed], Pomegranate juice inhibits the action of the drug metabolizing enzymes CYP2C9 and CYP3A4. Read all information provided with your medications and talk to your doctor, pharmacist or other health care provider to find out if a medication is affected by grapefruit juice, or how much, if any, grapefruit juice you can have.