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Pomegranate Juice Interacts With Medications

From Cathy Wong,
Your Guide to Alternative Medicine.

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The pomegranate, once considered exotic, is now immensely popular. Pomegranate juice is found in almost every grocery store in North America.

But a report published in the September 1 2006 issue of the American Journal of Cardiology suggests that we don't know enough about how pomegranate interacts with common medications.

A 48-year-old man was taking ezetimibe (trade name Zetia) 10 mg a day and rosuvastatin (trade name Crestor) 5 mg every other day for 17 months. Both medications are used to treat high cholesterol.

He began drinking pomegranate juice (200 ml twice weekly) and three weeks later, was admitted to emergency with thigh pain and an elevated serum creatine kinase level (138,030 U/L, normal < 200 U/L). Both are symptoms of rhabdomyolysis, a serious condition that causes the breakdown of muscle fibers and may lead to kidney failure.

Rosuvastatin belongs to a group of medicines called HMG-CoA reductase inhibitors, or ‘statins’. Grapefruit juice is known to increase the risk of statin-induced myopathy, but up until now, there was little information about whether pomegranate juice might also increase the risk.

Pomegranate juice and grapefuit juice, are both known to block the cytochrome P450 3A4 enzyme systems in the intestines. By inhibiting these enzymes, the juices may increase blood levels of many medications.

Potential Pomegranate-Drug Interactions

• Antiarrhythmics - Amiodarone (Cordarone), disopyramide (Norpace), quinidine
• Calcium channel blockers - Felodipine (Plendil), nicardipine (Cardene), nifedipine (Procardia), nimodipine (Nimotop), nisoldipine (Sular)
• Statins - Atorvastatin (Lipitor), lovastatin (Mevacor), simvastatin (Zocor)
• Immunosuppressants - Cyclosporine (Sandimmune, Neoral), tacrolimus (Prograf)
• Protease inhibitors - Saquinavir (Fortovase)

However, pomegranate juice may also interact with medications not on this list. The drugs ezetimibe and rosuvastatin are not thought to be broken down by cytochrome P450 3A4.

Based on the limited evidence about the potential drug interactions, it would be wise to talk with your doctor if you use pomegranate products regularly, and to avoid taking pomegranate products within 72 hours of taking the above medications.

Sources

Hidaka M, Okumura M, Fujita K, Ogikubo T, Yamasaki K, Iwakiri T, Setoguchi N, Arimori K. Effects of pomegranate juice on human cytochrome p450 3A (CYP3A) and carbamazepine pharmacokinetics in rats. Drug Metabolism and Disposition. 33.5 (2005):644-8.

Kim H, Yoon YJ, Shon JH, Cha IJ, Shin JG, Liu KH. Inhibitory effects of fruit juices on CYP3A activity. Drug Metabolism and Disposition. 34.4 (2006):521-3.

Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis associated with pomegranate juice consumption. American Journal of Cardiology. 98.5 (2006):705-6.
Updated: September 19, 2006