[Mari]

HI,

I ran across this today:
http://www.webmd.com/hypertension-hi...and-medication

Research about the interaction of grapefruit juice with drugs suggests that compounds in grapefruit juice, called furanocoumarins (or bergamottin), may be responsible for the effects of grapefruit juice. Researchers believe that furanocoumarins block the enzymes in the intestines that normally break down many drugs. One glass of grapefruit juice could elicit the maximum blocking effect, and the effect may persist for longer than 24 hours. Since the effects can last for such a prolonged period of time, grapefruit juice does not have to be taken at the same time as the medication in order for the interaction to occur.
Since waiting 24 hours between having grapefruit juice and taking -- sometimes daily -- medications, many people are advised not to drink grapefruit juice at all while also taking certain drugs.


These are medications with which grapefruit juice should NOT be consumed unless advised by a doctor:

Statins (cholesterol-lowering drugs): lovastatin (Mevacor), atorvastatin (Lipitor), simvastatin (Zocor, Vytorin)
Antihistamines: Ebastine
Calcium channel blockers (blood pressure drugs): felodipine (Nitrendipine, Plendil), nifedipine (Adalat, Procardia)

Psychiatric drugs: buspirone (Buspar), triazolam (Halcion), carbamazepine (Tegretol), diazepam (Valium), midazolam (Versed), sertraline (Zoloft)

Immune suppressants: cyclosporine (Neoral), (tacrolimus) Prograf
Pain medications: Methadone
Impotence drug (erectile dysfunction): sildenafil (Viagra)
Ant-HIV medication: saquinavir (Invirase)
Antiarrhythmics: amiodarone (Cordarone)

Apparently some benzos are affected by grapefruit while others are not:
http://www.health.harvard.edu/fhg/up...ate0206d.shtml
According to this site, Klonopin is in the group that has little to no interaction with grapefruit juice.


M

[Dmom3005]

Thanks Mari

I know that almost all epilepsy medications have the grapefruit juice
do not drink on the list.

Even though only one was listed.

So we have a automatic, no grapefruit juice, we also are very careful
to eat grapefruit at all with Derrick.

Donna

[mrsD]

Other citrus has been found to affect drug metabolism too.

I'd avoid orange juice and other citrus while using any drug on the lists. And those lists.... those change rapidly. One cannot count on them being accurate all the time either.

[Dmom3005]

Oh gosh that isn't exactly good.

Derrick is treating his cold with orange juice right now. And its helping.

So I hate to have him stop. Usually we don't push orange juice with him,
but this time it seemed like a good idea.

And there isn't a warning on his meds.

Donna

[Mari]

Originally Posted by Dmom3005

Oh gosh that isn't exactly good.

Derrick is treating his cold with orange juice right now. And its helping.

So I hate to have him stop. Usually we don't push orange juice with him,
but this time it seemed like a good idea.

And there isn't a warning on his meds.

Donna

Donna,

Apple juice has almost vitamin C as orange juice. Does he like apple juice or pineapple juice?


Here is a list of foods that have more vitamin C than oranges do:
http://www.examiner.com/article/10-f...than-an-orange


#1) Guava

#2) Red Bell Peppers

#3) Lychee

#4) Parsley

#5) Kiwi

#6) Broccoli

#7) Brussels Sprouts

#8) Papaya

#9) Strawberries

#10) Pineapple


M

[waves]

TO ALL

I deleted my post because I am googling various things and finding all sorts (not just one) agent which can affect the CYP3A4 pathway and new studies on citrus. At least one agent is present in common Orange Juice as well, although it appears that the effects are not nearly as pronounced as those of Grapefruit Juice. Beware doctors may not be informed since the studies i have seen are quite recent and leave room for a lot of hypotheses.

So ... at this point, I'd probably say limit OJ consumption and certainly do not increase (or decrease) the amount of OJ taken when in therapy with a CYP3A4 mediated drug. If desirable to increase (say for a cold) do it gradually and be vigilant for signs of drug intoxication.

(so much for being helpful huh... shoulda done the googling first... sigh. )
----------------------------
Mari...

On another note, Klonopin IS metabolized by CYP3A4, so at least in theory it can be affected by grapefruit. Some drugs are affected more and some less, depending on the site of metabolism.

[Mari]

Originally Posted by waves

----------------------------
Mari...

On another note, Klonopin IS metabolized by CYP3A4, so at least in theory it can be affected by grapefruit. Some drugs are affected more and some less, depending on the site of metabolism.

Waves,

This is good information. I always appreciate your research.

I m really annoyed that the Almond milk I have been drinking has added calcium --- can possibly interfere with the calcium channel blocker. Somedays I have two 8 oz glasses a day. I will need something else. . . . cannot always get to the store that has coconut milk.

M

[waves]

Also Verapamil!

Found a 2008 paper which documents verapamil interaction with citrus...

grapefruit increases plasma conc by about 90% (close to double) for drugs undergoing intestinal metabolism, this includes verapamil which is cited by the paper.

lime seems to be more potent than i had read in the past - similar to graprefruit. i would use the same caution as grapefruit. usually we don't consume it in quantity... but definitely no margaritas, no tequila shots with lime slices.

orange juice increases levels only by ~20%, but with high consumption, or meds having narrow therapeutic margin, this could be relevant.

sour orange (from a differnt paper) apparently can increase plasma levels by > 70% for certain drugs - quite significant.

haven't seen lemon cited anywhere... something to google tomorrow.

i see articles implicating red wine that i haven't got to yet.

it's time for me to go to bed though.

-------

That IS really annoying about your almond milk. Almond milk sounds so delicious. I hate when they adulterate things with supplements. If we want supplements we can take them "a la carte" and pick just what we want. grrr. idiot manufacturers.

nite nite. can't keep eyes open....

~ waves ~

[Dmom3005]

Everyone

Thanks for the list, And Derrick drinks apple juice more than
Orange juice.

Donna

[Brokenfriend]

Also Grapefruit juice,and the OCD drug Luvox have a possible dangerous interaction. BF