I have just had a bad experience with it. It is like grapefruit juice as it doesn't get along with some of our medications. They are in the same family, which I didn't know until today. I have been dealing with the side effects of it since Saturday. I am starting to feel better but I thought I better put the word out about it.

ehhh, hi i'm waves, there, we've been introduced

i will research this - i am aware of grapefruit juice reactions with carbamazepine for instance (GF juice to be avoided). but have not seen/heard about pomegranate interactions before. it is used in the case of urinary tract infections, which makes me think kidneys but this is all imagination so far... Mrs D. might know something about this...

anyway, i'll check it out - it would help to know:

what meds are you taking (and how much)?

i hope you will be ok. good idea to raise a flag about this.

~ waves ~ from all over the place

Here is an article I just ran across.

Pomegranate Juice Interacts With Medications

From Cathy Wong,
Your Guide to Alternative Medicine.

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About.com Health's Disease and Condition content is reviewed by our Medical Review Board
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

and found conflicting data:

1) http://www.ncbi.nlm.nih.gov/sites/en...ubmed_RVDocSum
Pomegranate juice does not impair clearance of oral or intravenous midazolam, a probe for cytochrome P450-3A activity: comparison with grapefruit juice.

2) Only problem here is tolbutamide is not used much anymore.

3) here is a handy chart showing various metabolic pathways:
http://www.healthanddna.com/drugchart.html
The one for pomegranate juice is CYP2C9
Remember, that lists like this are subject to change.

Here is a chart just for grapefruit juice:
http://www.fhma.com/grapefruit.htm

4) here is a paper giving relative potency/effects of various juices:
5) And there is a difference between enteric enzymes and liver enzymes:
And there is some concern that data is not forthcoming in humans as much as rats. There may be differences there too.

It took a LONG time for data to be compiled on grapefruit juice. Since pomegranate has become popular, it will take a long time to get really good data on that one too. Since there is not a definitive answer it is best to avoid pomegranate if you are on Rx medications.

This link explains some of the above PubMed papers into clear English:
http://www.netwellness.org/question.cfm/44966.htm

I wonder how much a doctor really knows or understands about complex drug metabolism, so it is best if YOU look up stuff as well yourselves. I have found many doctors rather clueless on this topic.
And of course the studies do not include data on genetically "slow metabolizers". These are people who don't metabolize drugs like the majority.

In response to the article that fibrowendy posted about Crestor and Zetia... Crestor has been found to not
be metabolized normally in genetically "slow metabolizers". This includes many Asians, and about 10% of the rest of the
population. Many people had toxicity from Crestor until FDA sent out letters to doctors to LOWER doses in this
group or not use this drug. So that may be a factor in that report.
Crestor is the most toxic statin, and during trials there were deaths on it....a rare event. So I suspect some additive
situation with it.

I personally don't think pomegranate juice is going to be a huge problem, but something to watch in any event.

I agree. But after my issues with the juice, it will be one I will stay away from.

What drug was affected for you fibrowendy?
Send me a PM if you don't want to post. I am curious, and will keep it
confidential. (I may be able to help someone else, with this issue in the future).

I drink grapefruit juice all the time, but I don't see any of my meds on that list.

Nikko

I take Verapamil and Klonopin -- both of these are effected by grapefruit juice.

I suspect that they are also effected by other citrus too. But I got a "D" in high school chemistry and can't figure out these studies on my own.
And I can't trust drs to give me good advice either.
Good freaking luck getting a dr who knows anything about food and med reaction.

I like Pomegranate juice. I suspect, in my case, that I can drink a little of it now and then but not regularly.

M.

lime
SOUR orange or Seville oranges
possibly bergamot
have similar metabolic effects as does grapefruit, whereas

lemons
sweet orange varieties
appear to be safe.

tangerines and hybrids i don't recall reading about.

also, the effect on meds metabolism appears less related to originally the originally indicted flavonoid, but rather to the action of contained fumarocoumarins(hmm?), also present in smoke, smoked and charred foods (makes ya think about the "bitter" quality of these indicted citrus. These may affect UGT processes (a different enzyme system than the CYP group) as well - aside from the CYP interactions earlier mentioned. However those mechanisms, are, to me, not well understood. i can't recall yet if the article talked about the UGT processes wrt smoking. The effects i do know of regarding smoking pertain to the CYP interactions i.e. 1A2 increases olanzapine clearance but now i'm rambling waaaaaaayy off topic.

most of this stuff is the post-short-term-memory-impaired remnants of an article i read ... will find link for another time am sorry am not up to it.

such a good researcher i am these days. bad waves.

ooooops. cranberry is used for urinary tract infections (UTI). pomegranate i could not comment on.

any Mod: can you pls modify original post by deleting in it the text indicated in red above. THANKS. this post itself should remain for any who may have read the previous, to specify the change in content.

~ waves ~ from half a brain and not even half a migraine.