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Grapefruit Juice and Medications

by C. Devin Hastings

Article References--Click here

"But it's natural.  How can grapefruit juice be harmful?" 

This statement reflects a commonly held sentiment about 'natural' supplements in general.  Bear in mind that I am a big fan of natural supplementation when it's done intelligently.  So, this is not a vitamin bashing article but rather, a wake up call to those who don't know the dangers of inappropriately mixing substances.

First of all, have people actually died from grapefruit juice?  Yes and no.  Yes, at least one person has died from mixing grapefruit juice with common medications however and no, in and of itself, grapefruit juice is quite beneficial.  (Milk however, is another story which I'll cover in a future article.)

Here's what happened to one person ⁽¹⁾: He was put on Lipitor, a cholesterol lowering drug.  Two months later he went to vacation in Florida.  While there he began enjoying fresh grapefruit.  Within a short period of time he experienced muscle pain, fatigue and fever.  After going to the emergency room, his kidneys failed and he died.

What happened?  Grapefruit juice is metabolized by the same liver enzyme (cytochrome P-450 3A4 enzyme) that breaks down about 50 ⁽²⁾ commonly used drugs. 

When the liver is overloaded with too many 'things' to metabolize or break down, some substances are simply not broken down and made safe for the body.  Then, dangerous levels of essentially toxic chemicals build up in the body.

Death is the worst result of the this 'overloading' of the liver.  Other symptoms of toxic build up of un-metabolized substances include heart rhythm disturbances, impaired kidney function, blood pressure changes and anaemia. ⁽³⁾

Bear in mind that other citrus fruits do not pose the same risk. 

Also note that all medications do come with warning labels so you are advised to read them carefully.

And, it is generally advised that a person simply quit drinking grapefruit juice when taking certain medications.  It is also a very good idea to wait a number of days after finishing a medication before having any grapefruit.

Below is a list of some medications that should not be mixed with grapefruit juice.

Finally, as always, check with your doctor about what to do.  This article is only intended to be educational, not prescriptive.

Drugs that are known to have potentially serious interactions with grapefruit products include:
 Antiseizure drugs such as carbamazepine (Carbatrol, Tegretol)
 Antidepressants such as buspirone (BuSpar), clomipramine (Anafranil) and sertraline (Zoloft)
 Benzodiazepines such as diazepam (Valium) and triazolam (Halcion)
 Calcium channel blockers such as felodipine (Plendil), nifedipine (Adalat, Procardia, nimodipine (Nimotop), nisoldipine (Sular) and possibly verapamil (Isoptin, Verelan)
 Human immunodeficiency virus (HIV) protease inhibitors such as saquinavir (Fortovase, Invirase) and indinavir (Crixivan)
 HMG-CoA reductase inhibitors such as simvastatin (Zocor), lovastatin (Mevacor) and atorvastatin (Lipitor)
 Immunosuppressant drugs such as cyclosporine (Neoral, Sandimmune), tacrolimus (Prograf) and sirolimus (Rapamune)
 Antiarrhythmic drugs such as amiodarone (Cordarone)

 

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REFERENCES:

(1) “The Grapefruit Challenge: The juice inhibits a crucial enzyme, with possibly fatal consequences,”  December 2004 American Journal of Nursing--by Amy Karch, R.N., M.S., of the School of Nursing at the University of Rochester Medical Center

(2) At risk medications including but not limited to are drugs used to treat high cholesterol, depression, high blood pressure, cancer, depression, pain, impotence, and allergies.

(3) Reported by Chief health officer Greg Steward of the New South Wales Health Department.  This story was found at: http://www.theage.com.au/articles/2002/08/14/1029113955019.html