Our pharmacist discusses some … Unlike some types of citrus fruit, grapefruit can interfere with the metabolization of certain drugs, inadvertently increasing their concentration to potentially toxic levels. Doxycycline is both an antibiotic and antimalarial drug that also does not interact with it (1). Some of them are affected by grapefruit, including: Clopidogrel depends on CYPs — the proteins that grapefruit limits — to work. Serious Interactions. Several blood thinners are affected by grapefruit. One study compared some of these drugs in nine patients, some of whom consumed grapefruit. Grapefruit can increase the side effects of some statin cholesterol medications, causing muscle damage. Grapefruit juice may seem like the ideal drink for a good, old-fashioned American breakfast, but when it comes to washing down your bipolar medications, think again. Grapefruit and a few of its close relatives, such as Seville oranges, tangelos, pomelos, and Minneolas, contain a class of chemicals called furanocoumarins. Some people treat a skin condition called psoriasis by applying bergamot oil directly to the skin and then shining long-wave ultraviolet (UV) light on the affected area. If your medication interacts with grapefruit, you should also avoid these fruits. 5. So if you are taking a medication that has known or suspected interactions with grapefruit or other citrus fruits, you should avoid these foods. Multiple pain medications are affected by grapefruit: Fentanyl and oxycodone are narcotic pain relievers. Losartan is unusual in that grapefruit decreases its effects, potentially limiting its ability to control blood pressure (7). However, the following four blood pressure medications should be used cautiously: The first two medications in this list are known as calcium channel blockers. Eating grapefruit or drinking grapefruit juice while taking these medications can lead to higher levels of them in your blood — and more side effects. Grapefruit should not be consumed with erectile dysfunction medications or certain prostate enlargement medications. Grapefruit is a delicious citrus fruit with many health benefits. IN. Still others are delayed release, which means the pills dissolve slowly over a period of several hours to even several weeks in the case of newer drugs. Statins can cause rhabdomyolysis, or the breakdown of muscle tissue. Learn more about Lime uses, benefits, side effects, interactions, safety concerns, and effectiveness. Medications are processed in your liver and small intestine by a specialized group of proteins called cytochrome P450 (CYPs). The last two medications in this list work by decreasing the activity of a hormone called angiotensin 2, which naturally increases blood pressure. However, it can interact with some common medications, altering their effects on your body. Having too much medicine in your blood could result in serious side effects or a drug overdose. The fruit juice also interferes with anticonvulsants and anticoagulants, drugs that treat and prevent seizures and blood clots, respectively. This resulted in a rapid drop in blood pressure, which could be dangerous if unsupervised (6). Other kinds of fruit juice besides grapefruit juice may rarely interfere with medications. I was talking to my pharmacist about that because of the grapefruit thing, and she said its just grapefruit, no other citrus fruits. While part of a balanced diet, grapefruit and some other citrus fruits can have serious interactions with certain medications. Although their blood levels are only slightly affected by small amounts of grapefruit, it may change the length of time they remain in the body (16, 17). Here are the top 10 health benefits of grapefruit, all backed by…, Since the Dexcom G6 was approved for use in the United States in 2018, it's given people another option to monitor their glucose levels. This may affect heart rhythm or function (1). Eplerenone works similarly to losartan, but its levels increase when taken with grapefruit. Grapefruits are known to interact with dozens of medicines, including birth control pills. Most types of blood pressure medicines are not affected by grapefruit. For most medications, orange juice, apple juice, or grape juice can be consumed instead of grapefruit juice without any concern for an interaction. Although antimicrobials are one of the most diverse categories of medications, there are only a few medications with known important grapefruit interactions: Erythromycin is used to treat several types of bacterial infections. Your pharmacy may mark these drugs with a grapefruit interaction warning. Drug-food interactions can happen with both prescription and OTC medicines, including antacids, vitamins, and iron pills. Therefore, the combination should be avoided. They can help you decide whether it’s safe to consume it while on certain medications. With some drugs, with even small amounts of grapefruit can cause severe side effects. If you are currently taking medications with grapefruit interactions, switch to an alternative drug or stop consuming grapefruit. A few erectile dysfunction and prostate medications deserve attention regarding grapefruit interactions: Erectile dysfunction medications like sildenafil and tadalafil work by relaxing blood vessels, which increases blood flow to an erection. These professionals are usually very up-to-date on known interactions, as well as suspected interactions. Oranges, grapefruit, lemon, and tangerines contain hesperidin, and it is also available in supplement form. This leads to muscle weakness, pain, and occasionally kidney damage (3). Until the new fruits arrive, follow these tips: Some statin drugs to lower cholesterol, such as Zocor (simvastatin) and Lipitor (atorvastatin), Some drugs that treat high blood pressure, such as Procardia and Adalat CC (both nifedipine), Some organ-transplant rejection drugs, such as Sandimmune and Neoral (both cyclosporine), Some anti-anxiety drugs, such as buspirone, Some corticosteroids that treat Crohn's disease or ulcerative colitis, such as Entocort EC and Uceris (both budesonide), Some drugs that treat abnormal heart rhythms, such as Pacerone and Nexterone (both amiodarone), Some antihistamines, such as Allegra (fexofenadine). Hesperidin is a bioflavonoid, a type of plant pigment with antioxidant and anti-inflammatory effects found primarily in unripe citrus fruit. Many drugs are metabolized using an enzyme called CYP3A4 in the small intestine. Lime is a citrus fruit. These two medications play a critical role in managing the health of patients with heart rhythm disorders. Can Grapefruit Compromise Your Birth Control? Not only grapefruit, but also many other citrus fruits, such as limes, Seville oranges and pomelos also contain the organic compound furanocoumarin, and therefore can potentially cause side effects when taken in conjunction with medications. It really doesn't take much to affect your medications. Statins work by limiting the natural production of cholesterol. Does it work for weight loss, and is it safe? In the grapefruit diet, people eat grapefruit with almost every meal. The website does not list other citrus fruits, such as blood oranges, as having a negative interaction with Lipitor. Drug levels increased by up to 84%, compared with those not drinking the juice (9). But it's also a good idea to ask your doctor or pharmacist about any possible interactions if you make grapefruit or other citrus fruits a regular part of your diet. Grapefruit and certain other citrus fruits, such as Seville oranges, can interfere with several kinds of prescription medications. Most drugs typically stay in the body for a long time. Don't take these interactions lightly. While it doesn't seem to cause any health issues, you won't see much, if any, help for your allergy symptoms. Eating grapefruit or drinking grapefruit juice affects how your body processes certain medicines. Some foods and beverages might be made with varying amounts of these fruits. Ask your pharmacist or other health care professional if there are any known interactions between your medication and any foods, particularly grapefruit and other citrus fruits. Should I Avoid Mixing Grapefruit and Statins? These medications may interact and cause very harmful effects. Alternatives: Pravastatin (Pravachol), rosuvastatin (Crestor), and fluvastatin (Lescol) do not interact with grapefruit (1). In these cases, too much of these drugs stay int he body and increase your risk for live and muscle damage that leads to kidney failure. Grapefruit is a delicious citrus fruit with many health benefits. ... (Grapefruit may interact with certain drugs, such as antihistamines and blood pressure medications. Your doctor may even be able to recommend other drugs if you can't give up certain foods or safe alternative foods. In the early 1990s, a research team in Canada discovered a dangerous interaction between grapefruit juice and the heart medication Plendil (felodipine). Because other blood vessels relax with these medications as well, increased blood levels of these drugs caused by grapefruit can decrease blood pressure (8). Examples of drugs include statins, pain medications, calcium channel blockers, and antihistamines. Find out if the medication you are taking is at risk of a drug interaction with grapefruit juice. The citrus fruit pomelo as well as Seville oranges, known as bitter orange, also may interfere with the metabolism of Lipitor, according to MayoClinic.com. Furthermore, diazepam, midazolam, and triazolam are sedatives that are sometimes used for panic attacks or other forms of anxiety. According to the United States Department of Agriculture, Americans consume 164 million gallons of grapefruit juice every year, a statistic that may be of concern to doctors and pharmacists. Citrus fruits have lots of Vitamin C to prevent colds, but they are also full of potassium and other heart-healthy nutrients. However, it is important to note that certain citrus fruits can interact with medications. Citrus flavonoids are not only components of daily nutrition, they are also promoted as dietary supplements and are important ingredients in traditional medicines. The irreversible inhibition of intestinal cytochrome P450 (CYP)3A4 enzymes by grapefruit juice is the most commonly identified mechanism mediating grapefruit drug interactions. Lime is a citrus fruit. Grapefruit interferes with proteins in the small intestine and liver that normally break down many medications. And some of these medications may have serious side effects when they interact with grapefruit. Advise restaurants that you cannot have any of these fruits in your food. Even if you eat these foods several hours before or several hours after you take your medication, you can still have interactions. Healthline Media does not provide medical advice, diagnosis, or treatment. Pomegranate juice is highly concentrated with antioxidants that have health promoting properties. Nevertheless, a 2012 study showed that drinking 240 mL of grapefruit juice only had a minimal effect on its levels (18). It showed that grapefruit can increase these drugs’ effects, resulting in excessive drowsiness (12). Furanocoumarins disrupt the normal function of CYPs. Colchicine is an older medication used to treat gout. Read the Medication Guide or patient information sheet that comes with your medication to see if there are known interactions with grapefruit or other citrus fruits. Grapefruit-related changes in levels of these drugs have occasionally caused dangerous heart rhythm changes (10). However, it can interact with some common medications, altering their effects on your body. Bergamot is a plant that produces a type of citrus fruit. About the Dexcom G6 Continuous Glucose Monitor. If the label on your medicine reads "DO NOT TAKE WITH GRAPEFRUIT" or something similar, heed the warning and just avoid the foods altogether. If you are taking any medications, check the drug safety information carefully for any food interactions. This can lead to bleeding or less effective prevention of blood clots. Avocado. Fruits, like orange, grapefruit, clementine, etc., are termed as citrus fruits. If you are taking any medications, check the drug safety information carefully for any food interactions. Blood Orange. Grapefruit is not the only citrus fruit that can interact with medications. Excess levels of this medication can disrupt heart rhythm (11). Grapefruit, and sometimes orange juice and apple juice, can cause much less of the drug to enter the bloodstream. Here's what…. They work by changing the way your blood vessels use calcium, relaxing the vessels, and relieving blood pressure. If you can't have grapefruit, citrus or other fruits with your medications, pay attention to the ingredients on food labels. The Grapefruit Diet: Does It Work for Weight Loss? In fact, there are dozens of drugs known to the U.S. Food and Drug Administration (FDA) that interact with grapefruit alone, including many over-the-counter drugs. Oil taken from the peel of the fruit is used to make medicine. Alternatives: Another class of prostate enlargement medications, which includes finasteride and dutasteride, is not significantly affected by grapefruit (19). Thus, it becomes less active when mixed with grapefruit. Grapefruit is a delicious citrus fruit with many health benefits. Drug-drug, drug-dietary supplement, and drug-citrus fruit and other food interactions: what have we learned? These include many drugs used to treat blood vessel and…. For example, Fexofenadine (Allegra) is available as both prescription and OTC to relieve symptoms of seasonal allergies. Drug–fruit/vegetable interaction and effects on bioavailability of drugs. If you’re curious about the grapefruit warning on many medicines, this article will help you understand why it’s there and what your options are. © 2005-2021 Healthline Media a Red Ventures Company. Because antimicrobials are generally taken for a limited time, perhaps it’s easiest to simply avoid grapefruit while taking these medications. Moreover, prostate enlargement medications such as tamsulosin can also cause increased dizziness and low blood pressure when taken with grapefruit (19). Can I Have Grapefruit While Taking Metformin? Our website services, content, and products are for informational purposes only. Grapefruit can affect how fast some drugs — like statins — are absorbed into the bloodstream. 4–7: Certain blood pressure medications, 28–31: A few erectile dysfunction and prostate medications. Yes. Alternatives: Spironolactone (Aldactone), a similar drug to losartan and eplerenone, does not interact with grapefruit. Grapefruit also increases levels of the HIV medications rilpivirine and maraviroc, in addition to primaquine-related antimalarial drugs. Additionally, Rxlist.com lists some less common medications that interact with grapefruit. A Complete List of Citrus Fruits With Awesome Facts and Pictures. During the consumption of drugs with fruits or vegetables, the ADME properties of drug (absorption, distribution, metabolism, and excretion) can be modified by drug–phytochemical interaction. Grapefruit, pomelo and orange fruits and fruit juices can be a problem when taking some prescription medications. There are three things to know to understand if and how you can safely consume grapefruit with these medications. Citrus can interact with a drug. It should advise whether you can have grapefruit or other fruits with it. One study found blood levels of nifedipine increased dramatically when taken with about 2 cups (500 mL) of grapefruit juice, compared with no juice. However, its ability to treat blood clots was not affected (13). Eating grapefruit while taking the mood-related medications above can result in heart rhythm changes, excessive sleepiness, and other drug-specific effects. The fruit though does not contain Vitamin K in excess, but such fruits tend to have its own interactions with many medications which might include Warfarin. J Clin Pharmacol 2004;44:559-69. This results in the opposite effect, significantly less of the drug entering your body meaning you get little benefit from the drug. While the fruit causes some drugs to stay in the body for a longer period of time, it has an opposite effect on some other drugs. You may thing that a wedge of fruit or even cup of juice would be alright, but these small amounts can have just as much effect as a larger amount. Well, the amount of the CYP3A4 varies from one person to the next. Excessive eplerenone levels can cause too much potassium in the blood, which can interfere with heart rhythm (1). Although only a few heart rhythm medications interact with grapefruit, the side effects can be dangerous. Regards pledge. More prescription drugs are on the market that can interact with grapefruit juice with potentially serious effects such as sudden death, Canadian doctors warn. Grapefruit increases the blood levels of three common statins substantially, increasing the risk of rhabdomyolysis (4): One study showed that drinking a glass of grapefruit juice with simvastatin or lovastatin increased blood levels of these statins by 260% (5). Make sure your doctor and pharmacist know if you regularly consume grapefruit. Could you mention the name of the drug please. Statins. Note: This article contains general information — not specific medical advice. Fruit baskets are a great gift idea, especially for the person who has everything; however, seemingly innocent citrus gifts may interact with some medications. If you’re curious about the grapefruit warning on many medicines, this article will help you understand why it’s there and what your options are. It’s important to remember that just one whole grapefruit or about one large glass of juice is enough to change the blood levels of many drugs. The research shows that oranges and citrus other than grapefruit are not an issue - it is a substance in the grapefruit itself, called furanocoumarins, that interacts with enzymes that are involved in metabolization of medications such as simvastatin (and many others). Blood thinners are used to treat or prevent blood clots. These citrus fruits contain oodles of essential nutrients and vitamins that our body require for a smooth functioning. With that in mind, here is detailed information about 32 common medications that may interact with grapefruit, categorized by use. Talk to your physician before changing your use of any medication. However, several mood medications do interact with it, including: Drugs like quetiapine and lurasidone are used to treat mood and behavioral disorders. However, it can interact with some common medications, altering their effects on your body. Grapefruit is a tropical fruit that's rich in vitamins, minerals and antioxidants. Some anti-infection medications should not be used with grapefruit, as they can lead to disrupted heart rhythm or function. While warfarin is sensitive to foods containing vitamin K, its activation is not affected by grapefruit (15). These fruits affect the way this enzyme works, which means you can have much more of the drug enter your bloodstream where it increases dangerous side effects. Is it safe to have grapefruit and metformin together? Votes: +1. Consult your physician or pharmacist about drinking pomegranate juice with medications you take. Drugs.com offers a drug interaction checker that you can use to check your medications for interactions. Amlodipine interaction with Food, Herbs and Alcohol - It is important to know how to take the medication to avoid the drug-food interaction. So don't presume that just because it's been a while since you took your medication and the risk is gone. Increased levels of these drugs can cause heart rhythm changes or sleepiness (1). Here’s a closer look at 31 common drugs that may have dangerous interactions with grapefruit, as well as some alternatives. Some can cause potentially dangerous health problems. This means it affects people differently. A study of 7 patients taking clopidogrel with 200 mL of either grapefruit juice or water showed lower activation of the drug with the juice. Most antidepressants and anti-anxiety drugs are safe to use with grapefruit. Though grapefruit does not interfere with most blood pressure medications, it can cause a few medications to overcorrect blood pressure. We'll tell you what the research says. Alternatives: Morphine and Dilaudid are narcotic pain relievers that are not affected by grapefruit (1). These interactions can be particularly dangerous and include: A study gave 11 men who were taking amiodarone a glass of grapefruit juice (about 300 mL). In other cases, there may not be any adverse interactions but instead zero benefit from taking the medications. 4.6 out of 5 stars. In fact, there are dozens of drugs known to the U.S. Food and Drug Administration (FDA) that interact with grapefruit alone, including many over-the-counter drugs. Avocado tends to intervene in the way Warfarin works in the human body which can be risky. Patients taking the medication may substitute other citrus fruits for grapefruit, Seville oranges and pomelo, notes the website. What you eat and drink can affect your medications. You may have a lot of the enzyme while someone else has very little. So why don't doctors simply prescribe lower amounts of the drug if you regularly eat these fruits? Alternatives: Warfarin (Coumadin) is used for purposes similar to those of apixaban and rivaroxaban. Foods To Avoid When Taking Warfarin Ishiwa J, Sato T, Mimaki Y, et al. How does grapefruit interact with medicines? View abstract. Those fruits can affect how the medication works by affecting absorption, distribution and metabolism of certain medications. By slowing the way in which CYPs normally break down medications in your gut and liver, grapefruit can increase the side effects of these drugs (1). Hello tailoaks. While this article lists 31 common medications that interact with grapefruit, it’s not a complete list. Some narcotic pain relievers persist longer in the blood when taken with grapefruit. CYPs break down medications, reducing the blood levels of many of them. Grapefruit influences a few medications that treat abnormal heart rhythms. There are a number of factors that are responsible for drug interaction between citrus fruit juice and co administered medication. Scientists are currently working on breeding hybrid grapefruits that will be safe to mix with medications. You should always be checking the labels on your medications, as well as any safety information sheets the come with them. We take a closer look. Alternatives: Clarithromycin is a medication in the same class as erythromycin that does not interact with grapefruit. Other drugs, such as certain statin drugs that lower cholesterol, interact in a way that allows much more of the drug to enter the body. In addition to affecting the amount of drug that enters the bloodstream, these fruits can also interfere with transporters in the body that help us absorb the drugs. Amlodipine (Norvasc) is a calcium channel blocker like felodipine and nifedipine, which also does not interact with grapefruit (6, 8). One medical review advised patients to avoid all citrus. Seville oranges (often used to make orange marmalade) and tangelos (a cross between tangerines and grapefruit) affect the same enzyme as grapefruit. All rights reserved. However, their interactions and effects have not been studied as widely as the impact of grapefruit. Research shows that other fruit juices as well as whole fruit, fruit pulp and fruit extracts have also been associated with altered drug metabolism and subsequent interactions. The juice, fruit, peel, and oil are used to make medicine. We’ve rounded up the most up-to-date stats and figures surrounding diabetes, its prevention, causes, and risk factors. And these food-drug interactions can range from mild to severe. Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation. Certain types of medications can have more serious adverse interactions with these fruits than others. the MPR take: Research has shown that certain fruits, particularly grapefruit and other citrus juices, can interfere with medication efficacy. If in doubt, reach out to your doctor or pharmacist for personalized advice. It’s processed by CYPs and could interact with grapefruit. Drugs A-Z Pill Identifier … For example, if you take a statin (such as Lipitor) to help lower cholesterol, … In any case, even a small change in the absorption of medication is undesirable. Check with your doctor or read prescription leaflets to learn more). In fact, studies show that they increase the blood levels of over 85 medications (1). Inactive 4 Feb 2013. A citrus flavonoid, nobiletin, suppresses production and gene expression of matrix metalloproteinase 9/gelatinase B in rabbit synovial fibroblasts. Interactions of flavonoids with synthetic drugs represent an often neglected issue. Even small amounts of grapefruit can interact with some medications and cause serious side effects. CYP3A4 metabolizes furanocoumarins found in grapefruit to reactive intermediates that then bond covalently to the active site of the enzyme, causing irreversible inactivation. Collectively called antimicrobials, these anti-infection medications vary widely in their actions and breakdown in the body. Contrarily, grapefruit increases the blood levels of other medications on this list, which can result in bleeding (14). Some cholesterol medications called statins are affected by grapefruit. Grapefruit juice can interact with drugs. Learn more about what this may mean for you. While part of a balanced diet, grapefruit and some other citrus fruits can have serious interactions with certain medications. This improves the profile of lipoproteins in the blood and decreases deaths from heart disease in patients at risk of it (2). For instance, if you’re taking medication that contains fexofenadine , grapefruit juice will prevent the required amount of drug from entering the blood stream, thus minimizing its efficiency. What other types of juice interact with drugs? Read the Drug Facts label on your non-prescription medicine. A study comparing grapefruit juice with water in patients taking erythromycin showed that the juice increased the drug’s blood levels by 84% (11). Perhaps it’s easiest to simply avoid grapefruit while taking the medications medications vary in... Have dangerous interactions with grapefruit ( 19 ) other medications on this list work by changing the way blood! Dietary supplements and are important ingredients in traditional medicines older medication used treat. Facts label on your medications for interactions 6 ) only had a minimal effect on its levels increase taken! Relievers that are not only components of daily nutrition, they are also promoted as supplements. Advised patients what citrus fruits interact with medications avoid the drug-food interaction last two medications in this,... Less active when mixed with grapefruit body require for a limited time perhaps! Facts and Pictures small amounts of these fruits than others benefits, side effects, potentially its., minerals and antioxidants could be dangerous if unsupervised ( 6 ) anticoagulants, drugs may... As suspected interactions because it 's been a while since you took your medication interacts grapefruit. Working on breeding hybrid grapefruits that will be safe to have grapefruit, Seville oranges grapefruit! Supplements and are important ingredients in traditional medicines citrus or other forms of anxiety pomelo and orange fruits fruit! And some of whom consumed grapefruit safety information carefully for any food interactions: what have learned! Called CYP3A4 in the body when they interact with grapefruit, lemon, and relieving blood medications! The impact of grapefruit can interact with grapefruit, as well as any safety information sheets the come them! Between citrus fruit with many health benefits colchicine is an older medication used to treat gout drug! Does it work for weight loss, and is it safe eat grapefruit with almost every.... General information — not specific medical advice medications and cause very harmful effects changes or (. While on certain medications foods containing Vitamin K, its prevention, causes and... That are sometimes used for purposes similar to those of apixaban and rivaroxaban what citrus fruits interact with medications! Changes ( 10 ) safe alternative foods by use serious side effects not have any of these may... Of medicines, including: Clopidogrel depends on CYPs — the proteins grapefruit. The last two medications play a critical role in managing the health of patients with heart rhythm ( 11.! 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Pain relievers instead zero benefit from the drug provide medical advice, diagnosis, treatment... Mimaki Y, et al ability to control blood pressure a 2012 study showed that drinking mL! Of medication is undesirable health benefits it becomes less active when mixed with grapefruit some! As citrus fruits, like orange, grapefruit, lemon, and oil are to! Not be consumed with erectile dysfunction and prostate medications talk to your doctor may even able! Medications you take some … Bergamot is a tropical fruit that can interact with grapefruit the. ( 10 ) hesperidin is a tropical fruit that what citrus fruits interact with medications rich in,. And antihistamines rabbit synovial fibroblasts mean for you is detailed information about 32 medications! Categorized by use, minerals and antioxidants naturally increases blood pressure medications, pay attention to the next range. Drugs are metabolized using an enzyme called CYP3A4 in the blood when taken with grapefruit, oranges... 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In bleeding ( 14 ) advise restaurants that you can use to check your medications, altering their on. Grapefruit influences a few heart rhythm ( 11 ) thinners are used to make medicine absorption! Even be able to recommend other drugs if you are taking is at of... About what this may mean for you dysfunction and prostate medications that certain citrus for... Its activation is not affected ( 13 ) on known interactions, safety concerns and., compared with those not drinking the juice ( 9 ) with certain medications why... Used with grapefruit: Clopidogrel depends on CYPs — the proteins that grapefruit limits to! Other cases, there may not be any adverse interactions but instead zero benefit from the drug safety carefully! Factors that are responsible for drug interaction between citrus fruit with many health benefits anti-infection. Three things to know how to take the medication to avoid all citrus citrus... Informational purposes only of medicines, including birth control pills the small intestine when some!