7 Medications That Don’t Mix With Grapefruit and Its Juice
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Grapefruit and its juice are unquestionably nutritious additions to your diet. With vitamin C galore and plenty of potassium, this fruit may support a healthy immune system, improve skin health, reduce blood pressure, and more, as research suggests.
Unfortunately, though, for all their sunny health benefits, they have one particularly notable risk. Grapefruit and grapefruit juice can interact with a variety of medications, making them either less or more effective, and sometimes causing extra side effects.
If you’ve ever been told not to eat grapefruit while on a certain mediation, it may have seemed like a strange caveat — what’s the deal with this particular fruit? “When you take certain medications, they are broken down (metabolized) with the help of a vital enzyme called CYP3A4 in the small intestine,” says Alyssa Pike, RD, of the International Food Information Council in Washington, DC. “Grapefruit juice can block the action of intestinal CYP3A4, so instead of being metabolized, more of the drug enters the blood and stays in the body longer.” The result: too much medication in your system.
Oddly enough, however, in some cases, grapefruit can actually have the opposite effect. According to the U.S. Food and Drug Administration (FDA), its enzymes can decrease the effectiveness of proteins called drug transporters, which help the cells absorb medication. When this happens, less of a drug enters the bloodstream.
Different people’s bodies may respond differently to grapefruit’s enzymatic action, Pike says. “The impact grapefruit juice will have on certain medications depends on three key things: the person, the dosage of the medication, and the amount of grapefruit or juice consumed.” It’s important to discuss your personal risk with your healthcare provider — and always follow the recommendations of a doctor or pharmacist regarding grapefruit while you’re on meds.
Here are 7 medications that don’t tend to mix well with grapefruit and its juice.
1. Allegra (Fexofenadine)
Allegra, a popular antihistamine, may help you enjoy the spring air without a stuffy nose and watery eyes. But to soak up the outdoor delights of allergy season, leave grapefruit juice off the menu. Allegra is one of the few drugs that’s made less effective by grapefruit. Research shows that grapefruit juice diminishes the availability of fexofenadine (Allegra’s active ingredient).
Indeed, neither apple nor orange juice is a smart pairing with Allegra. All these juices contain compounds that prevent polypeptides in the small intestine from absorbing this medication. One study found that these beverages decreased the absorption of Allegra by about 85 percent.
2. Organ Transplant Rejection Drugs (Neoral and Sandimmune)
If you’ve recently received an organ transplant, you may be put on medications that keep your body from rejecting your precious kidney, heart, or liver. These immunosuppressants, which include cyclosporine (Neoral or Sandiummune), don’t play nicely with grapefruit. “When taking immunosuppressive drugs (Neoral or Sandimmune), grapefruit juice may increase how long or how much medication stays in the system,” says John Walczyk, PharmD, of Waltham, Massachusetts. “This can lead to higher levels of the medication that can cause damage to organs or other negative effects.”
3. Statins (Lipitor, Mevacor, and Zocor)
As part of a heart-healthy diet to reduce cholesterol, you typically can’t go wrong eating low-calorie, high-antioxidant grapefruit. But if you’re on a cholesterol-lowering statin, check with your doctor about whether you can continue to enjoy this type of citrus. Some cholesterol-lowering statins, such as simvastatin (Zocor) and atorvastatin (Lipitor) are contraindicated with grapefruit. “If you drink a lot of grapefruit juice while taking [these drugs], too much of the drug may stay in your body, which can increase your risk for liver and muscle damage that can lead to kidney failure,” says Pike.
Fortunately, grapefruit doesn’t have this effect on all statins. Fluvastatin (Lescol), pravastatin (Pravachol), pitavastatin (Livalo), and rosuvastatin (Crestor) have little to no interaction with grapefruit, per Harvard University.
4. Antihypertensives (Procardia, Adalat, Plendil, and Afeditab CR)
As the Centers for Disease Control and Prevention (CDC) notes, nearly half of American adults have high blood pressure — so it’s common to be on an antihypertensive drug like nifedipine, a category that includes Procardia, Adalat, and Afeditab CR. But if you’re taking one of these meds, downing a glass of grapefruit juice with breakfast could set you up for trouble later in the day. One study found that grapefruit juice increased the bioavailability of nifedipine and slowed gastric emptying, keeping the medication in subjects’ systems longer than usual. “This can lead to the blood pressure lowering too much (hypotension), which can cause falls or dizziness,” Walzcyk says.
Grapefruit may affect the efficacy of another antihypertensive, felodipine (Plendil). An older study found that consuming grapefruit juice, grapefruit segments, or grapefruit extract increased the concentration of the drug threefold. Meanwhile, another study found a 32–99 percent increase in felodipine in the bloodstream after consuming grapefruit juice.
5. Drugs for Abnormal Heart Rhythms (Including Cordarone, Nexterone, and Pacerone)
Multiple drugs that stabilize an irregular heartbeat, including Cordarone, Nexterone, and Pacerone, are all forms of amiodarone. If you’ve been placed on an amiodarone, you’ll want to pass on grapefruit. Walczyk says it’s once again a case of grapefruit inhibiting the CYP3A4 enzyme, causing increased absorption.
This can have some grave consequences. “In the case of amiodarone, it can have a negative effect on the rhythm of the heart (arrhythmias),” Walczyk says. “Mixing grapefruit juice can cause potential worsening of arrhythmias, dizziness, or drug toxicity.”
6. Psychiatric Drugs (Including Zoloft, Valium, Versed, Halcyon, and Tegratol)
Grapefruit is known to ramp up the effects of a variety of mental health drugs — but that’s actually not a good thing. According to research, grapefruit’s enzyme-blocking mechanism can affect anxiolytics, antidepressants, mood stabilizers, antipsychotics, and procognitive compounds, and raise the risk of potentially dangerous interactions.
Older studies, for example, have found that the fruit increased the concentration of Valium (aka diazepam) and Zoloft (aka sertraline) in subjects’ blood, which could cause more intense side effects like dizziness or drowsiness.
7. Viagra (Sildenafil)
As early as 2002, four years after its initial 1998 release, researchers confirmed that grapefruit and the erectile dysfunction (ED) medication Viagra shouldn’t mix. Because of its impact on the CYP3A4 enzyme, grapefruit could make this impotency drug much more potent. While that might sound appealing to some men with ED, it could create problematic symptoms like headaches, flushing, or low blood pressure, per Harvard. Research has found that the combination of Viagra and grapefruit juice could even become toxic.
Again, for best results from your medications (and minimal unpleasant side effects), be sure to read packaging labels and adhere to any dietary instructions from your doctor or pharmacist. Even if you can’t eat grapefruit, there are plenty of other delicious citrus options to enjoy.
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