Does grapefruit really interact with medications, or is this a myth?
This has been known for some time and it wasn't until about 2 years ago that scientists identified the exact substance in grapefruit that causes the problem.
Phew! Good News About Grapefruit and Breast Cancer
It's become one of those emails that people seem to forward obsessively, along with the ones about waking up with a kidney missing and anti-perspirants leading to breast cancer (there's no proof of that, either).
More on Lipitor and Grapefruit
You are certainly correct regarding the CYP3A4 enzyme that is made in the liver and its action on different medications. Strictly speaking this enzyme acts by affecting how different medications are broken down. The ongoing presence of the grapefruit in the body continues to have an effect on the system.
Get the latest health and diet news - along with what you can do about it - sent to your Inbox once a week. Get Dr. Gourmet's Health and Nutrition Bites sent to you via email. Sign up now!
Scientists have now identified the exact substance in grapefruit juice that interacts with various medications. Researchers at the University of North Carolina knew that furanocoumarins (a naturally-occurring substance found in grapefruit juice) had been found in laboratory tests to enhance the absorption of some medications, but lab tests are not the same as tests in human subjects.
Accordingly, Dr. Mary Paine and her colleagues created a furanocoumarin-free grapefruit juice to test against regular grapefruit juice and orange juice (Am J Clin Nutr 2006;83:1097-105). Eighteen healthy subjects were recruited and given a medication that is known to be affected by grapefruit juice, along with a glass of either grapefruit juice, orange juice, or furanocoumarin-free grapefruit juice. Their blood was then drawn and analyzed for appropriate levels of the medication.
As they had suspected, it was indeed the grapefruit juice that contained furanocoumarin that had the most effect on medication levels. Sadly, furanocoumarin-free grapefruit juice is not available on the market, even though researchers noted that the furanocoumarin-free grapefruit juice tasted sweeter and less bitter than the regular grapefruit juice.
If you're on any medications, you need to be sure to tell your doctor what other medications or supplements you're using, as you can never be sure what will interact with your life-saving medications. I've included a partial list of the drugs that interact with grapefruit juice below, but you may also wish to consult the Center for Food-Drug Interaction Research and Education, at http://www.druginteractioncenter.org.
Type of medication : Name (Brand name in parenthesis)
Anticoagulant : Warfarin (Coumadin)
Antibiotics : Clarithromycin (Biaxin) | Erythromycin
Heart rhythm : Amiodarone (Cordarone)
High blood pressure (calcium channel blockers) : Felodipine (Plendil) | Nifedipine (Adalat, Procardia) | Nimodipine (Nimotop) | Nisoldipine (Sular) | Verapamil (Isoptin, Verelan)
High blood pressure or Congestive heart failure (CHF) (beta blockers) : Carvedilol (Coreg)
Emphysema / Asthma : Theophylline (Theo-dur)
Cholesterol lowering agent (statins) : Atorvastatin (Lipitor) | Lovastatin (Mevacor) | Simvastatin (Zocor) | Simvastatin-ezetimibe (Vytorin)
Immunosuppressants : Cyclosporine (Neoral, Sandimmune) | Tacrolimus (Prograf) | Sirolimus (Rapamune)
Anti-HIV : Saquinavir (Fortovase, Invirase) | Indinavir (Crixivan)
Anti-seizure : Carbamazepine (Carbatrol, Tegretol)
Antidepressants : Buspirone (BuSpar) | Clomipramine (Anafranil) | Sertraline (Zoloft)
Anti-anxiety : Diazepam (Valium) | Triazolam (Halcion)
Cough : Dextramethorphan (in many cough syrups and lozenges)
Pain : Methadone
Impotence : Sildenafil (Viagra) | Tadalafil (Cialis)
Eat well, eat healthy, enjoy life!
Timothy S. Harlan, M.D.