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Posted on 07/21/2025 7:10:18 AM PDT by Red Badger
Grapefruit and its close relatives can increase the blood levels of certain drugs and cause serious side effects. Affected drugs include some medications for blood pressure and heart rhythm, among others.
Grapefruit is a delicious citrus fruit with many health benefits. However, it can interact with some common medications, altering their effects on your body.
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.
Here’s a closer look at 31 common drugs that may have dangerous interactions with grapefruit, as well as some alternatives.
Note: This article contains general information — not specific medical advice. Talk to your physician before changing your use of any medication.
How does it interact with medications?
Medications are processed in your liver and small intestine by a specialized group of proteins called cytochrome P450 (CYPs).
CYPs break down medications, reducing the blood levels of many of them.
Grapefruit and a few of its close relatives, such as Seville oranges, tangelos, pomelos, and Minneolas, contain a class of chemicals called furanocoumarins.
Furanocoumarins disrupt the normal function of CYPs. In fact, studies show that they increase the blood levels of over 85 medications (1).
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).
There are three things to know to understand if and how you can safely consume grapefruit with these medications.
It doesn’t take much. One whole grapefruit or one glass of grapefruit juice is enough to alter how these medications affect you.
Its effects last several days. Grapefruit’s ability to affect medication lasts for 1–3 days. Taking your medication a few hours apart from consuming it isn’t long enough.
It’s significant. For a small number of drugs, grapefruit’s effects can be serious. With that in mind, here is detailed information about 32 common medications that may interact with grapefruit, categorized by use.
1–3: Some cholesterol medications
Some cholesterol medications called statins are affected by grapefruit.
Statins work by limiting the natural production of cholesterol. This improves the profile of lipoproteins in the blood and decreases deaths from heart disease in patients at risk of it (2Trusted Source).
Statins can cause rhabdomyolysis, or the breakdown of muscle tissue. This leads to muscle weakness, pain, and occasionally kidney damage (3Trusted Source).
Grapefruit increases the blood levels of three common statins substantially, increasing the risk of rhabdomyolysis (4Trusted Source):
Atorvastatin (Lipitor)
Lovastatin (Mevacor)
Simvastatin (Zocor)
One study showed that drinking a glass of grapefruit juice with simvastatin or lovastatin increased blood levels of these statins by 260% (5Trusted Source).
Alternatives:
Pravastatin (Pravachol),
rosuvastatin (Crestor), and
fluvastatin (Lescol) do not interact with grapefruit (1).
SUMMARY
Grapefruit can increase the side effects of some statin cholesterol medications, causing muscle damage.
4–7: Certain blood pressure medications Most types of blood pressure medicines are not affected by grapefruit.
However, the following four blood pressure medications should be used cautiously:
Felodipine
Nifedipine (Procardia)
Losartan (Cozaar)
Eplerenone (Inspra)
The first two medications in this list are known as calcium channel blockers. They work by changing the way your blood vessels use calcium, relaxing the vessels, and relieving blood pressure.
The last two medications in this list work by decreasing the activity of a hormone called angiotensin 2, which naturally increases blood pressure.
One study found blood levels of nifedipine increased dramatically when taken with about 2 cups (500 mL) of grapefruit juice, compared with no juice. This resulted in a rapid drop in blood pressure, which could be dangerous if unsupervised (6Trusted Source).
Losartan is unusual in that grapefruit decreases its effects, potentially limiting its ability to control blood pressure (7Trusted Source).
Eplerenone works similarly to losartan, but its levels increase when taken with grapefruit. Excessive eplerenone levels can cause too much potassium in the blood, which can interfere with heart rhythm (1).
Alternatives:
Spironolactone (Aldactone), a similar drug to losartan and eplerenone, does not interact with grapefruit.
Amlodipine (Norvasc) is a calcium channel blocker like felodipine and nifedipine, which also does not interact with grapefruit (6Trusted Source, 8Trusted Source).
SUMMARY
Though grapefruit does not interfere with most blood pressure medications, it can cause a few medications to overcorrect blood pressure.
8–9: A few heart rhythm medications
Grapefruit influences a few medications that treat abnormal heart rhythms.
These interactions can be particularly dangerous and include:
Amiodarone
Dronedarone (Multaq)
A study gave 11 men who were taking amiodarone a glass of grapefruit juice (about 300 mL). Drug levels increased by up to 84%, compared with those not drinking the juice (9Trusted Source).
These two medications play a critical role in managing the health of patients with heart rhythm disorders. Grapefruit-related changes in levels of these drugs have occasionally caused dangerous heart rhythm changes (10Trusted Source).
SUMMARY
Although only a few heart rhythm medications interact with grapefruit, the side effects can be dangerous.
10–13: Some anti-infection medications
Collectively called antimicrobials, these anti-infection medications vary widely in their actions and breakdown in the body.
Although antimicrobials are one of the most diverse categories of medications, there are only a few medications with known important grapefruit interactions:
Erythromycin
Rilpivirine and related HIV drugs
Primaquine and related antimalarial drugs
Albendazole
Erythromycin is used to treat several types of bacterial infections. A study comparing grapefruit juice with water in patients taking erythromycin showed that the juice increased the drug’s blood levels by 84% (11Trusted Source).
Excess levels of this medication can disrupt heart rhythm (11Trusted Source).
Grapefruit also increases levels of the HIV medications rilpivirine and maraviroc, in addition to primaquine-related antimalarial drugs. This may affect heart rhythm or function (1).
Because antimicrobials are generally taken for a limited time, perhaps it’s easiest to simply avoid grapefruit while taking these medications.
Alternatives: Clarithromycin is a medication in the same class as erythromycin that does not interact with grapefruit. Doxycycline is both an antibiotic and antimalarial drug that also does not interact with it (1).
SUMMARY
Some anti-infection medications should not be used with grapefruit, as they can lead to disrupted heart rhythm or function.
14–20: Several mood medications
Most antidepressants and anti-anxiety drugs are safe to use with grapefruit.
However, several mood medications do interact with it, including:
Quetiapine (Seroquel)
Lurasidone (Latuda)
Ziprasidone (Geodon)
Buspirone (Buspar)
Diazepam (Valium)
Midazolam (Versed)
Triazolam (Halcion)
Drugs like quetiapine and lurasidone are used to treat mood and behavioral disorders. Increased levels of these drugs can cause heart rhythm changes or sleepiness (1).
Furthermore, diazepam, midazolam, and triazolam are sedatives that are sometimes used for panic attacks or other forms of anxiety.
One study compared some of these drugs in nine patients, some of whom consumed grapefruit. It showed that grapefruit can increase these drugs’ effects, resulting in excessive drowsiness (12Trusted Source).
SUMMARY
Eating grapefruit while taking the mood-related medications above can result in heart rhythm changes, excessive sleepiness, and other drug-specific effects.
21–24: Certain blood thinners
Blood thinners are used to treat or prevent blood clots. Some of them are affected by grapefruit, including:
Apixaban (Eliquis)
Rivaroxaban (Xarelto)
Clopidogrel (Plavix)
Ticagrelor (Brilinta)
Clopidogrel depends on CYPs — the proteins that grapefruit limits — to work. Thus, it becomes less active when mixed with grapefruit.
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. However, its ability to treat blood clots was not affected (13Trusted Source).
Contrarily, grapefruit increases the blood levels of other medications on this list, which can result in bleeding (14Trusted Source).
Alternatives: Warfarin (Coumadin) is used for purposes similar to those of apixaban and rivaroxaban. While warfarin is sensitive to foods containing vitamin K, its activation is not affected by grapefruit (15Trusted Source).
SUMMARY
Several blood thinners are affected by grapefruit. This can lead to bleeding or less effective prevention of blood clots.
25–27: Several pain medications
Multiple pain medications are affected by grapefruit:
Fentanyl
Oxycodone
Colchicine
Fentanyl and oxycodone are narcotic pain relievers. 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 (16Trusted Source, 17Trusted Source).
Colchicine is an older medication used to treat gout. It’s processed by CYPs and could interact with grapefruit. Nevertheless, a 2012 study showed that drinking 240 mL of grapefruit juice only had a minimal effect on its levels (18Trusted Source).
Alternatives: Morphine and Dilaudid are narcotic pain relievers that are not affected by grapefruit (1).
SUMMARY
Some narcotic pain relievers persist longer in the blood when taken with grapefruit.
28–31: A few erectile dysfunction and prostate medications A few erectile dysfunction and prostate medications deserve attention regarding grapefruit interactions:
Sildenafil (Viagra)
Tadalafil (Cialis)
Tamsulosin (Flomax)
Silodosin (Rapaflo)
Erectile dysfunction medications like sildenafil and tadalafil work by relaxing blood vessels, which increases blood flow to an erection.
Because other blood vessels relax with these medications as well, increased blood levels of these drugs caused by grapefruit can decrease blood pressure (8Trusted Source).
Moreover, prostate enlargement medications such as tamsulosin can also cause increased dizziness and low blood pressure when taken with grapefruit (19Trusted Source).
Alternatives: Another class of prostate enlargement medications, which includes finasteride and dutasteride, is not significantly affected by grapefruit (19Trusted Source).
SUMMARY
Grapefruit should not be consumed with erectile dysfunction medications or certain prostate enlargement medications.
Should you give up grapefruit? While this article lists 31 common medications that interact with grapefruit, it’s not a complete list.
Drugs.com offers a drug interaction checker that you can use to check your medications for interactions.
Additionally, Rxlist.com lists some less common medications that interact with grapefruit.
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. And some of these medications may have serious side effects when they interact with grapefruit.
If you are currently taking medications with grapefruit interactions, switch to an alternative drug or stop consuming grapefruit.
If in doubt, reach out to your doctor or pharmacist for personalized advice.
SUMMARY
Even small amounts of grapefruit can interact with some medications and cause serious side effects.
The bottom line Grapefruit interferes with proteins in the small intestine and liver that normally break down many medications.
Eating grapefruit or drinking grapefruit juice while taking these medications can lead to higher levels of them in your blood — and more side effects.
With some drugs, with even small amounts of grapefruit can cause severe side effects. Therefore, the combination should be avoided.
Your pharmacy may mark these drugs with a grapefruit interaction warning.
Make sure your doctor and pharmacist know if you regularly consume grapefruit. They can help you decide whether it’s safe to consume it while on certain medications.
Last medically reviewed on May 8, 2020
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CBD medications have the same affect as grapefruit on blood thinners- which means you should avoid them.
Don’t forget cranberry juice
Cagney, what an animal...
I always chew a little Juicy Fruit afterwards.
It’s good for your soul.
Ah, Mae Clarke! I got this photo with her autograph in the mail. She wrote that James Cagney was a perfect gentleman when filming this scene.
I take this every time I feel something "off" in my throat (that decades of life have proven to be an onset of a cold or flu), and in the morning it is always gone:
Pure Encapsulations Grapefruit Seed Extract, 60 Capsules
I used to megadose B complex, but don't need to anymore because of this amazing stuff. My wife doesn't like capsules, and sprays this stuff into the back of her throat. Just as effective:
Thanks for the post! Although I already knew about the statin issues, grapefruit’s impact on so many other meds is surprising. Since leaving the US Army, I’ve been unable to eat my favorite fruit per my pharmacist due to interactions. Yuck!
Again, thanks.
I think you forgot Metformin. When I first began taking it, my doctor warned me not to eat grapefruit or drink grapefruit juice. Not even to eat grapefruit-flavored fruit drops.
BRAVE AI:
Metformin and Grapefruit Interaction
There is no strong evidence to suggest that metformin reacts with grapefruit. According to multiple sources, including medical articles and expert opinions, there is no scientific evidence indicating that grapefruit affects the safety or effectiveness of metformin.
The body does not metabolize metformin, and it is excreted unchanged in the urine, which means that grapefruit’s ability to block certain enzymes does not impact metformin.
However, some studies have suggested a potential interaction in animal models. For instance, a 2009 study on non-diabetic rats found that combining grapefruit with metformin increased lactic acid production, raising concerns about lactic acidosis.
Despite this, no human studies have confirmed such an interaction, and the FDA does not list grapefruit as a food to avoid while taking metformin.
Some sources also note that while grapefruit juice may have beneficial effects on blood sugar levels, it is still advisable to consult a healthcare provider before making any dietary changes while on metformin.
Additionally, there is a suggestion that grapefruit may interact with other medications metabolized by the CYP3A4 enzyme, but metformin is not affected by this interaction.
AI-generated answer. Please verify critical facts.
https://www.medicalnewstoday.com/articles/323603
Well, I am following my doctor’s explicit instructions.
Yes, that is best...............
Midazolam (Versed). I actually enjoy a little versed, mixed with Demerol and a little Tito’s. Helps me relax.
What you mean is , not everyone takes the time to read the information that comes with their medication or has a pharmacist who warns them of interactions.
There is this thing called the internet, you know that thing Al Gore invented , and it is really easy to look up all your meds and check for not just interactions with things like grapefruit juice but with each other. I find it baffling that people would not do a few minutes of research into some pharmaceutical their doctor prescribed.
You’re talking about the same people who will not read an article on FR before posting a comment..............🙄
I take Synthroid every morning. My doctor always told me not to drink citrus juices when I take it. Also, two of my youngest son’s heart medications warn against eating or drinking grapefruit or grapefruit juice.
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