Grapefruit Is a Culprit in More Drug Reactions

NY Times ^ | DECEMBER 17, 2012 | RONI CARYN RABIN

[neverdem]

The patient didn’t overdose on medication. She overdosed on grapefruit juice.

The 42-year-old was barely responding when her husband brought her to the emergency room. Her heart rate was slowing, and her blood pressure was falling. Doctors had to insert a breathing tube, and then a pacemaker, to revive her.

They were mystified: The patient’s husband said she suffered from migraines and was taking a blood pressure drug called verapamil to help prevent the headaches. But blood tests showed she had an alarming amount of the drug in her system, five times the safe level.

Did she overdose? Was she trying to commit suicide? It was only after she recovered that doctors were able to piece the story together.

“The culprit was grapefruit juice,” said Dr. Unni Pillai, a nephrologist in St....

--snip--

The interaction also can be caused by other citrus fruits, including Seville oranges, limes and pomelos; one published case report has suggested that pomegranate may increase the potency of certain drugs.

Older people may be more vulnerable, because they are more likely to be both taking medications and drinking more grapefruit juice. The body’s ability to cope with drugs also weakens with age, experts say.

Under normal circumstances, the drugs are metabolized in the gastrointestinal tract, and relatively little is absorbed, because an enzyme in the gut called CYP3A4 deactivates them. But grapefruit contains natural chemicals called furanocoumarins, that inhibit the enzyme, and without it the gut absorbs much more of a drug and blood levels rise dramatically.

For example, someone taking simvastatin (brand name Zocor) who also drinks a small 200-milliliter, or 6.7 ounces, glass of grapefruit juice once a day for three days could see blood levels of the drug triple, increasing the risk for rhabdomyolysis, a breakdown of muscle that can cause kidney damage...

[JimRed]

I like grapefruit, but one of my heart meds says not to eat it or drink the juice while taking it.

But here is an unaddressed question: if grapefruit increases the level of the drug, why not use grapefruit to decrease the quantity of the drug you need?

The probable answer, my educated guess: they’ll sell less of the drug that way; profit rules!

[doug from upland]

Thanks, yes I know all about oxalates and I drink so much water I run down the hall all day and night. Have not eaten meat or fowl since 1991, so I do have nuts and soy and beans and milk for protein, but I have lowered my intake of protein. A human being should not have to live without chocolate. :)

[doug from upland]

Thanks. My urologist is going to do a metabolic test on me and see if we can find some answers.

[doug from upland]

Thanks. I have taken herbal supplements and for some months I have not had a stone. We will see how long it lasts. When I bowl, I typically bowl 12 games. In two hours, my water intake is now 6+ glasses. I believe I have been so physically active and did not realize I was dehydrating myself.

[csmusaret]

The prostate drug Flomax can help you pass kidney stones.

[allmendream]

Not a very good idea unless you have a good understanding of what CYP P450 enzyme is responsible for metabolizing the drug you are taking.

If it isn't the one that grapefruit juice inhibits - you will not be taking an effective dose - half the concentration is almost always not half as efficacious - usually it doesn't work at all.

Moreover there is no guarantee that the drug you are taking with grapefruit juice will maintain an efficacious level of the therapeutic long term even if it is metabolized by the correct CPY P450 enzyme - either you will not be taking enough, leading to it not working - or you would be taking too much, leading to a build up of toxic levels.

I think there would be far better avenues to save money than playing with fire drinking grapefruit juice with your medications. You might save money right into the emergency room or the morgue. Death can be a real money saver!

[Conservativegreatgrandma]

Maybe it’s wise to consider cutting back on medications.

[Lady Jag]

Saw it on FNC last night. Dr. suggested it would be wise to also curtail other citrus as well.

A med I take says no grapefruit and I miss the stuff.

[Bon mots]

A while back, someone who was a medical transcriber told me, that, grapefruit juice was a trick older folks used with their meds to save money. They’d take half the dose prescribed with a glass of grapefruit juice. The medical establishment would frown on that because they would lose money... and it would mess up their statistics.

I don’t know how much of that is true.


I know personally a friend who does that with Cialis.

He says that 1/4 of a pill works like magic with some grapefruit juice.

Since Cialis is quite expensive, he saves a lot of money that way. It is also a quality of life drug and the effective dose can easily be guessed at safely.

Not that I would know otherwise of course...

I wouldn't recommend this for life saving drugs that you need to stay alive...

[Bon mots]

A while back, someone who was a medical transcriber told me, that, grapefruit juice was a trick older folks used with their meds to save money. They’d take half the dose prescribed with a glass of grapefruit juice. The medical establishment would frown on that because they would lose money... and it would mess up their statistics.

I don’t know how much of that is true.


...more on using GF juice with Cialis>>>
The standard dose for erectile dysfunction is 20mg., the normal pill dose. However, Cialis is also prescribed for Pulmonary and arterial hypertension, but the recommended dose is 40mg. EVERY DAY!
This leads one to believe that there is little risk in trying, say a 5mg dose with grapefruit juice.
My friend simply bites the 20 mg. pills into a quarter or third and drinks a whole glass of grapefruit juice.
(on an empty stomach, of course.)

[Bon mots]

A while back, someone who was a medical transcriber told me, that, grapefruit juice was a trick older folks used with their meds to save money. They’d take half the dose prescribed with a glass of grapefruit juice. The medical establishment would frown on that because they would lose money... and it would mess up their statistics.

I don’t know how much of that is true.


...more on using GF juice with Cialis>>>
The standard dose for erectile dysfunction is 20mg., the normal pill dose. However, Cialis is also prescribed for Pulmonary and arterial hypertension, but the recommended dose is 40mg. EVERY DAY!
This leads one to believe that there is little risk in trying, say a 5mg dose with grapefruit juice.
My friend simply bites the 20 mg. pills into a quarter or third and drinks a whole glass of grapefruit juice.
(on an empty stomach, of course.)

[doug from upland]

Thanks. I have used Flomax. It won’t pass a 14mm.

[Vigilanteman]

Skip the pharmaceuticals, they are all poison to me.

Generally, damn good advice although there are certain exceptions. Antibiotics are wonderful when you are treating a bacterial based infection. The side effects are generally limited to giving you the sh*ts.

There are other prescription drugs which are helpful under certain specific and usually limited short term circumstances.

But generally, a person will do better studying herbal remedies and nutrition and making sure their body has a proper balance.

For instance, I have a very high pain threshold because I have lousy insensitive nerves. Extra vitamin B-12 works wonders for me. I take about 14 times the minimum daily requirement. OTOH, if I was ever captured by aliens or Democrats and tortured, I'd just skip the B-12 doses.

[Does so]

Now you tell me! ;)

[fanfan]

Happy Chanukah, Merry Christmas and Happy New Year to you and yours, neverdem!

Thanks for the pings all year!

[grey_whiskers]

Thank you for this. I had known that grapefruit juice and other citrus interferes with some drugs, but didn’t know about the statins.

You might enjoy this old vanity:

(Vanity) A Merck-y Decision, or, Is Pfizer Wiser?

...and neverdem, you already corrected my factual error in the article the *first* time. (chagrined, ashamed muttering)

Cheers!

[grey_whiskers]

Aw, crud.

RIP, JA.

[grey_whiskers]

By now she could post some really definitive comments in the religion threads!

She might even have acquired ZOT! privileges...

[grey_whiskers]

Good to hear your friend is standing up for himself...

Cheers!

[Alamo-Girl]

Thanks for the link!