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Although nutritious for most people, fruit may interact poorly with some medicines
By Barbara Quinn Monterey County Herald
Published on Tuesday, Sep 25, 2007
Our hospital no longer offers grapefruit on our patient menu. Not because grapefruit isn't nutritious. Like other citrus fruits, it is an excellent source of vitamin C, fiber and even contains natural substances that help lower blood cholesterol and triglyceride levels.
Ironically, however, some of these same substances that render grapefruit and its juice so healthful have also been found to interfere with the action of some medications . . . including several that lower cholesterol levels.
What we have here, say dietitians and pharmacists, is a ''food-drug'' interaction an ingredient in food that interferes with the intended action of a medication. Certain active components in grapefruit and its juice hinder certain enzymes in the digestive tract that break down certain medications. As a result, these particular drugs can enter the bloodstream in higher (or lower) amounts than expected, possibly causing serious side effects.
Grapefruit and related foods such as Seville oranges, tangelos (a grapefruit hybrid) and lime juice have all been singled out as foods to avoid when taking medications that react with grapefruit juice. Other foods such as lemons, regular oranges, tangerines and grapefruit-flavored sodas are on the ''OK to eat'' list.
Here is a partial list of common medications that most experts agree should not be taken with grapefruit or its juice, and a few substitute drugs:
Cholesterol-lowering medications: atorvastatin (Lipitor), lovastatin (Mevacor), simvastatin (Zocor, Vytorin). Alternate drugs: pravastatin (Pravachol), rosuvastatin (Crestor) and fluvastatin (Lescol).
Heart and blood pressure medications: cilostazol (Pletal), felopidine (Plendil), nifedipine (Procardia, Adalat). Grapefruit juice does not significantly affect: amlodipine (Norvasc), digoxin (Lanoxin) or diltiazem (Cardizem).
Sedatives and anti-seizure medications: diazepam (Valium), triazolam (Halcion), carbamazepine (Carbatrol, Tegretol). Drugs in this category that do not react significantly with grapefruit juice: haloperidol (Haldol) and alprazolam (Xanax).
Antidepressants: buspirone (BuSpar), clomipramine (Anafranil), sertraline (Zoloft).
Allergy medications: fexofenadine (Allegra). Experts suggest desloratadine (Clarinex) is safe.
HIV drugs: saquinavir (Fortovase, Invirase), indinavir (Crixivan).
Immunosuppressant drugs: cyclosporine (Neoral, Sandimmune), tacrolimus (Prograf).
Other no-no's with grapefruit: sildenafil (Viagra), amiodarone (Cordarone, Pacerone).
Doses and timing matter, too. Less than 1 cup of grapefruit juice can affect the action of some medications for up to three days, according to one study. Yet the blood-thinning medication warfarin (Coumadin) does not interact significantly with grapefruit juice . . . unless you drink more than 24 ounces a day.
Bottom line: Always check with your doctor and/or pharmacist to make sure you understand any potential food interactions with any prescribed medication.
Barbara Quinn is a registered dietitian at the Community Hospital of the Monterey Peninsula. E-mail her at bquinn@chomp.org.
Our hospital no longer offers grapefruit on our patient menu. Not because grapefruit isn't nutritious. Like other citrus fruits, it is an excellent source of vitamin C, fiber and even contains natural substances that help lower blood cholesterol and triglyceride levels.
Get the full article here.
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