Berks County Medical Society Medical Record Summer 2017 - 27

The Ugly

Most drugs that have a significant interaction with grapefruit are labeled on its packaging as such.
Examples of common drugs that interact with grapefruit can be found below.
Cholesterol lowering drugs (statins)

Zocor (simvastatin), Lipitor (atorvastatin), Pravachol (pravastatin)

Blood pressure drugs

Nifediac or Afeditab (nifedipine), Plendil (felodipine)

Anxiety drugs

BuSpar (buspirone)

Arrhythmia drugs (heart)

Cordarone or Nexterone (amiodarone), Multaq (dronedarone)

Migraine drugs

Cafergot or Ergomar (ergotamine), Elavil (amitriptyline), Nimotop (nimodipine)

Immunosuppressant drugs

Prograf (tacrolimus), Rapamune (sirolimus), Sandimmune Neoral (cyclosporine)

Erectile dysfunction drugs

Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil)

When grapefruit blocks the drugs listed in the table above
from breaking down in the body, the increased drug level can
cause serious health problems with the heart, muscles, and
kidney.
When statin medications for cholesterol cannot break
down, this causes liver damage and destroys the muscle tissues which injures the kidneys.
Another example is heart complications that can occur
when taking drugs that regulate heart rhythm, such as amiodarone, and certain cancer drugs. It causes a change in the
rhythm of the heartbeat, which can be very dangerous and
can lead to serious complications. Lastly, kidney damage can
occur with immunosuppressant drugs, such as cyclosporine
or tacrolimus.
Grapefruit also causes issues that are not related to drug
interactions. People with kidney disease should be careful
about the amount of potassium they consume.
Grapefruit is rich in potassium which builds up in people
with kidney disease. Also, people with gastroesophageal reflux disease (GERD) can experience an
increase in heartburn symptoms because the
fruit and juice is highly acidic.

The Recommendation
Grapefruit is a wonderful produce that has a lot of health
benefits. However, caution should be taken when using certain medications or with certain health conditions. The best
way to avoid the issues that this citrus fruit causes is to avoid
or limit it. If you are a grapefruit lover, ask your healthcare
provider is there is another medication you can take that does
not have an interaction. You can also explore some other
fruits and juices. Always check with your pharmacist or other
healthcare provider if you are not sure if it is safe. Grapefruit
is certainly a friend. However, if you fail to take the proper
precautions, it can become your worst enemy.

References:
Agrana Group (2017). The Misleading Name and 10 Other Fun Facts. Retrieved from
http://www.agrana.com/en/products/fruit/fruit-preparations/trendblog/fruit-of-the-month/fun-facts/
Gorinstein S., Caspi A., Libman I., Lerner H.T., Huang D., Leontowicz H., Tashma Z., Katrich E., Feng S. & Trakhentenb S. (2006). Red grapefruit
positively influences serum triglyceride level in patients suffering from coronary atherosclerosis: studies in vitro and in humans. J Agric Food Chem. 2006
Mar 8;54(5):1887-9
Ware M. (2015). Grapefruit: Health Benefits, Facts, Research. Medical News Today.
Retrieved from http://www.medicalnewstoday.com/articles/280882.php
Grapefruit. In: Facts & Comparisons eAnswers. (2016) Clinical Drug Information, LLC.
Bailey D.G., Dresser G., Malcolm J. & Arnold O. (2013). Grapefruit-medication interactions: Forbidden fruit or avoidable consequences? CMAJ. 2013
Mar 5; 185(4): 309-316.
FDA Consumer Health Information (2014). Grapefruit Juice and Medicine May Not Mix. U.S. Food and Drug Administration. 2014 Jan: 1-2.

SUMMER 2017

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http://www.agrana.com/en/products/fruit/fruit-preparations/trendblog/fruit-of-the-month/fun-facts/ http://www.medicalnewstoday.com/articles/280882.php
Table of Contents for the Digital Edition of Berks County Medical Society Medical Record Summer 2017
