Some antianxiety medications including Valium (diazepam) and BuSpar (buspirone).Certain cholesterol medications like Lipitor (atorvastatin), Zocor (simvastatin) and Mevacor (lovastatin).Blood pressure and heart medications such as Plendil (felodipine), nifedipine and Multaq (dronedarone).Some of these include Verzenio (abemaciclib), Xalkori (crizotinib), Sprycel (dasatinib), Tarceva (erlotinib), Afinitor (everolimus), Ibrance (palbociclib), Votrient (pazopanib), Kisqali (ribociclib) and Sutent (sunitinib). Certain oral anticancer drugs called tyrosine kinase inhibitors and CDK inhibitors.Some common drugs that interact with furanocoumarins include: The interaction is drug-specific, so not all medications within a class are affected. They range from heart and blood pressure drugs to antianxiety medicines to a growing list of anticancer drugs. Today, that list is up to 121 medications. In 1989, when Bailey and his team discovered the grapefruit interaction, 85 drugs were on the interaction list. Because the degree of interaction is so variable, doctors and pharmacists recommend that anyone taking an affected drug avoid grapefruit and related fruits. But without testing, it’s impossible to predict who will be affected by grapefruit,” he says. Those with more CYP3A4 in their small intestine are at greater risk of drug toxicity. “Some people make more of the CYP3A4 enzyme than others. However, he says furanocoumarins can affect everyone differently. He notes that other potential side effects include gastrointestinal bleeding, kidney damage, breathing problems and rhabdomyolysis, a condition where muscle tissue breaks down. “Sweet Valencia or navel oranges do not contain these compounds and are safe substitutes,” he says.Īccording to Bailey, one of the most severe side effects of furanocoumarins is an irregular heartbeat called Torsade de Pointes, which can cause sudden death. And it’s not just the juice but also the fruit and rind that can be problematic. Of these, grapefruit has been studied the most because it’s commonly consumed in large enough quantities to cause a reaction. Tangelos, pomelos, limes and bitter Seville oranges (often used in orange marmalade) also have them. Grapefruit isn’t alone in containing furanocoumarins. In the worst-case scenario, grapefruit can be deadly when combined with some of these medications,” he says. “Combining grapefruit with certain drugs can potentially cause toxic side effects. Drinking the juice three times a day for five days further increased drug levels by as much as five times. “Even small amounts of furanocoumarins can cause dangerous levels of some drugs to build up in your blood.”Ī 1998 research review he and his team published in the British Journal of Clinical Pharmacology reported that just 250 milliliters (about 8 ounces) of grapefruit juice multiplied drug levels in the blood up to three times compared with water. “That enzyme metabolizes certain oral drugs, so blocking its action means more of the drug enters your blood,” Bailey explains. Grapefruit contains compounds called furanocoumarins that inactivate the CYP3A4 enzyme in your intestine. If you take one of the affected drugs, you’ve probably noticed a warning on the bottle’s label or in the patient information guide from the pharmacy. Bailey is the researcher who discovered over 30 years ago that grapefruit interacts with many common medications taken by mouth, including several oral cancer drugs. “But that’s the case with grapefruit,” says David Bailey, a clinical pharmacologist and scientist at Lawson Health Research Institute in London, Ontario. IT IS UNUSUAL THAT A FRUIT with significant health benefits could also be dangerous for some people to eat.
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