11 ms·
Prescription drugs and grapefruit a 'deadly mix' (2012)
- open-source-ux 7y agoHere's a 2012 article from the NHS website on this topic which I think is more readable than the Wikipedia entry: https://www.nhs.uk/news/medication/prescription-drugs-and-grapefruit-a-deadly-mix/ https://www.nhs.uk/news/medication/prescription-drugs-and-gr...
- antsoul 7y agoI'd even prefer the Erowid page : https://erowid.org/ask/ask.php?ID=2726 https://erowid.org/ask/ask.php?ID=2726
- dang 7y agoThanks! Changed from https://en.wikipedia.org/wiki/Grapefruit%E2%80%93drug_interactions https://en.wikipedia.org/wiki/Grapefruit%E2%80%93drug_intera...
- guscost 7y agoThanks - but also check out the “citrus genetics and interactions” section further down in the wiki, it’s fascinating.
- benj111 7y agoCaffeine is on the list. So a breakfast of coffee and grapefruit is a medically proven stimulating start to the day?
- throwaway8941 7y agoSadly, no. >One study, by Maish and colleagues in Pharmacotherapy 1996, looked at whether grapefruit juice increased caffeine effects and found little or no difference in blood concentrations and blood pressure when caffeine was given with and without GFJ. Other research has confirmed these results. Since specific enzyme systems most often metabolize similar chemicals, one would not necessarily expect GFJ to affect other stimulants, but this is far from conclusive. https://erowid.org/ask/ask.php?ID=2726 https://erowid.org/ask/ask.php?ID=2726
- foobarian 7y agoIIRC naringin has an indirect effect on coffee, where it inhibits an enzyme that is involved in metabolizing caffeine. So the outcome is that the effect of your coffee lasts a lot longer, instead of being more potent. Edit: Now that I go looking again, there is also evidence against this conclusion: https://www.eurekalert.org/pub_releases/2003-04/aps-rsm040903.php https://www.eurekalert.org/pub_releases/2003-04/aps-rsm04090...
- ghettoimp 7y agoIt would certainly be a horrific jolt to your taste buds... geish.
- adrianmonk 7y agoI might have expected colchicine (https://en.wikipedia.org/wiki/Colchicine https://en.wikipedia.org/wiki/Colchicine) to be on the list. It's a fairly harsh drug with a narrow therapeutic window. Getting the right dosage is already hard enough, as there are some unpleasant (and common) side effects, and it can also be pretty dangerous to your health. Add something like grapefruit that throws off the concentration, and things get that much worse. EDIT: This HN story link was updated. The list I was referring to above is the old link: https://en.wikipedia.org/wiki/Grapefruit–drug_interactions https://en.wikipedia.org/wiki/Grapefruit–drug_interactions
- ziroshima 7y agoInteresting to see this now. As a teenager I experimented with DXM (https://en.wikipedia.org/wiki/Dextromethorphan https://en.wikipedia.org/wiki/Dextromethorphan) as a hallucinogen. You could buy it in powdered form over the internet for a while, or one could just take corricidin pills or find certain cough syrups that didn't have acetaminophen. Anyways, it was well known on usenet/IRC at the time that drinking grapefruit juice prior to ignesting the drug would enhance its effects.
- hombre_fatal 7y agoI had just come out of the peak of an acid trip so intense that I was in the fetal position under my covers. 1-2 hours had passed but it felt like an entire day. And it took me 10 minutes just to finally message my friend the profound admission: "im trippin". I was pretty hungry after all this and glad the peak was behind me. Got a grapefruit out of the fridge. Wasn't even halfway through when I found myself back in the peak. Had to crawl back into my bed where the curtains were closed and endured another 20 minutes of that. Grapefruit + <drug> has always been the source of superstitious arguments in uni among my drug-using friends. Does it enhance the effect? Kill the effect? Do anything at all? But my acid experience confirmed one pairing beyond all doubt.
- deleted 7y ago[deleted]
- mayniac 7y agoI vaguely remember grapefruits being Hunter S Thompson's favourite fruit. I don't think it was for the taste. And your experience matches mine. Washing down MDMA with grapefruit juice definitely makes it more intense.
- htfu 7y agoInhibiting CYP3A4 should definitely increase LSD AUC, but it can't magically conjure more of a substance out of thin air after it's all already entered your bloodstream - only slow down breakdown. Albeit the apparent effect would be the former, if ingested beforehand and/or dealing with something with very slow uptake and high first-pass metabolism. In any case it's not something that plays out so quickly. Waving in and out of tripping balls a couple hours in sounds pretty par for the course, I'd say :)
- HarryHirsch 7y agoI wonder why it took the medical profession so long to become aware of the effect. Piperonyl butoxide, another cytochrome C inhibitor, has been used as synergist in insecticides since before the war, so it should have occurred to someone that the plentiful polyphenols in citrus juice could act as cytochrome C inducers/inhibitors and would have a measurable influence on the pharmacokinetics of stuff.
- arkades 7y agoJust because the article says that the healthcare community is ignorant of it, doesn’t mean that it’s ignorant of it. We had to memorize major CYP4503A4 inducers and inhibitors for step exams back when I was in med school, and memorized metabolic pathways and involved cytochromes for most major drugs. Granted, most docs don’t remember all the details long out of med school (because that’s literally what pharmacists are -for-), but we retain the broad brushstrokes. Ain’t new. Just editorializing bs.
- p1necone 7y agoYeah, hasn't "don't eat grapefruit while on birth control" been common advice for years?
- KineticLensman 7y agoYes, also on medication for high-blood pressure. (luckily I never had a great liking for grapefruit)
- imroot 7y agoIf you've had a liver transplant, grapefruit is on the list of things that you can never eat again -- it messes with the anti-rejection drugs that you have to take to suppress your immunological system.
- drefanzor 7y agoI take atorvastatin for high cholesterol; it says don't eat grapefruit on the side of my medication bottle. I never really thought about why, but this gives me more reasons to avoid it. Although now I have a huge craving for grapefruit juice, of course.
- british_india 7y agoAlso Fresca is packed with grapefruit juice.
- mirimir 7y agoAlso, I know that *mycin antibiotics can decrease liver metabolism of statins, and increase their side effects. In particular, rhabdomyolysis (muscle damage).[0] So I suspect that grapefruit isn't the only issue. In that there may well be interactions among the drug classes listed. 0) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006404/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006404/
- dr_dshiv 7y agoAlcohol? In student days, I was always fond of a greyhound: vodka and grapefruit juice. Placebo effect, or diminished liver capacity?
- neom 7y agoI usually Lemon Tek when I take psilocybe: https://www.mushmagic.com/blog-magic-mushroom-lemon-tek-a-way-to-trip-harder-n41 https://www.mushmagic.com/blog-magic-mushroom-lemon-tek-a-wa...
- collyw 7y agoThat's different, that converts the psilocybin to psilocin - something that would go on in your stomach anyway. Adding lemon gets that step out of the way so it all hits you faster.
- amelius 7y agoShouldn't there be a warning label in the Grapefruit section of supermarkets?
- unparagoned 7y agoNo, because the warning comes with the medecine
- alan-crowe 7y agoI've been scrutinizing my package leaflet for tamsulosin. No mention of grapefruit. Revision date October 2017. The article links to research from 2012. I'm going to guess that the dangers turned out to be small and eat my grapefruit for breakfast tomorrow as planned.
- not_a_doctor2 7y agohttps://www.webmd.com/drugs/2/drug-1592/tamsulosin-oral/details/list-interaction-details/dmid-141/dmtitle-avoid-grapefruit-unless-md-instructs-otherwise/intrtype-food https://www.webmd.com/drugs/2/drug-1592/tamsulosin-oral/deta...
- alan-crowe 7y agoThank you, very helpful.
- hmx48 7y agoIts useful for getting the most bang for your buck ouy of expensive medications.
- burk96 7y agoHah I know right? I do wonder however, is there a use case for these furanocoumarins found in grapefruit? Perhaps it could make for more efficient drugs that could (potentially) be cheaper? Or perhaps doctors prescribing ludicrously expensive drugs (like the cancer drugs listed) could prescribe a lower dose and a grapefruit concentrate?
- cwkoss 7y agoI wonder if grapefruit + reduced dosage could be as effective for primary effects, but reduce side effects for some drugs. Would be interesting to find some research in this area: most of what I can find warns of increased side effects from maintaining constant dosage. Interesting related info: "Seville oranges, (often used in marmalades), limes and pomelos also produce this interaction. Varieties of sweet orange, such as navel or valencia, do not contain furanocoumarins and do not produce this interaction." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589309/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589309/
- emmelaich 7y agoI've heard it's best to avoid or reduce citrus intake while taking drugs. I don't know why, but this could be why.
- open-source-ux 7y agoAlso from the NHS website is this interesting 2014 report on grapefruit juice and diabetes. In the reported study, grapefruit juice was as effective at lowering blood sugar as metformin, a leading drug for type 2 diabetes. However, this report cautions about the results - the study was not carried out on humans, but on non-diabetic mice: Could grapefruit juice protect against diabetes? https://www.nhs.uk/news/diabetes/could-grapefruit-juice-protect-against-diabetes/ https://www.nhs.uk/news/diabetes/could-grapefruit-juice-prot...
- cwkoss 7y agoSimilarly, piperdine in black pepper can function as a bioavailability enhancer https://www.ncbi.nlm.nih.gov/pubmed/21434835 https://www.ncbi.nlm.nih.gov/pubmed/21434835 I read an interesting online report that claimed co-administration of black pepper and certain essential oils would produce psychoactive effects.
- xtracto 7y agoOooh I read that they use this with tumeric to enhance its absorption. I wonder if grapefruit would work similarly.
- cwkoss 7y agoInteresting! I found this thread which claims that curcumin + black pepper can function as a reversible MAOI, similarly to caapi or harmala ayahuasca admixture plants. https://drugs-forum.com/threads/curcumin-is-an-effective-anti-depresant-and-maoi.140992/ https://drugs-forum.com/threads/curcumin-is-an-effective-ant... I've been taking turmeric for an inflammatory issue, will try adding pepper, thanks!
- myself248 7y agoThis killed my friend's dad. He was on a bunch of heart drugs and had a pacemaker and everything, but was generally stable. One day, grapefruit comes up in conversation with his doctor, who sternly advises him "never eat grapefruit, it'll mess with your meds!", so he stops eating the grapefruit he'd been having for breakfast every morning for years. Which promptly hoses up the finely-adjusted dosages, his symptoms suddenly get real weird, the situation spirals out of control, and he's dead in 4 days. Doctors, please don't rush out of the room. Take time to talk to your patients, and take twice as much time to listen to them. I'm sure he would've mentioned that detail if he'd had time to find the English words.
- corey_moncure 7y agoDoctors want you in and out of the room in 5 minutes or less so they can pull the insurance money dispensing lever again. The last physician I had any respect for was my own pediatrician and I had consulted him on various issues having gone through several GPs that got even simple diagnoses disastrously, hilariously wrong. Such as telling me the tiny red lump in my finger was an anthrax infection and notifying the health department when it was really a small benign vascularity that was removed in a fifteen minute procedure. Since my pediatrician retired I just do all my own medical research and order my own lab tests. The advantage I have is that I have all the insight into my own body, history, and habits that no doctor these days ever takes the time to find out. You're just a money pinata. Thank you, here are some antibiotics for an unspecified pathogen I didn't culture, Alisha will see you at checkout. Examining the patient? Ain't nobody got time for that.
- ohazi 7y agoHow do you order a lab test on your own?
- Judgmentality 7y agoIn the US there are surprisingly few barriers to this, an extreme rarity in our healthcare system. https://questdirect.questdiagnostics.com/ https://questdirect.questdiagnostics.com/ https://www.walkinlab.com/ https://www.walkinlab.com/ https://requestatest.com/how-it-works https://requestatest.com/how-it-works https://www.healthonelabs.com/ https://www.healthonelabs.com/ https://www.directlabs.com/ https://www.directlabs.com/ I have no affiliation with any of the above, they were just the first to pop up on Google (there are plenty more).
- journalctl 7y agoI avoid grapefruit-anything. I’m on two pretty standard drugs, and they shouldn’t have any reactions, but I’d rather not take that chance anyway.
- brianpgordon 7y agoThere's no need to guess; you can look up specifically whether CYP450 enzymes metabolize your medications (and its metabolites). If not then the answer is almost certainly that you're safe.
- brianpgordon 7y agoI don't know what the downvotes are about. I'm right. This stuff isn't magic. The mechanism of grapefruit-drug interactions is well-understood.
- presidentender 7y agoThis bit my brother once, on a trip to visit our grandparents. Grandpa would eat a half grapefruit every morning, believing that the acidity would alkalize one's system in response and lead (along with frequent alternative chelation treatments) to better health. We didn't drink the chelation shakes, but we did eat the grapefruits, since they were there and prepared. Over the two-week visit, my brother got harder and harder to be around - he'd always been surly, and he struggled with grandpa's wife, but we'd never experienced the level of emotional turmoil he went through on that trip. He self-harmed, sliced his arms up deeply. I stitched him up with the sewing kit that the resort had mercifully left in the room for us, and we kept the wounds dressed with neosporin until they healed. The next stop on the trip was a visit to grandpa's wife's sister, a professor of neuroscience. She just happened to mention the interaction between antipsychotics and grapefruit, and it was like a light went on in my brother's mind. He stopped eating grapefruit and returned to his usual mental state within a few days.
- loceng 7y agoDid none of the doctors prescribing the antipsychotics highlight and caution against eating grapefruit - hopefully to not consume alcohol either?
- presidentender 7y agoI can't speak to his interactions with any doctors. I imagine he forgot. This was before he was 21, so alcohol wasn't an issue yet.
- loceng 7y agoOne of the many pitfalls between doctor-patient relationship. Thank you. Hope he's continued to have relative stability.
- bjornsing 7y agoMy hay fever medication (called Teldanex in Sweden) was withdrawn from the market in 1998 due to some fatalities when combined with grapefruit. So it must have been well known long before 2012. I remember feeling quite lucky I wasn’t into that particular fruit... :P
- Scoundreller 7y agoOne thing glossed over in these articles is that the impact is mostly on this enzyme as it exists in the intestines. There’s less impact on this enzyme as it exists elsewhere in the body (primarily the liver).
- indziektor 7y agoAnd yet it never seems to get enough coverage. The last time I was prescribed something important, I had no idea I wasn't supposed to have grapefruit or marmalade with Seville oranges. Luckily it's not my usual fare. The leaflet did have all sorts of other warnings though, like even for St. John's Wort. I only found out by a chance comment from a different physician.