9 ms·

I had no idea that grapefruits had so much risk associated with them if you're taking medication. Most of the ones listed in the article are actually hugely pop

I had no idea that grapefruits had so much risk associated with them if you're taking medication. Most of the ones listed in the article are actually hugely popular, I wonder how many people took some innocent stuff like Tylenol and then drank some grapefruit juice and felt weird, without realizing what happened.

1_player 6y ago
https://en.wikipedia.org/wiki/Grapefruit%E2%80%93drug_interactions#Incomplete_list_of_affected_drugs https://en.wikipedia.org/wiki/Grapefruit%E2%80%93drug_intera... They interact with so many drugs, if you take any medication for chronic illnesses, chances are you should not eat any grapefruit for the rest of your life. Also whether a drug is affected by it or not is not clear, so the common advice is just to avoid the fruit whatever the drug you're taking. It's one of my favourite fruits, and not being able to eat it once in a while hurts. Though I'm not sure how _dangerous_ it really is. Does it affect the half-life of a drug by 5%, or by 100%?
- dmurray 6y ago
  TFA says it increases the bioavailability of felodipine, the drug where the effect was first noticed, by about a factor of 5. For most prescription drugs for chronic illness, you probably do not want to find out what happens when you move to 5x the effective dose.
  - jychang 6y ago
    Depends on the dose and drug. 5x the dose of adderall is probably pretty fun.
    - mardifoufs 6y ago
      Adderall/Vyvanse/Amphetamines don't interact well at all with vitamin C, of which grapefruits are full of. So sadly enough, you don't get any 5x intake boost with the enjoyable meds. Would have been way too much fun ;)
      - 3np 6y ago
        Isn't the vit C thing just because of acidity? Combining with a teaspoon of NaHCO3 would cancel that out, no?
      - sudoaza 6y ago
        But apparently the effect lasts up to 12 hours, vitamin c should be gone from the stomach by then. Grapefruit has been anecdotally recommended for MDMA (an amphetamine).
        mdmthrowaway 6y ago
        The reason it's recommended for MDMA is because it inhibits the CYP3A4 enzyme which metabolizes MDMA (3,4-Methylenedioxymethamphetamine) to MDA (3,4-Methylenedioxyamphetamine). MDA is more neurotoxic than MDMA which is why it's advised to reduce the amount your body intakes.
      - cik2e 6y ago
        The majority of adderall breaks down through the urea cycle due to urine acidity. Enzymes don’t play as significant a role as they do for other drugs. That’s why baking soda is the best potentiator for amphetamines, as it neutralizes urine acidity.
        3np 6y ago
        For anyone considering actually doing this, beware that it needn't take much baking soda to be harmful. People have died from overdosing. Maybe someone with journal access can dig out dosage ranges from any of these many sources: https://scholar.google.com/scholar?q=related:4ssWhTcQeYEJ:scholar.google.com/&scioq=Homespun+Remedy,+Homespun+Toxicity:+Baking+Soda+Ingestion+for+Dyspepsia&hl=en&as_sdt=0,5 https://scholar.google.com/scholar?q=related:4ssWhTcQeYEJ:sc...
    - garmaine 6y ago
      If by “fun” you mean think-your-heart-is-about-to-literally-explode and lie down in fear for 8 hours. (Source: have accidentally double dosed my amphetamine Rx. A 5x dose would probably be lethal.)
    - soylentcola 6y ago
      As someone prescribed Adderall, to my knowledge, grapefruit juice (and citrus in general) will inhibit the absorption so if anything, it would just lower the effectiveness of a typical dose.
  - seamyb88 6y ago
    Even for "some innocent stuff like Tylenol", as the original comment puts it, you do not want to be taking 5x the dose. This is a very harmful drug in (not very) large quantities. I know of somebody whose boyfriend ended things with her, she took a load of tylenol to end her life, but the doctors managed to resuscitate her. When she came to, she said to her mother "I'm so glad I didn't kill myself over that bastard". A week later she died from liver failure.
    - nullc 6y ago
      Tylenol is most of the most deadly (in terms of effective dose vs harmful dose) of anything commonly used.
    - TheOtherHobbes 6y ago
      That's a standard thing with Tylenol/Paracetamol. You can recover from the initial overdose, but then the metabolites build up in your liver over the next few days and trash it beyond any hope of repair. At that point it's either a transplant or death. The scary thing is that it's incredibly easy to overdose by accident. For some people the lethal dose is less than twice the recommended dose, and if you're in a lot of pain - e.g. from a dental abscess - you can easily overdo it.
  - mark-r 6y ago
    I'm on a blood pressure drug. My pharmacy ran out of the dose I needed and substituted a 2x size, with instructions to cut the pill in half. I ended up forgetting about the substitution and took the 2x dose daily for a couple of months. Didn't find out until I went to renew the prescription and was told I was trying to refill it too early. Suddenly the recent dizzy spells I had were easily explained.
- hinkley 6y ago
  I think I knew about interactions with benzos, but didn’t know about Tylenol, Aleve, caffeine (!?) or protease inhibitors.
- deleted 6y ago
  [deleted]
mikestew 6y ago
innocent stuff like Tylenol On a pedantic note, acetaminophen should not be considered innocent, but rather considered to be something very easy to get too much of because it’s in friggin’ everything. Cough syrup, Tylenol, many opioids that your doctor might prescribe. Read those labels, because if you take some Tylenol for those aches and pains and wash it down with some cough syrup for that cold, your liver might want to have a word with you.
- mark-r 6y ago
  Acetaminophen is added to opiates to make sure there are bad side effects if you take too much.
  - et2o 6y ago
    That's not why. Acetaminophen is highly hepatoxic but it's only very delayed. It's added because they have a synergistic effect on pain relief.
    - unethical_ban 6y ago
      I'm not suggesting the parent comment is correct, but I think they are implying that medicines are "spiked" with a chemical in order to deter recreational use, lest someone injure themselves.
- et2o 6y ago
  Agree! Acetaminophen is very dangerous in overdose. I've seen lots of 20 year olds who get liver transplants after they OD (intentionally) on Tylenol. If they had taken Motrin instead they'd have been fine.
- TT3351 6y ago
  I have a close family member who works in pharma who regularly tells me there is no way the FDA would approve Tylenol over the counter if it was invented today.

1_player 6y ago

https://en.wikipedia.org/wiki/Grapefruit%E2%80%93drug_interactions#Incomplete_list_of_affected_drugs https://en.wikipedia.org/wiki/Grapefruit%E2%80%93drug_intera... They interact with so many drugs, if you take any medication for chronic illnesses, chances are you should not eat any grapefruit for the rest of your life. Also whether a drug is affected by it or not is not clear, so the common advice is just to avoid the fruit whatever the drug you're taking. It's one of my favourite fruits, and not being able to eat it once in a while hurts. Though I'm not sure how _dangerous_ it really is. Does it affect the half-life of a drug by 5%, or by 100%?

dmurray 6y ago
TFA says it increases the bioavailability of felodipine, the drug where the effect was first noticed, by about a factor of 5. For most prescription drugs for chronic illness, you probably do not want to find out what happens when you move to 5x the effective dose.
- jychang 6y ago
  Depends on the dose and drug. 5x the dose of adderall is probably pretty fun.
  - mardifoufs 6y ago
    Adderall/Vyvanse/Amphetamines don't interact well at all with vitamin C, of which grapefruits are full of. So sadly enough, you don't get any 5x intake boost with the enjoyable meds. Would have been way too much fun ;)
    - 3np 6y ago
      Isn't the vit C thing just because of acidity? Combining with a teaspoon of NaHCO3 would cancel that out, no?
    - sudoaza 6y ago
      But apparently the effect lasts up to 12 hours, vitamin c should be gone from the stomach by then. Grapefruit has been anecdotally recommended for MDMA (an amphetamine).
      - mdmthrowaway 6y ago
        The reason it's recommended for MDMA is because it inhibits the CYP3A4 enzyme which metabolizes MDMA (3,4-Methylenedioxymethamphetamine) to MDA (3,4-Methylenedioxyamphetamine). MDA is more neurotoxic than MDMA which is why it's advised to reduce the amount your body intakes.
    - cik2e 6y ago
      The majority of adderall breaks down through the urea cycle due to urine acidity. Enzymes don’t play as significant a role as they do for other drugs. That’s why baking soda is the best potentiator for amphetamines, as it neutralizes urine acidity.
      - 3np 6y ago
        For anyone considering actually doing this, beware that it needn't take much baking soda to be harmful. People have died from overdosing. Maybe someone with journal access can dig out dosage ranges from any of these many sources: https://scholar.google.com/scholar?q=related:4ssWhTcQeYEJ:scholar.google.com/&scioq=Homespun+Remedy,+Homespun+Toxicity:+Baking+Soda+Ingestion+for+Dyspepsia&hl=en&as_sdt=0,5 https://scholar.google.com/scholar?q=related:4ssWhTcQeYEJ:sc...
  - garmaine 6y ago
    If by “fun” you mean think-your-heart-is-about-to-literally-explode and lie down in fear for 8 hours. (Source: have accidentally double dosed my amphetamine Rx. A 5x dose would probably be lethal.)
  - soylentcola 6y ago
    As someone prescribed Adderall, to my knowledge, grapefruit juice (and citrus in general) will inhibit the absorption so if anything, it would just lower the effectiveness of a typical dose.
- seamyb88 6y ago
  Even for "some innocent stuff like Tylenol", as the original comment puts it, you do not want to be taking 5x the dose. This is a very harmful drug in (not very) large quantities. I know of somebody whose boyfriend ended things with her, she took a load of tylenol to end her life, but the doctors managed to resuscitate her. When she came to, she said to her mother "I'm so glad I didn't kill myself over that bastard". A week later she died from liver failure.
  - nullc 6y ago
    Tylenol is most of the most deadly (in terms of effective dose vs harmful dose) of anything commonly used.
  - TheOtherHobbes 6y ago
    That's a standard thing with Tylenol/Paracetamol. You can recover from the initial overdose, but then the metabolites build up in your liver over the next few days and trash it beyond any hope of repair. At that point it's either a transplant or death. The scary thing is that it's incredibly easy to overdose by accident. For some people the lethal dose is less than twice the recommended dose, and if you're in a lot of pain - e.g. from a dental abscess - you can easily overdo it.
- mark-r 6y ago
  I'm on a blood pressure drug. My pharmacy ran out of the dose I needed and substituted a 2x size, with instructions to cut the pill in half. I ended up forgetting about the substitution and took the 2x dose daily for a couple of months. Didn't find out until I went to renew the prescription and was told I was trying to refill it too early. Suddenly the recent dizzy spells I had were easily explained.
hinkley 6y ago
I think I knew about interactions with benzos, but didn’t know about Tylenol, Aleve, caffeine (!?) or protease inhibitors.
deleted 6y ago
[deleted]

mikestew 6y ago

innocent stuff like Tylenol On a pedantic note, acetaminophen should not be considered innocent, but rather considered to be something very easy to get too much of because it’s in friggin’ everything. Cough syrup, Tylenol, many opioids that your doctor might prescribe. Read those labels, because if you take some Tylenol for those aches and pains and wash it down with some cough syrup for that cold, your liver might want to have a word with you.

mark-r 6y ago
Acetaminophen is added to opiates to make sure there are bad side effects if you take too much.
- et2o 6y ago
  That's not why. Acetaminophen is highly hepatoxic but it's only very delayed. It's added because they have a synergistic effect on pain relief.
  - unethical_ban 6y ago
    I'm not suggesting the parent comment is correct, but I think they are implying that medicines are "spiked" with a chemical in order to deter recreational use, lest someone injure themselves.
et2o 6y ago
Agree! Acetaminophen is very dangerous in overdose. I've seen lots of 20 year olds who get liver transplants after they OD (intentionally) on Tylenol. If they had taken Motrin instead they'd have been fine.
TT3351 6y ago
I have a close family member who works in pharma who regularly tells me there is no way the FDA would approve Tylenol over the counter if it was invented today.