Grapefruit juice

[Harpoon]

Got the brand spankin' new laptop goin' and I'm putting it through it's paces...

Happened across this after installing Netscape:

I did a little editing in the cut&paste.

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Grapefruit Juice Affects Some Rx Drugs

Check 'Drug-Food Interaction' Label on Prescription Medicine

By Miranda Hitti
WebMD Medical News Reviewed By Michael Smith, MD
on Thursday, January 20, 2005

Jan. 20, 2005 -- Grapefruit juice interacts with many prescription drugs, which can cause potentially serious side effects or make some lifesaving drugs less effective.

This interaction is listed on a medication's "drug-food interaction" label. But many people overlook those labels.

That's what happened to Lucas King, a 59-year-old retired government auditor. King's story appeared recently in the American Journal of Nursing. It's a cautionary tale shared by Amy Karch, MS, RN, an assistant professor of clinical nursing at University of Rochester in New York.

Patient's Story

At first, King's health problems had nothing to do with grapefruit juice. Instead, he was facing a high risk of heart disease, like millions of Americans.

King was obese, inactive, and had a family history of heart disease. His LDL "bad" cholesterol level was way too high: 225 mg/dL, even after a month of dieting and exercising.

King's doctor prescribed Lipitor, along with continued diet and exercise. King obeyed. His Lipitor dose was gradually increased to a high dose of 60 milligrams a day. After four months, he'd brought his LDL cholesterol down to 104. He'd also lost 36 pounds.

Later, King headed to his winter home in Florida. With a grapefruit tree on his patio, he drank two to three daily glasses of fresh grapefruit juice.

But just two months after getting the good news about his cholesterol, King was in a Florida emergency room. His symptoms: muscle pain that had started suddenly, fatigue, and high fever. King was diagnosed with rhabdomyolysis, a severe muscle reaction that can cause death.

Cholesterol-lowering statin drugs such as Lipitor can cause rhabdomyolysis. The possible risk is noted on the drug's warning labels. In fact, the teaching sheet given to King may have saved his life. The sheet listed signs and symptoms of the condition, advising patients to take them seriously and seek immediate medical attention.

Lipitor was stopped and King was monitored for kidney problems, which rhabdomyolysis can trigger. He said he'd taken the prescribed doses and wasn't taking any over-the-counter or alternative medicines.

When a nurse asked King if he'd made any changes in diet or exercise, he told her about his grapefruit juice consumption. The nurse looked up Lipitor and found that grapefruit juice slows activity of the liver enzyme that metabolizes Lipitor. This led to high drug levels in King's body, raising the risk of rhabdomyloysis.

Most Drugs Safe

The Florida Department of Citrus (FDOC) acknowledges that grapefruit juice interacts with some cholesterol-lowering drugs.

The FDOC says grapefruit juice doesn't interact with most prescription drugs. The FDOC also notes that patients can usually take other drugs in the same drug class that don't interact with grapefruit juice.

That's what King did. He was switched to another cholesterol-lowering drug,cholesterol-lowering drug, Pravachol, that doesn't interact with grapefruit juice.

Drugs That Interact With Grapefruit Juice

Here are some drugs that interact with grapefruit juice. Check with your doctor or pharmacist if you're concerned about any of your medications.

Xanax, Buspar, Versed, Halcion, Luvox, Zoloft
Allergies, Allegra, Cordarone, quinidine, Coumadin, Tegretol, Cyclophosphamide, etoposide, ifosfamide, tamoxifen, vinblastine, vincristine, Dextromethorphan, Agenerase, Crixivan, Viracept, Norvir, Fortovase, Proscar, Coreg, Cardizem, Plendil, Cardene, Adalat, Procardia, Nimotop, Sular, Covera, Calan, Verelan, Viagra, Cialis, Theophylline, Lipitor, Lescol, Mevacor, Zocor, Alfenta, Duragesic, Actiq, Sufenta, Biaxin, Sporanox, erythromycin, troleandomycin

Patients should check with their doctors about specific interactions between grapefruit juice and medication.

SOURCES: Karch, A. American Journal of Nursing, December 2004. WebMD Medical Reference from Healthwise: "Statins for High Cholesterol." WebMD Medical Reference from Healthwise: "Selective Serotonin Reuptake Inhibitors." News release, University of Rochester Medical Center. News release, Florida Department of Citrus.


© 2004 WebMD Inc. All rights reserved.

 

[ladyofthelake]

Grapefruit Juice

Grapefruit Juice

Harpoon,

Thanks for the caution post. The caution with grapefruit interaction is not something that I have seen commonly educated to patients as it should be.

The drug that I am on is not listed in the interacting drug section but it can have the most devestating interaction and I was never told this by the prescribing doctor. Fortunately when I saw my former cardiologist's resistance to give me ANY information on the drug, I chose to dig through Pharmacology Journals until I found the exact dangers published about it. (at the time I was put on the drug it was not published in the PDR yet as it was brand new) So I can assume that I was lucky to learn that I needed to avoid all products with grapefurit in it.

Lisa

 

[McCln]

A nurse from my insurance company told me about the grapefruit interaction about three months ago. She mentioned that it could interact with heart medications. Thanks for sharing the list. Always good to be updated with the latest information.

 

[Raverlaw]

Harpoon,

Definitely something those of us on statins should be aware of. But as with most other things, the horror stories are caused by large doses. Note that King was on a VERY high does of Lipitor (60mg) and drank 3 glasses of grapefruit juice daily - way above normal.

I love my grapefruit. I take 10mg of Lipitor daily, so here's what I do- I take my Lipitor in the evening, so that 10-12 hours intervene between the drug and the grapefruit ingestion (the warning label on the medicine says not to eat grapefruit within 2 hours before or after taking the drug). I eat NO MORE than 1/2 of a grapefruit in the morning - equivalent to about 4-6 ounces of juice. I've never had a problem. Now if I was to eat a half dozen grapefruit a day, or take a large dose of Lipitor, or both, I might wind up like Mr. King.

Moderation in all things seems to be the key.

 

[Glenda]

Another medication that grapefruit juice will interfere with is Gleevec. Used for CML. I was told not to drink it at any time. That's too bad, I really like grapefruit juice. Oh well! !

 

[Harpoon]

Bill - General rule of thumb really, do EVERYTHING in moderation....




Well, 'cept maybe s-e-x but that's for another discussion......

 

[Bryan B]

A competent pharmacist SHOULD warn you of any interactions between the medication he or she is dispensing and grapefruit (or anything else for that matter). Too often all pharmacy's say when they dispense meds is "do you have any questions?". I'll add that most pharmacies are not staffed adequetely to allow pharmacists time to thoroughly consult with their patients, but if you ask them to explain any possible interactions or side effects they will. As someone that has worked in and around pharmacies for over 15 years it's a pet peeve of mine that there is not more face to face interaction between the pharmacist and their patients. That's why the last several years I've gone from working IN pharmacies to implementing software that will help alert RPh's to things like drug interactions and automation equipment that will help free up the RPh to spend more time with their patients.


OK...climbing down off of my...

 

[Harpoon]

Eckards (at least around here) puts all kinds of warning labels on the bottle. When I was on amiodarone, those bottles had a label that warned against having grapefruits and grapefruit juice.


I'm sure not every pharmacy does this, but there are some that are VERY throrough. Eckards seems to be one and I can go to ANY of their stores and they can call up my records for refills or whatever I might need from them.

 

[hensylee]

being raised in Florida, we had grapefruit everywhere. I always hated it. I also was on Lipitor and got those same conditions, muscle-wise. I stopped it once, numbers went up, so had to start it again. I got worse and worse and a year ago I could barely walk - used walkers at times and cane most times. In March 2004, I quit that stuff, swore I would never take it again - haven't. I can now walk but will never be quite the same. I bet the man would've gotten that condition with or without grapefruit juice. We have some serious Lipitor/statin discussions in VR if anyone cares to search.

But, it's been known for a long time that grapefruit juice causes many medicines to become ineffective - especially antibiotics. (milk also renders some of them useless). Ask your pharmacist for the 'printout' that should come with every single RX you get. Then be sure you read it. I read mine when I first get the rx filled, then if still on it, read again in a few months to refresh.