Eliquis and grapefruit

[ralft]

I have just started Eliquis and am confused about grapefruit. The Bristol Meyers website says nothing and I have read postings that their agents say there is no problem. But other websites like WebMD advise against it, What is the prevailing wisdom. I only eat a half per day and no juice which I have been told is more important to avoid with some drugs

[CaroleF]

Have you read the leaflet in the box containing the medication? I take Apixaban (Eliquis) too and there is no mention about not eating grapefruit or drinking the juice in the leaflet.

Isn't it Warfarin with which one should not consume grapefruit?

My advice would be to consult your pharmacist for a definitive reply.

[BobD Volunteer]

Warfarin is a vitamin K antagonist and lots of things are contra indicated. .Eliquis is not. Too much confusion here. Works in a totally different way.

[rosyG]

Hi,

This is from NICE on google

does mention Apixaban- which i take and have avoided grapefruit

Grapefruit–drug interactions

A review article details the evidence for a pharmacokinetic interaction between grapefruit and certain drugs, and the potential clinical consequences of this.

Overview: A pharmacokinetic interaction between grapefruit and certain drugs was first identified over 20 years ago. To date, more than 85 drugs have the possibility of interacting with grapefruit, many of which are widely prescribed for important or common medical conditions. The main interaction results from interference in the activity of the cytochrome P450 3A4 (CYP3A4) enzyme.

Current advice: The British National Formulary Appendix 1 Interactions lists the drugs that interact with grapefruit juice, and advises on whether concomitant use should be avoided. More specific advice is given in the relevant Summary of Product Characteristics for each drug.

The Medicines and Healthcare Regulatory Agency (MHRA) has issued specific warnings about statins and grapefruit juice in 2 editions of Drug Safety Update (atorvastatin, January 2008, and simvastatin, August 2012).

New evidence: A review article (Bailey et al. 2012) has stated that drugs that interact with grapefruit have all of the following characteristics: they are administered orally, they have very low to intermediate absolute bioavailability, and they are metabolised by CYP3A4. Grapefruit juice contains furanocoumarins which can cause irreversible inhibition of CYP3A4, mainly in the small intestine. This results in reduced pre-systemic metabolism of the affected drug, and increased systemic exposure. As an editorial in the BMJ points out, the clinical consequences of this interaction can vary from an asymptomatic increase in drug concentrations to potentially life-threatening events (Pirmohamed 2013).

Case reports of serious adverse events related to grapefruit-drug interactions include torsade de pointes with amiodarone and rhabdomyolysis with atorvastatin and simvastatin. Other drugs that could be affected by grapefruit include anticoagulants (apixaban, rivaroxaban), calcium channel blockers (amlodipine, felodipine, verapamil), central nervous system drugs (qu

[CDreamer in reply to rosyG]

Thanks Rosy, very helpful. I knew about Calcium Chanel Blockers & a few others, I was told to avoid grapefruit on Apixaban.

[aloysius2 in reply to rosyG]

I am able to confirm this excellent response. I take a variety of drugs - Apixaban, Atorvastatin, Ramiprill, Bisoprolol, Nicorandil etc. I mistakenly drank a bottle of grapefruit juice at Tel Aviv airport, thinking that it was lemon juice! By the time that I had arrived at Manchester Airport I was feeling very ill indeed - breathless, rapid heart-beat, unable to walk etc, These symptoms persisted for several days, by which time I had rationalised my mistake. I had mistakenly thought the colour of the drink being lemonish denoted a lemon drink. How foolish!

[rosyG in reply to aloysius2]

Glad it turned out alright in the end- sounds nasty!

[Frances123]

Ditto exactly as Bob says. I’ve been on it for 4 years and counting. x

[MarkS]

Funnily enough, there's no interaction between grapefruit and warfarin whereas there is with apixaban (eliquis) and rivaroxaban. Interactions with warfarin are easy to identify as INR is so easily measured. However interactions with the NOACs are very difficult due to the complexity of laboratory assays to measure their effect.

I wonder what other interactions there are which just haven't been identified yet?

[rosyG in reply to MarkS]

There are many interactions listed for medications but few for food- I don't know what it is about grapefruit!!!

[Sue5453 in reply to rosyG]

I was told carnt have greapefruit cranberries pomigranit green tea and was told ginger now which I like ginger tea

[PattsieL]

I was told to avoid grapefruit with apixaban too.

[ralft]

I called the Eliquis Info line and was forwarded to a nurse who said grapefrujit was NOT a problem. In general she said there were no dietary restrictions but seemed to mostly be making a comparison to coumaden.

[KFog]

Here's what I came up with from the US Food and Drug Administration website. Grapefruit contains furanocoumarene which interferes with the CYP3A4 enzyme. This enzyme metabolizes certain drugs in the small intestine. These drugs include apixaban. If the drug is not metabolized properly, it builds up in your bloodstream. It is like getting a higher dose of the drug than you need, which could be dangerous.

This is different from coumadin/Warfarin. Vitamin K in green leafy vegetables blocks the action of coumadin so that you don't have enough warfarin in your blood as you can see by its effect on your INR.

It seems like avoiding grapefruit and grapefruit juice is the right thing to do when taking apixaban. There is a long list of medications that grapefruit interferes with.

I am neither a doctor nor an expert, but this is what I pulled up on the internet.