Grapefruit

[Grannyblue]

Hi, I have been eating grapefruit regularly, but have just read today that it should be avoided, haven’t got a n appointment with specialist until end of March, didn’t really want to wait that long for an answer, because I am running out of things I can safely eat as it is, only meds I am on is low dose diuretics, anyone able to shed some light on this? Tia

[AyrshireK]

Grapefruit is high in vitamin c and supposedly has anti inflammatory properties.

However, it can be problematic if you are on various drugs as it either increases or decreases their effectiveness and can in some cases be dangerous.

Quite a comprehensive list of medications that are contraindicated with grapefruit.

1. Certain Statins

Certain statins and grapefruit do not mix well together. For example, consuming grapefruit while taking Lipitor (atorvastatin) can result in high atorvastatin levels in your bloodstream.3 Too much atorvastatin may increase your risk of rhabdomyolysis (muscle breakdown).

This interaction is more likely when you drink or eat grapefruit at more than 1.2 liters daily.

The following is a list of statins that interact with grapefruit:

Atorvastatin

Lovastatin

Zocor (simvastatin)

However, there are alternative statins with a lower risk of interacting with grapefruit. These statins include:

Crestor (rosuvastatin)4

Fluvastatin

Pravastatin

2. Calcium Channel Blockers

Grapefruit may interact with some blood pressure medications—specifically the calcium channel blocker drug class.

For example, grapefruit can raise levels of Procardia (nifedipine), a calcium channel blocker, in your bloodstrea.This increases your risk for side effects, such as low blood pressure (hypotension) and swelling

Some alternatives to calcium channel blockers with little to no interaction with grapefruit include:

Cardizem (diltiazem)

Norvasc (amlodipine)

Verelan (verapamil)

3. Estrogen-Containing Medications

Grapefruit can increase estrogen levels in estrogen-containing medications, such as hormonal contraceptive pills or estradiol tablets. High estrogen levels may lead to more side effects.

In general, high doses of estrogen are linked to a risk of heart-related conditions, such as heart attack and blood clots. Overdose with estrogen may also cause nausea, vomiting, and vaginal bleeding.

4. Certain Immunosuppressants

Grapefruit interacts with certain immunosuppressants—drugs that decrease the intensity of the immune response when the immune system is overactive and doing damage. It raises the levels of some immunosuppressive drugs, which can increase the risk of problems such as kidney toxicity.

The following is a list of example immunosuppressants that interact with grapefruit:

Afinitor, Zortress (everolimus)

Neoral (cyclosporine)

Prograf (tacrolimus)

Rapamune (sirolimus)

You'll likely need to avoid or limit grapefruit while taking any of the above medications.

5. Buspirone

Grapefruit interacts with a medication called buspirone, which is used to treat anxiety disorders. It does this by increasing the amount of the drug in your bloodstream.

High levels of buspirone may increase your risk of side effects, such as:

Dizziness

Drowsiness

Headache

Nausea

Nervousness

Restlessness

If you are taking buspirone, it's recommended to avoid drinking grapefruit juice in large amounts.

6. Corticosteroids

Grapefruit can raise the levels of certain oral corticosteroids (steroids) in the body. This includes budesonide, a steroid used in treating the inflammatory bowel disease Crohn's disease, and Medrol (methylprednisolone), which treats several inflammatory conditions.

Too much steroid in the bloodstream can cause Cushing's syndrome (hormonal disorder caused by high levels of cortisol) or increase the risk of side effects, such as high blood pressure or fluid retention.

7. Anti-Arrythmic Medications

Grapefruit can interact with some anti-arrhythmic medications, such as Multaq (dronedarone) and Pacerone (amiodarone).4 Grapefruit raises the drug levels in your body. This may increase the risk of side effects, including severe heart rhythm problems.

8. A Few Diabetes Medications

Onglyza (saxagliptin) is a diabetes medication in the dipeptidyl peptidase 4 (DPP4) inhibitor drug class.Grapefruit might increase saxagliptin levels by blocking the CYP3A4 liver protein that breaks down this drug.

Common side effects of saxagliptin include:

Headache

Upper respiratory tract infection—like the common cold

Urinary tract infection (UTI)

If taken with something that strongly blocks the CYP3A4 liver protein—like grapefruit—the saxagliptin dosage should be low at 2.5 milligrams (mg) daily.

Alternatives may include a similar but different class of diabetes medication called glucagon-like peptide 1 (GLP-1) agonists. Examples include Victoza (liraglutide) and Ozempic (semaglutide).

9. Allegra (Fexofenadine)

Allegra (fexofenadine) is an example of an OTC antihistamine that interacts with grapefruit. Grapefruit can limit how much fexofenadine enters the bloodstream. This decreases the drug's effectiveness.

An alternative antihistamine that is likely safe against grapefruit is Claritin (loratadine).

10. Blood Thinners (Anticoagulants)

Grapefruit might increase the levels of certain blood thinners by blocking the CYP3A4 liver protein that breaks them down. As a result, you might be at an increased risk of bleeding.

Examples of blood thinners that can interact with grapefruit are:

Eliquis (apixaban)

Plavix (clopidogrel)

Xarelto (rivaroxaban)

[AyrshireK in reply to AyrshireK]

Continued as Health Unlocked is limiting comments to 7000 characters ......... that's a first.

11. Some Cancer Medications

Grapefruit can interact with some cancer medications, such as dasatinib and nilotinib used for chronic myeloid leukemia (CML). Grapefruit can raise the amount of these medications in your body. This can increase the risk of side effects, such as severe heart rhythm problems and toxicity.

Some dosage adjustments are possible with dasatinib.

12. Certain Drugs Used to Treat Infections

Grapefruit can interact with certain drugs used to treat infections, such as:

An antibiotic called Ery-Tab (erythromycin)

Certain human immunodeficiency virus (HIV) medications, such as Edurant (rilpivirine), Selzentry (maraviroc), bictegravir, and doravirine

Paxlovid (nirmatrelvir and ritonavir)

The product labels do not list grapefruit as an interaction. However, grapefruit might raise these anti-infective drug levels by blocking the CYP3A4 liver protein that breaks down these medications.

In general, high drug levels might be linked to more side effects, such as a severe heart rhythm problem with erythromycin and rilpivirine or dangerously low blood pressure with maraviroc.

As for Paxlovid, bictegravir, and doravirine, some of the common side effects are related to the digestive system.

13. Certain Opioids

Grapefruit can interact with some pain medications, including opioids like oral oxycodone, fentanyl, and methadone. Grapefruit might raise levels of these medications in the blood. In some cases, this can increase the risk of a dangerously slow breathing rate, which is a side effect of an opioid overdose.

14. Erectile Dysfunction and Urinary Tract Drugs

Grapefruit juice may interact with the following medications:

Flomax (tamsulosin)

Rapaflo (silodosin)

Uroxatral (alfuzosin)

Viagra (sildenafil)

The product labels may not specifically list grapefruit as an interaction. However, grapefruit can lead to high drug levels by blocking the CYP3A4 liver protein. This could result in increased side effects, such as low blood pressure.

Summary

Grapefruit is a citrus fruit that is a source of various nutrients. However, grapefruit can also be dangerous due to numerous drug interactions. Therefore, grapefruit should be avoided with certain medications.

While this article provided several examples of grapefruit medication interactions, it is not a complete list. Before including grapefruit as part of your routine or making any medication changes, reach out to a healthcare provider.

[Grannyblue in reply to AyrshireK]

Thank you so much for this, I take none of these so will happily continue to enjoy my grapefruit ❤️

[TrudiT in reply to AyrshireK]

Thank you for that information. I've always been slightly confused by the whole 'can I?can't I ?' grapefruit issue.

[Sunnyskies33]

The other related factor ...which doesn't apply to you probably ...is for people with Hemochromatosis. Vitamin C can increase iron absorption so I get most of my Vitamin C through veggies and some fruits but mostly avoid citrus. If I wanted to have some I would have it apart from any iron heavy foods. Everyone needs some Vit C though! Citrus can also be tough if you have reflux.

[QuietButBold in reply to Sunnyskies33]

I too source most of my Vitamin C mostly via

Vitamin C Vegetable Sources (usually well tolerated):- e.g. Yellow or Red (Bell) Sweet Peppers (in moderation), Brussels Sprouts, Spinach, Cauliflower, Cabbages and Potatoes,

Some Non-Citrus Fruit Vitamin C Sources (in moderation):

- e.g. Strawberries, Blackcurrants, Blueberries, Kiwi Fruit and Tomatoes.

I find that I can also use Lemon / Lime ...but definitely not: Grapefruit, Orange / Clementine / Satsuma etc., nor Broccoli - as their higher salicylate levels (a natural aspirin-style compound) cause me too many intolerance / allergy reactions in my case.

For Salicylate reasons; I also need to avoid / limit my use of some herbs and spices e.g.: Cumin, Five Spice, Mace Mixed Herbs, Nutmeg, Cloves, Paprika, Oregano, Rosemary, Tarragon and Black Pepper.

Some nuts are OK (Salicylate-wise) e.g. walnuts, hazelnuts and pecans. Others, e.g. Brazil Nuts, Almonds and Macadamia Nuts are not OK.

Some seeds are (Salicylate-wise) OK e.g.: Poppy Seeds, Sesame Seeds and Sunflower Seeds. Others are a problem e.g.: Pumpkin Seeds, Chia Seeds, Linseeds and Flaxseed.

In the cool of Winter, I generally experience my tolerance of medium / high Salicylate foods and beverages is a bit broader.

Whereas, in the heat and humidity of Summer; I find it necessary to much more strictly follow my low Salicylate diet.

Unrelated to Salicylate; for reasons still unknown to me: I also unfortunately get a bad reaction from both leek - even tiny quantities (and yet, fine with Onions, Spring Onions, Shallots, Chives and Garlic) and from melon (which is a shame, as I really like all varieties of melon).

I find these restrictions are rather annoying, as, with the exception of Broad Beans (Fava) ...a taste for which I have never acquired, I pretty much like all fruit, vegetables, nuts, seeds, herbs and spices.

(If I really make a poor Salicylate food selection / the ingredients in a supermarket product change without obvious "new recipe" notification ...the antihistamine Loratadine is my go-to quell option).

[Gyproc]

Hi TiaHappy New Year to you.

I was eating grapefruit quite happily, it was only when I went onto simvastatin that I had to stop eating grapefruit. Have you been put on them, or other statins? It tells you on the leaflet that comes with the tablets. Ask your health care advisor and don't believe everything you read. For example i read with cirrhosis I should not eat pork. Another article regarding to a cirrhosis type of diet said in its first line take two pork chops (then rest of ingredients). So I would say ask your doctor, liver nurse, etc.

All the best

Mike

[Grannyblue in reply to Gyproc]

Thanks, no not on any meds, so will carry on eating it for now.

[Ubwa]

As with the above advice, with regards to liver patients, the only absolute no no with grapefruit is if you have had a transplant. This is because it can cause you to overdose fatally on anti rejection medication. More of a FYI as it doesn’t apply to you so enjoy away 🙂