Acalabrutinib and Cirtus Fruit

[SERVrider]

The Acalabrutinib data sheet states that one should avoid grapefruit and Seville oranges. Does that mean that orange juice from concentrate which may be from the EU, the US or, say, Brazil, is OK and that fresh oranges from the Mediterranean area, including Spain, is OK or not? Anyone got any bright ideas?

[mrsjsmith]

Suggest you avoid all orange juice as difficult to know what type of orange used, unless something like clementine. The clue is in the name Seville oranges come from Spain but usually only used for marmalade.

Colette

[fapumpkin]

You also might find that you need to not consume pomegranate or star fruit. Seville oranges are bitter so used for marmalade rather than drink.

[SERVrider in reply to fapumpkin]

I binged on marmalade before starting Acalabrutinib, a pleasure lost for the future!

[Hidden]

i drink Florida orange juice ever day. Obviously not seville oranges.

[morepork]

I was amazed to find Pomegranate Juice was suspect - no-one here had told me about that ! 😊

[AussieNeil Partner Administrator in reply to morepork]

Pomegranate has been discussed here on occasion, per these search results: healthunlocked.com/cllsuppo...

In this pinned post: healthunlocked.com/cllsuppo... pomegranate isn't specifically mentioned.

Neil

[morepork in reply to AussieNeil]

Sorry,, misinterpretation, I meant here in NZ NOT Health Unlocked as that is where I discovered the fact !

[1susiE]

Seville is a type of orange - not related to its origin

[SERVrider]

Thanks everyone for the comments, the question would apply equally to rhubarb because that also has the bitter characteristics of Seville oranges. Indeed, I contacted AstraZeneca yesterday to ask them the question and await an e-mail from them.

[Agiledog]

I am in an acalabtutinib trial at NIH(U.S.). The grapefruit and Seville orange prohibition was in place until several months ago. My attending then told me that those restrictions have been lifted in light of further findings. I did not ask for the reference. You might call the drug company to check it.

Bud

[SERVrider]

Thanks Agiledog, I have contacted AZ (UK) and they knew nothing about Acalabrutinib and didn't recognise the generic name but needed "Calquence", largely because it is not licensed in the UK yet but they said they would find out and e-mail me with the answer. I await but your results are encouraging - not that I eat grapefruit anyway as a) I don't like it and b) it is contra-indicated with Simvastatin. I do, however, like a nice, thick cut Oxford marmalade and it is a pity to lose my Saturday morning treat! I also like a glass of orange juice with breakfast - there's no knowing where it comes from; within the EU so Italy or Spain, Israel, Brazil, possibly the US, Florida floats on the stuff. The concentrate can come from mixed sources as our latitude and climate means that we can't grow oranges here.

[SofiaDeo]

former pharmacist here. the issue is that grapefruit, Seville oranges, CBD oil, certain herbs, and other things inhibit the cytochome P450 enzymes in your liver, which leads to elevated blood drug levels. the trick would be, IF you want to include any of these things in your diet, you MUST be consistent. you don't want fluctuations due to diet. if you want the weekly marmalade thing, you've got to be consistent with it, and include your doctor in the decision. Personally, I used CBD oil to potentiate ibrutinib/resolve pain (instead of other pain meds) so I could take a very low dose and still get therapeutic effects, but my Dr's knew about it and I was careful to be consistent with dosing as well as followup labwork, plus I was careful not to take any other things that affected my liver (like Tylenol). I wouldn't recommend trying to include grapefruit, since size varies and the amount of enzyme inhibition could fluctuate. But a regular, once a week, consistent size serving of your marmalade should be do-able. The caution is there, so that you have a discussion with your doctor if it possible for you to have this food, not an outright ban. And FWIW seville oranges are rarely used in juice because it is bitter, so should be no worries there.

[SERVrider]

Sofia, That's brilliant; a scientific reasoning as to why those fruits are contra-indicated. I can live without the marmalade but can drink a small glass of ordinary orange juice for breakfast safely. Thanks for the explanation.