Lemon

[ANA4]

Is it fine to eat/drink lemon while I’m on IBRUTINIB as I know grapefruit is not allowed during the treatment

[AussieNeil Partner Administrator]

Citrus fruit other than seville oranges and grapefruit are fine when on Ibrutinib.

[Sepsur in reply to AussieNeil]

Hi @AussieNeil - I was warned off limes & pomelos too - but lemons were ok(??)

[Sushibruno in reply to Sepsur]

Really I love limes🤨

[Sepsur in reply to Sushibruno]

Same here, in fact, I love lime, marmalade, ginger, turmeric 😳 but the sacrifice is worth it.

[Canuck901 in reply to Sepsur]

Really no limes?

I just heard Seville oranges

[AussieNeil Partner Administrator in reply to Canuck901]

From the official Patient Resources Imbruvica/Ibrutinib website: imbruvica.com

"What should I avoid while taking IMBRUVICA®?

You should not drink grapefruit juice, eat grapefruit, or eat Seville oranges (often used in marmalades) during treatment with IMBRUVICA®. These products may increase the amount of IMBRUVICA® in your blood."

Now I would expect, (I don't know), that all citrus fruit would have varying degrees of inhibition of the CYP3A enzyme, which can cause an increased serum level of Ibrutinib and hence worsened side effects. From looking at a few papers examining the impact on some other drugs, the effect is strongest with grapefruit and Seville oranges.

pubmed.ncbi.nlm.nih.gov/129...

link.springer.com/article/1...

The degree on inhibition is going to depend on the specific variety, the soil and other growing condition influencing factors, when the fruit was picked, how long it has been kept in storage and the conditions of that storage and so on, even before you consider how much you are consuming. Welcome to the vagaries of active ingredient concentrations in natural products!

Neil

[Belkin123 in reply to AussieNeil]

If those fruits/juices increase concentration of ibrutinib in blood, maybe it is a good idea to continue with the fruits and decrease the amount of ibrutinib to avoid the side effects? Just joking...

[AussieNeil Partner Administrator in reply to Belkin123]

It's the furanocoumarin in grape fruit juice that increases drug absorption in the intestines. You'd think that this would be a useful way of extending the half life, for example, enabling Acalabrutinib to be taken once, rather than twice per day. However, it seems that in vitro results are not a good guide to on vivo results and "The susceptibility varies between individuals depending upon their genetic expression of CYP3A4, the effects being more prominent in those with high small intestinal CYP3A4 content".

bjmp.org/content/drug-inter...

Neil

[Belkin123 in reply to AussieNeil]

Thank you, Neil. Then it does look that it depends on individual and for some of them can be an advantage... to take grapefruit juice and one pill of Acalabrutnib instead of two.

I love grapefruit juice...I will talk to my doctor, thanks for this discussion and for many others. You are a very special person for this community in cense of knowledge, experience and deep understanding of Cll related subjects.

Wishing you to stay well and have a long long remission.

[PaulaS Volunteer]

Hi Ami4,

I was officially warned off Seville oranges (as in marmalade) and grapefruit when on Ibrutinib, but told other citrus was OK. So lemon should be OK. Some folk have also been advised to avoid kiwi fruits and pomegranates (must add here, that kiwi fruits are probably fine as I haven't seen them on any list of possible problem foods, though pomegranates are) .

However, since being on Ibrutinib my stomach is much more sensitive and all citrus fruits upset my stomach (probably because they're very acidy). Sadly I now avoid them all. Other fruits don't give me any problems though - eg peaches, melon, grapes, mangos, blackberries, raspberries, bananas...

Paula

[Canuck901 in reply to PaulaS]

Kiwi ? Why kiwi ? We were never told that , just ginger and Seville oranges and grapefruit I believe

[Kmegood in reply to Canuck901]

My hematologist said no Seville oranges or grapefruit . There was never any mention about kiwi or ginger in my Ibrutinib/ Imbruvica Manuel

[PaulaS Volunteer in reply to Canuck901]

Hi Canuck901 , I was never told to avoid Kiwi myself - it was just that I remember someone else saying this. My apologies - I shouldn't have mentioned it when it was just hearsay.

The ibrutinib website clearly says avoid grapefruit and Seville oranges, but it doesn't mention other things.

The links that MsLockYourPosts has given are very interesting, as they list many other things that inhibit CYP3A4 9 (the enzyme that breaks down drugs in the body). Green tea, black pepper, licorice, pomegranate, ginger, curcumin/turmeric and star fruit are included, but no mention of kiwi. . The varying strengths of these substances are also mentioned, which is very helpful.

I reckon it’s a matter of degree and the important things to avoid completely are grapefruit and Seville oranges, and maybe just go easy on the other suspect things.

Paula

[MsLockYourPosts Passed Volunteer in reply to PaulaS]

I was surprised to see licorice, but a friend had such a problem with ibrutinib (she thought) that her doctor was going to take her off of it. It turned out that her fondness for licorice was the problem. She is now doing well on ibrutinib.

[sandybeaches in reply to MsLockYourPosts]

licorice is known to increase blood pressure, so that may be why your friend was told not to have it.

Sandy Beaches

[MsLockYourPosts Passed Volunteer in reply to sandybeaches]

It is actually on some "avoid" lists for Ibrutinib, and it was the interaction with Ibrutinib that caused her particular issues. I don't know how much of it she ate per day or whatever.

[Canuck901 in reply to PaulaS]

Kiwi is very good for platelets so I hope it’s fine . We eat them regularly

[ANA4 in reply to Canuck901]

Me too I love Kiwi

[ANA4 in reply to Canuck901]

Hi Canuck901!

What’s the relation between Ibrutinib and ginger ? I was never told to avoid ginger

[Canuck901 in reply to ANA4]

It’s a CPY inhibitor for Ibruntnib

[MsLockYourPosts Passed Volunteer]

A couple of links with expanded lists.

consumerlab.com/answers/gra...

herbpedia.wikidot.com/cyp3a4

[Fastbike14]

Ive only ever been warned off Seville oranges. Been on Ibrutinib 5 yrs.

[morepork]

Kiwifruit? Can't find any evidence so I shall carry on eating.

[Jds7]

I was told to also avoid star fruit-whatever they are!

[onu1tadi2]

I drink lemon and warm eater every morning and add it to lots of foods. Only red oranges and grapefruit forbidden as they can elevate blood pressure.

[Patc890USA]

Like most people here I was warned not to eat Seville oranges or grapefruit. While looking around at articles about this I found this article at the NIH. It found that clementines could cause a problem also. The last paragraph in the article says

"Our data indicate that clementine juice similar to grapefruit juice bears the potential for

profound interactions with drugs potentially leading to adverse drug effects e.g. through

over-exposure to CYP3A4 substrates."

pubmed.ncbi.nlm.nih.gov/278...

My doctors at NIH had never seen the article and were not sure about eating them. They told me skip them just in case.

[Patc890USA]

AussieNeil said that furanocoumarin is what causes the problem. So I was wondering how much does it take to cause a problem? If I had half a grape fruit for breakfast every morning (which I used to) I can see how that would be a problem. But if I had half of one just once a week would that still cause a problem? Likewise, I love marmalade which needs to be made from Saville oranges. So if I had say 2 teaspoons on toast once a week would that be bad? How much furanocoumarin could be in 2 teaspoons. Just wondering.

[ANA4 in reply to Patc890USA]

Thank you for your reply 😀