Are all oranges bad for CLL?

[CCgroup]

We are all aware that Seville Oranges and grapefruit are taboo for those with CLL. Are all oranges, for example mandarin oranges, also a bad idea for CLL people?

[seelel]

No - grapefruit and seville oranges are not taboo for people with CLL.

They should only be avoided if taking any medication, as they tend to expel the ingredients from the body rather than assimilating them.

So only a person in treatment for CLL should avoid them.

[SofiaDeo in reply to seelel]

Um, the grapefruit effect may also be the opposite. It usually is the opposite, it's only recently that a grapefruit-drug interaction where *less* drug enters the body, had been discovered. One usually sees "elevated" levels of *certain* drugs in the body, not less. These drugs are not expelled, they are increased. And it's *certain* medications, not all of them. Whether or not one has CLL. There are a number of drugs for variety of disease states that will see interactions if patients eat grapefruit/Seville orange. And it turns out, this can also be somewhat patient specific.

fda.gov/consumers/consumer-...

[seelel in reply to SofiaDeo]

You are absolutely right. I'm probably getting too old for this. I checked sources and ......

Grapefruit juice can block the action of intestinal CYP3A4, so instead of being metabolized, more of the drug enters the blood and stays in the body longer. 

[SofiaDeo in reply to seelel]

The "expels more drug" is newer news, so I am not surprised that it may have come first to mind, or be something that you remember reading more recently. For many, many years, we were taught that the grapefruit-drug interaction *always* resulted in higher drug concentrations. Fexofenadine was approved in 1996 but the fexofenadine-grapefruit interaction wasn't noted until 2005, and was considered "novel"

pubmed.ncbi.nlm.nih.gov/157...

And it's not the same liver enzymes that grapefruit affects, for the fexofenadine. Apparently a number of fruits can affect absorption, there may be more prohibitions against citrus and certain medications as time goes by & more are tested.

verywellhealth.com/allegra-...

[carnvellan in reply to SofiaDeo]

This alerted me as I am taking Fexofenadine. The package leaflet in the box does not mention any food interactions and my doctor did not mention any. Drugs.com says:

'Consuming large amounts of certain fruit juices, including grapefruit, orange and apple, may decrease the levels of fexofenadine in your body. Fexofenadine should be taken with water and refrain from drinking large amounts of grapefruit, orange, or apple juice. This will make it easier for your body to absorb the medication.'

[SofiaDeo in reply to carnvellan]

I think the reason why one isn't routinely warned, is that the enzymes responsible for less absorption can vary wildly from person to person, from what I read. They are in the gut lining. Unlike the liver enzyme ones; most everyone has those liver enzymes, they are used for things other than just drugs, and livers in adults are roughly the same size. It's also interesting that your source says "avoid large quantities" but doesn't mention what a "large quantity" is. The study I found indicated a standard serving amount (300ml, a 10 oz glass) had the same effect as 1200 ml (four of those 10 oz glasses).

[Sepsur]

If you aren’t on treatment then eat sensibly anything

[CCgroup in reply to Sepsur]

Thanks, Sepsur. I've been on ibrutinib for a little under three years.

[cllady01 Former Volunteer]

Please do be aware there are other medications besides CLL treatment meds that have a negative interaction with grapefruit and seville oranges. One I have firsthand knowledge of is my Thyroid meds.

fda.gov/drugs/special-featu...

mayoclinic.org/healthy-life...

[thb4747]

if you’re being treated with Venetoclax these fruits are forbidden. I eat mandarins though.

[Oleboyredw-uk]

i thought that Star Fruit and Pomelos are also not allowed during treatment (from memory of restrictions on a trial ithat included Venetoclax)

best to all,

[morepork]

Pomegranate juice also to add to list, I was told.

[Leo71]

I only know this from Health Unlocked. My husband wasn't given any information of this kind when he started treatment.

[mdsp7]

This is such a great website! Thank you all for chiming in! Good question, good discussion.

[CCgroup in reply to mdsp7]

Many thanks for the input from all of you. It was a good discussion, and I learned quite a bit. I have also heard starfruit can be a problem, but have not seen any written warnings.

Thanks again

Dan

[CocoMolly]

There is no problem eating oranges and grapefruit,if you have CLL ,the problem is the medication you are on and if it reacts with Seville oranges or Grapefruit. I have been on Imbruvica for more than 3 years and I eat oranges and mandarins, and no reaction whatsoever,but I have accidentally eaten product with Seville orange in it and mark my words,it is not a nice reaction ,at times I get a similar reaction from green grapes, although this doesn’t appear on the list of reactions. The reaction to Seville oranges feels like you have overdosed on the medication.I hope this helps.Life is beautiful.

[AussieNeil Administrator in reply to CocoMolly]

That's exactly why grapefruit and Seville oranges are contraindicated with BTKi drugs. These citrus fruit have a particularly high concentration of what blocks the enzyme that breaks down the BTKi, so you can end up with extended high serum levels, increasing your risk of side effects.

Neil

[CCgroup in reply to CocoMolly]

Thanks for the comments. I eat a lot of green grapes with no problem, I'm sorry they react with you. I'll give mandarin oranges a try.

All the best

Dan

[MovingForward4423]

All fruit is fine, it’s the drugs that interact. Ibrutinib you avoid Seville Oranges and Grapefruit.

[CCgroup in reply to MovingForward4423]

Thanks. That was my understanding as well. I shall have the odd mandarine orange - I just wanted to double check.