Citrus fruits and Acalabrutinib

[kitchengardener2]

Now I am aware that we can't have Grapefruit and Seville Oranges with Acalabrutinib but does anyone know if Lemons are allowed?

[JLJC]

I sure hope lemons 🍋 are allowed because I eat/use them all the time. It was my understanding only the grapefruit and seville should not be consumed while using acalabrutinib.

[kitchengardener2 in reply to JLJC]

Me too, use them in so many ways. In cooking, in my preserves. I also enjoy lemon tea.

[lankisterguy Volunteer]

Hi kitchengardener2,

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The short answer is that most citrus fruits do not contain the enzyme (CYP3A) that affects the way your liver removes acalabrutinib / Calquence from your blood stream.

If you consume grapefruit or its juice, bitter oranges, pomegranate or star fruit that enzyme is altered so the side effects of your CLL drug may be much stronger.

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See en.wikipedia.org/wiki/CYP3A4

SNIP: Inhibition through fruit ingestion

In 1998, various researchers showed that grapefruit juice, and grapefruit in general, is a potent inhibitor of CYP3A4, which can affect the metabolism of a variety of drugs, increasing their bioavailability.[18][19][20][21][22] In some cases, this can lead to a fatal interaction with drugs like astemizole or terfenadine.[19] The effect of grapefruit juice with regard to drug absorption was originally discovered in 1989. The first published report on grapefruit drug interactions was in 1991 in the Lancet entitled "Interactions of Citrus Juices with Felodipine and Nifedipine", and was the first reported food-drug interaction clinically. The effects of grapefruit last from 3–7 days, with the greatest effects when juice is taken an hour previous to administration of the drug.[23]

In addition to grapefruit, other fruits have similar effects. Noni (Morinda citrifolia), for example, is a dietary supplement typically consumed as a juice and also inhibits CYP3A4.[24] Pomegranate juice has shown some inhibition in limited studies, but has not yet demonstrated the effect in humans.[25][26]

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oncolink.org/cancer-treatme....

SNIP: The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. These include: grapefruit, grapefruit juice, Seville oranges (often used in marmalade), St. John's Wort, itraconazole, erythromycin, fluconazole, rifampin, and diltiazem, among others. Be sure to tell your healthcare provider about all medications and supplements you take.

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Len

[kitchengardener2 in reply to lankisterguy]

Thank you for this. I don't eat Grapefruit or Seville Oranges. We are in Spain at the moment and the discussion came up over breakfast. My husband has blood pressure medication and therefore cannot have Grapefruit. No one has told him 'no Seville Oranges '. I am just over two years into Acalabrutinib/Calquence without problems. I was told early on to avoid Grapefruit but it was only after reading posts here that I queried the Oranges. Oops said my nurse, should have told you. It was only this that we were chatting about fruit and I then wondered about the bitterness of lemons which we both love. I shall ask my consultant in October for advice. I have been fine, my liver is normal as are my blood numbers at the last check.

[curlscurls in reply to kitchengardener2]

I called the specialty pharmacist about one of the BTK inhibitors or umbralisib. She explained the enzyme CYP3A and it's inhibiting breakdown that leaves you with too much in your bloodstream of the medication.

She listed grapefruit, seville oranges, and starfruit. Juice being particularly problematic, but not to eat any of those.

She didn't mention pomegranate. She clarified that other everyday fruits are not on the list.

The insert for the medications may have a list as well specific for that medication.

Ooo, FDA has a good write up, and they expand the list

"Seville oranges, pomelos, and tangelos (a cross between tangerines and grapefruit) might have the same effect as grapefruit juice."

fda.gov/consumers/consumer-...

FDA says, jow much there's an enzyme problem can vary from person to person period. So one person may have a serious response of too much men in their system and another person may not.

[Mtk1 in reply to lankisterguy]

Hi Len , I have been taking diltiazem for 10 months now and calquence for 2 years.

Dave.

[lankisterguy Volunteer in reply to Mtk1]

I hope your doctors are fully aware and modifying, if needed, the amount of each drug appropriately

[Mtk1 in reply to lankisterguy]

I will see my haematologist next week, it’s definitely a question I will be asking him.

[Skyshark]

I'll just leave this here and do a runner.

frontiersin.org/journals/on...

Upshot, 600ml/day grapefruit juice = 4x dose increase of Venetoclax allowing quarter dose.

Effect on BTKi is not reported.

[DanBro1]

I drank grapefruit juice frequently while on treatment. The drug interaction notes for many drugs say don't consume grapefruit while on the drug... mostly because it makes the drug a little stronger and it stays in your bloodstream longer. In fact, many 'Doctor Welby' type physicians say to eat grapefruit if on some antibiotics. ('Doc Martin' types for you Brits out there... the type of doctor who treats the individual not an impersonal case number). Anyway, just my thoughts about grapefruits...not medical guidance. I also drank a few Greyhounds on treatment, as well.

[Gardengirl44]

I was on O and V and when it was over, I ran to everything grapefruit!

[Eedew]

yes or they would have been listed