Just came across this warning on Drugs.com. I had never seen before. Have those of you on Jakafi (ruxolitinib) seen this warning?
ruxolitinib food Applies to: Jakafi (ruxolitinib)
Do not consume grapefruit or grapefruit juice during treatment with ruxolitinib unless directed otherwise by your doctor. Grapefruit juice can increase the blood levels of ruxolitinib. This may increase the risk of side effects that affect your bone marrow function, resulting in low numbers of different types of blood cells. You may be more likely to develop anemia, bleeding problems, or infections. Contact your doctor if you experience potential signs and symptoms of these conditions such as paleness, fatigue, dizziness, fainting, unusual bleeding or bruising, fever, chills, sore throat, body aches, or other flu-like symptoms. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
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hunter5582
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I just read that about a week ago in information sent to me by my hem/onc doc. It won’t be a problem for me, as I never liked grapefruit in any form. Ick!
If I remember correctly it was about interaction with drugs. I also take clopidogril blood thinners. It was mentioned in the leaflet with those. I am from the UK so it could be a difference in drug control laws.
it is written on the front of my prescription bag. Otherwise I wouldn’t have known. I’m sad as I love the smell & taste of grapefruit! It is a great detoxifier.
I guess it can go in an essential oil diffuser! Assuming that’s ok as it’s not ingested!!
Most interesting actually. Makes one wonder about just why this is. From our friends at the FDA.
Many drugs are broken down (metabolized) with the help of a vital enzyme called CYP3A4 in the small intestine. 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. The result: too much drug in your body. fda.gov/consumers/consumer-....
For future reference this is so good to know…I love grapefruit.. fresh or even the little tubs I distorted you can buy from Costco. I grew up eating it for breakfast almost every day.
I am so cautious though with grapefruit and any medication as I experienced a terrible reaction to it when I was in hospital after having my first knee replacement. Opioids and grapefruit don’t mix well. Actually I reacted badly to the opioids full stop!!!
They actually offered grapefruit on the menu.. which I am surprised at as surely a hospital dietitian should be aware of these interactions.
On my Rux bottle the warning is written in bold on a flapping tail of paper. As we all see here it's a trouble for so many drugs. As in the link Hunter posted, it adds effect and some it reduces. Would be fine if these "adjustments" were predictable, but they are not.
I have always know this but not sure how I came upon the information. By the same token my understanding of the use of CBD oil should be avoided with any drug that has the same grapefruit warning. There is more research to be done into this but for now I have declined to use CBD oil too
I have not seen any interactions noted between CBD and Jakafi. I believe some on the forum are combining these. Please let us know if you have found something.
Avoid excessive or chronic alcohol consumption. Ingesting alcohol may increase the risk of sedation.
Avoid grapefruit products. Grapefruit inhibits the CYP3A metabolism of cannabidiol, which may increase its serum concentration. Cannabidiol dose reduction may be necessary if used together.
Avoid St. John's Wort. This herb induces the CYP3A metabolism of cannabidiol and may reduce its serum concentration. The dose of cannabidiol may need to be increased if used together.
Take with food. Taking cannabidiol with food (particularly high-fat food) increases its bioavailability. The absorption of cannabidiol is more consistent when meal macronutrients remain the same.
I’m not very technologically minded so I hope that works. A quick google search reveals the need for more research into this but the link between grapefruit and CBD is evident in the way that they both interfere with digestion of certain drugs
Interesting bit of data. Given how common the use of CBD has become, it is clear more research is needed. Hopefully a clear answer will emerge. Thanks for posting the link.
I was diagnosed with PV Nov, 2019 at age 69. I was put on hydroxy after venesection was too slow to change various blood counts. I switched from Hydroxy to Jakafi when HU failed also. My specialist spent time going over the possible side effects and reactions that could occur with Jakafi, especially the danger of consuming grapefruit. He also started me on low doses so that reactions and side effects could be monitored easily. I have been on Jakafi for 3 years now with full blood normalization for 9 months. Current dose is 10mg in the morning and 5 mg at night. I have been very fortunate in that my only side effect so for has been weight gain. He also informed me Jakafi can affect the JAK 1 interon-signaling mechanism. JAK 1 is know to also affect the metabolic systems. JAK 1 inhibitors include Xeljanz, Rhinvoq, Humira and others.
Yes: was warned abt grapefruit:juice( and also Seville oranges, the basis of English marmalade- tho you’d have to eat it by the spoonful to have an effect). But so long ad yr consistent ( always have same amount if juice) would it matter? I had a gastric bypass which also changes absorption patterns of various medications. it can increase or decrease the absorption. In the end, I realised that nobody really knew how to adjust the dose in advance, so as long as the dosage is having it a side-effect, for whatever reason, it seems to be safe.
Glad you added Seville oranges as they are a similar problem it is also worth checking out ingredients in some products. I believe some reduced fat products use grapefruit products
I have seen that jackfruit has the same effects as grapefruit with medication interactions, but I have never seen this mentioned in any documentation .
advice on our website is: Interactions with other medicines and foods Ruxolitinib is metabolized through a pathway known as CYP3A4 so some drugs can increase or reduce its activity. A list of such drugs will be in the package insert or ask a pharmacist before taking any new medicine. This also extends to certain herbal remedies eg St John’s Wort and foodstuffs eg grapefruit and Seville oranges.
My husband was on ruxolitinib, sadly passed away end of October. Would have been our thirtieth wedding anniversary today sadly. But yes he was very aware of the the need to avoid grapefruit.
Thanks very much Hunter. I love fresh grapefruit and don’t propose to resist it. I suppose the problem arises when one consumes a lot. But then that would apply to anything not taken in moderation My MPN Haematologist hasn't advised me to avoid certain types of food.
Yes, Hunter, I was warned by my heamatology/oncology team right at the start of any meds for my PV to avoid grapefruit completely, as well as St John’s Wort.
I see you’ve also found drugs.com but I’ve not had much luck finding results for rux vs foods…
Drugs.com is a useful site. I also like ePocrates.com and RxList.com .
Your asking about Drug-Food interactions prompted me to look. I just found this site that has a Food Interaction Checker. I have not used it enough to endorse it, but it does look interesting. go.drugbank.com/food-intera... .
Simply entering Jakafi yields this result
Avoid grapefruit products. Grapefruit inhibits CYP3A4 metabolism, which may increase the serum concentration of ruxolitinib.
Exercise caution with St. John's Wort. This herb induces CYP3A4 metabolism, which may reduce the serum levels of ruxolitinib.
Take with or without food. A high-fat, high-calorie meal had negligible effects on the pharmacokinetics of ruxolitinib.
Good post. I didn’t realize that Jaks affected the p450 enzyme. At least that is why most of those drugs you can eat grapefruit. If it does more than likely the other JAK inhibitors do too. Thanks, didn’t realize that. Glad I don’t like grapefruit😆
I stopped taking Jakafi about 16 months ago, replacing it with Inrebic, but I will say the "no grapefruit" warning was printed on every label when I did take it/ I would avoid it, fresh or otherwise. Good luck!
Just read your post about the warning of consuming grapefruit while taking Ruxolitinib and yes, the warning is there along with the other warnings about taking Jakafi. The pharmacy that dispenses mine, also stated this warning prior to starting on this drug. Not being a big grapefruit fan, no problem for me, although I do like the big, juicy pink grapefruits!
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