Grapefruit juice?

[Zebedee44]

Reading back through Kate Gilbert's excellent book, I find a mention of grapruit juice and whether there is an interaction with prednisolone. I have only recently returned to drinking pink grapefruit juice after a few years taking statins, and I was really enjoying it until I found this suggestion. Now I'm not sure I should be drinking it!

[PMRpro Ambassador]

nhs.uk/news/2012/11November...

webmd.com/hypertension-high...

give lists of the drugs grapefruit interacts with.

However - I also found this:

webmd.com/drugs/2/drug-6470...

and this: ncbi.nlm.nih.gov/pubmed/769...

where they say "Grapefruit juice had no significant effect on the metabolism of prednisone or prednisolone."

So - the evidence seems to be that the problem is with the "methyl" part of the methylprednisolone and it isn't present in prednisone or prednisolone so that doesn't apply.

What probably happens is that the grapefruit juice does something to increase the bioavailability of the pred (it increases the amount of pred the body is able to absorb from the gut) and in some drugs that will increase the effects so a fixed dose might actually be higher than they thought and dangerous/becomes and overdose.

That doesn't matter for us because we are titrating our dose to find the lowest dose that does the job - taking some grapefruit juice may well mean we can manage on less pred! I think you can carry on drinking it!

[Zebedee44 in reply to PMRpro]

Thank you PMRPro, I had a feeling you would be able to advise. And your confirmation that it's unlikely to be the prednisolone that's causing unwelcome side effects has brought me to the realisation that it's the Fentanyl patches I am still using that is causing the symptoms.

My GP hadn't spotted the connection, unsurprisingly, so I'm very glad I was reading Kate's book again and found the reference.

I learn something about PMR every day from this forum, and it really helps me deal with it. Now I will have to stop my morning grapefruit juice and home made marmalade! Yet Another Deprivation!

[HeronNS in reply to Zebedee44]

Will you be weaning off fentanyl now that you're on pred? There's always something, isn't there? Fortunately I only have one prescription med, but it seems that even food and supplements need to be arranged "just so"! Sigh. 🙄

[Zebedee44 in reply to HeronNS]

Yes, I think I am ready to wean off Fentanyl, not even sure what it is contributing any more. It's about time I found out if it's playing any part in reducing PMR pain. Then maybe I will get to enjoy some grapefruit juice again.

Not sure what withdrawal from Fentanyl will be like! It's another highly addictive drug, of course!

[PMRpro Ambassador in reply to Zebedee44]

Most people who have used opiods have said they didn't do much for their PMR. Suppose you'll have to find out if there is other pain.

[HeronNS in reply to Zebedee44]

Good Luck! I expect like anything there will be withdrawal discomfort, but hopefully not too bad. I guess it depends at least in part on how long you've been on it, and what your dosage has been. Probably one type of tapering schedule where the doctor really will know best (unlike pred for PMR)!

[PMRpro Ambassador in reply to Zebedee44]

What sort of homemade marmalade? Seville orange and grapefruit have the same compound in them but other oranges should be OK.

You might like this - didn't find it this morning...

pharmacist.com/juice-intera...

[Zebedee44 in reply to PMRpro]

Yes, we always make marmalade with Seville oranges unfortunately. It's an annual event in my family lol!

[Zebedee44 in reply to PMRpro]

Thanks PMRPro, Very interesting reading, and lists oral Fentanyl but not patches. It seems there can be a 72 hour delay in recovery, so with any luck my breathing will be easier in a couple of days. I thought it was stress that was causing the breathlessness, now it seems it was more sinister!

MY GP had a medical student with him when I mentioned that I was enjoying being able to drink grapefruit juice and neither of them commented. Looks like I have something else to brief them about. I even told them I had palpitations and tightness in my chest!

I guess they can't know everything! It's just as well there are folk out there who know more and are prepared to spend their time gaining knowledge and sharing it. Many many thanks PMRPro and Kate Gilbert.

[PMRpro Ambassador in reply to Zebedee44]

That may not mention patches - but other documentation I read did.

You can send me your Seville marmalade ... It will keep me going for about 20 years but I do like it!

[Zebedee44 in reply to PMRpro]

Sorry it's taken a while to get back to you. I use the Good Housekeeping Seville orange marmalade method 2 with whole oranges. It's online. I like course chopped but my partner told me he had tried a pizza cutter to shred his.

You can keep Seville oranges in the freezer successfully. You don't have to cook up a great batch if it's going to take years to eat it, although it's a very welcome gift for many people, English breakfast marmalade. Maybe in Italy too!

[PMRpro Ambassador in reply to Zebedee44]

I doubt it! Not their sort of breakfast here! And I don't think I have ever seen Seville oranges here anyway! Never saw them in Germany either - used to bring the cans of stuff for my friends long ago so they could make their own.