The forbidden fruit: How grapefruit could kill you
The video below is a new public service announcement from the US FDA on the risks of drinking grapefruit juice when taking medication.
We’ve known for over a couple of decades about the grapefruit juice interaction that affects half of all drugs to some degree, but a paper recently published in the Journal of the Canadian Medical Association (PDF) has warned that over the last four years there has been a major jump in the number of drugs that are affected by grapefruit juice to a dangerous degree. The list of drugs that are thought to be affected (PDF) includes anti-cancer drugs, anti-diabetic drugs, anti-infective drugs, anti-inflammatory agents, anti-lipemic agents, cardiovascular agents, estrogens, gastrointestinal drugs, immunosuppressants, urinary tract agents and CNS agents. The list includes painkillers that are sometimes used recreationally such as ketamine, diazepam, oxycodone and methadone. The list of potential complications is not pretty, including kidney failure, respiratory failure and gastric bleeding. Furthermore – the list is far from extensive, these are only the ones we know about. I’ve pasted the names of some of the drugs below - but this list should not be considered extensive by any means and is no substitute for checking with your doctor or pharmacist.
Crizotinib, dasatinib, erlotinib, everolimus, lapatinib, nilotinib, pazopanib, sunitinib,vandetanib, venurafenib, artemether, erythromycin, halofantrine, maraviroc, primaquine, quinine, primaquine, rilpivirine, atorvastatin, lovastatin, simvastatin, amiodarone, apixaban, cilostazol, clopidogrel, dronedarone, eplerenone, ergotamine, ticagrelor, verapamil, alfentanil – oral, buspirone, dextromethorphan, fentanyl – oral, ketamine – oral, lurasidone, oxycodone,p imozide, quetiapine, ziprasidone, cisapride, domperidone, cyclosporine, everolimus, sirolimus, tacrolimus, cyclophosphamide, imatinib, sorafenib, repaglinide, saxagliptin, albendazole, praziquantel, saquinivir, budesonide – oral, colchicine, methylprednisolone -oral, amlodipine, felodipine, losartan, manidipine, nicardipine, felodipine, losartan, manidipine, nicardipine, nimodipine, nisoldipine, nitrendipine, propafenone, quinidine, rivaroxaban, sibutramine,sildenafil, tadalafil, vardenafil, diazepam, fluvoxamine, methadone, midazolam – oral,quazepam,sertraline,triazolam,estradiol,ethinylestradiol, darifenacin, fesoterodine, solifenacin, silodosin, silodosin, etravirine, artemether, etravirine, aprepitant, carbamazepine
These drugs are cause for concern because they all have three things in common. They are all administered orally, they all aren’t very efficiently processed by the body (i.e. they have “very low to intermediate absolute bioavailability”) and crucially - they all happen to be metabolised by an enzyme called cytochrome P450 3A4 (CYP3A4) that is inhibited by grapefruit juice. If this occurs there is a risk of overdose. Once again, the list above is by no means extensive and other related citrus fruits including Seville oranges and limes also contain the same enzyme to a lesser degree. It's also worth noting that there are plenty of anecdotal reports that grapefruit juice may affect certain recreational drugs though the degree to which this may occur is extremely unclear due to the lack of experimental evidence. It seems unlikely that CYP3A4 has as much of an impact on most recreational drugs as folklore would have you believe, but it may be the case that other components of grapefruit juice could indeed have an effect, so strong caution is advised. The group most at risk of a dangerous grapefruit-drug interaction is the elderly, so if you do nothing else with this information, make sure you warn your gran!
Bailey, D., Dresser, G., & Arnold, J. (2012). Grapefruit-medication interactions: Forbidden fruit or avoidable consequences? Canadian Medical Association Journal DOI: 10.1503/cmaj.120951
This article is not intended as medical advice, before making any changes to your medication always consult your physician.
Image credit: Shutterstock/Amero
Swipe right to make the connections that could change your career.
Swipe right. Match. Meet over coffee or set up a call.
No, we aren't talking about Tinder. Introducing Shapr, a free app that helps people with synergistic professional goals and skill sets easily meet and collaborate.
The Oxfam report prompted Anand Giridharadas to tweet: "Don't be Pinkered into everything's-getting-better complacency."
- A new report by Oxfam argues that wealth inequality is causing poverty and misery around the world.
- In the last year, the world's billionaires saw their wealth increase by 12%, while the poorest 3.8 billion people on the planet lost 11% of their wealth.
- The report prompted Anand Giridharadas to tweet: "Don't be Pinkered into everything's-getting-better complacency." We explain what Steven Pinker's got to do with it.
Moans, groans, and gripes release stress hormones in the brain.
Could you give up complaining for a whole month? That's the crux of this interesting piece by Jessica Hullinger over at Fast Company. Hullinger explores the reasons why humans are so predisposed to griping and why, despite these predispositions, we should all try to complain less. As for no complaining for a month, that was the goal for people enrolled in the Complaint Restraint project.
Participants sought to go the entirety of February without so much as a moan, groan, or bellyache.
- Facebook and Google began as companies with supposedly noble purposes.
- Creating a more connected world and indexing the world's information: what could be better than that?
- But pressure to return value to shareholders came at the expense of their own users.
SMARTER FASTER trademarks owned by The Big Think, Inc. All rights reserved.