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Grapefruit Juice and Medication Can Be a Deadly Mix
Grapefruit Juice and Medication Can Be a Deadly Mix -- Posted by Gumbo on 02-02-05 06:36
Grapefruit Juice and Medication Can Be a Deadly Mix
ROCHESTER, NY -- January 18, 2005 -- Grapefruit juice can be deadly for
people on certain medications, nurse researchers remind doctors, nurses, and
everyone who takes medicine and enjoys grapefruit juice, in a paper in the
American Journal of Nursing, a journal of the American Nurses Association.
Amy Karch, R.N., M.S., of the School of Nursing at the University of
Rochester Medical Center reported on a man from a northern climate who moved
to Florida for the winter -- one of tens of thousands of "snowbirds" who
head south each winter -- and began drinking two to three glasses of
grapefruit juice each day. Two months later the man died, the victim of a
deadly interaction between grapefruit juice and his cholesterol-lowering
medication.
Karch's paper, "The Grapefruit Challenge: The juice inhibits a crucial
enzyme, with possibly fatal consequences," appears in the December 2004
issue of the journal.
Interactions between grapefruit juice and medications have long been
recognized. Last year, the Medical Letter on Drugs and Therapeutics devoted
an entire issue to grapefruit juice and the dangerous drug interactions that
can result. The U.S. Food & Drug Administration requires all prospective new
drugs to be tested for interactions with grapefruit juice. And a warning
about grapefruit juice is included in the "food-drug interactions" that come
with dozens of medications. Nevertheless, Karch says many health-care
professionals and patients don't know about the risk.
"The potential of drug interactions with grapefruit juice has been out there
a long time, but most people just aren't aware of it," says Karch, a
clinical associate professor of nursing. "There is so much information
bombarding people all the time, that a lot of people may have heard this but
forgotten it. But the problems can be life-threatening."
The patient profiled in Karch's article had high cholesterol and other risk
factors for cardiac disease. The doctor put the patient on atorvastatin
(Lipitor), and the patient began dieting and exercising. Two months after
the patient went to Florida for the winter, he suddenly had muscle pain,
fatigue and fever, and went to the emergency room. The patient ended up
going into kidney failure and ultimately died.
The only major change in the person's lifestyle had been that, upon arriving
in Florida, he began picking grapefruit off a tree on the patio and drinking
two or three glasses of fresh grapefruit juice every day.
Karch, an expert on drug interactions, explains that grapefruit juice is one
of the foods most likely to cause problems with drugs, because it is
metabolized by the same enzyme in the liver that breaks down many drugs. The
cytochrome P-450 3A4 enzyme breaks down grapefruit juice into useful
components for body, just like it breaks down dozens of medications. Karch
says when the system is overloaded, the grapefruit juice can "swamp" the
system, keeping the liver busy and blocking it from breaking down drugs and
other substances.
Drugs that use the same pathway and interact with grapefruit juice target
some of the most common health problems doctors see today. The list consists
of more than 50 medications, including some drugs used to treat high
cholesterol, depression, high blood pressure, cancer, pain, impotence, and
allergies.
Karch notes that interactions with grapefruit juice are well known and
documented among drug researchers, and that an appropriate warning label is
included with each prescription. Nevertheless, she says that many patients,
nurses and doctors aren't aware of the interactions or the potential serious
consequences, and that many people fail to read the warning labels about
drug-food interactions.
The consequences of an interaction depend on the drug involved. A woman on
birth-control pills who drinks a lot of grapefruit juice might find herself
pregnant because the juice blocks the action of the medication. A person on
an anti-depressant might have too much or too little energy, depending on
the specific medication. Someone on antibiotics might end up with diarrhea
or could be ill longer than usual because the drug won't work as well as it
should. A heart patient might not get the lowered blood pressure that a
medication should deliver, or the heart's rhythms might become irregular if
an anti-arrhythmia drug can't do its job.
The most severe effects are likely with some cholesterol-lowering
medications, Karch says. While the liver devotes its resources to grapefruit
juice, the medication can build up to dangerous levels, causing a breakdown
of the body's muscles and even kidney failure. This is what happened to the
patient discussed in the article.
To prevent such problems, Karch repeats what doctors and nurses tell their
patients every day: Read a medication's warning label carefully. If an
interaction with grapefruit juice is possible, the patient should stop
drinking the juice until speaking with his or her doctor. In some cases it
might be possible to switch a patient to a different drug without the risk;
in other cases the patient might simply have to give up grapefruit juice.
She says that more people than usual are vulnerable at this time of year,
because losing weight is among the most popular New Year resolutions, and
some diets are built around drinking lots of grapefruit juice.
Karch's paper is the latest in a column the journal devotes to "practice
errors," where nurses report unusual clinical problems and Karch looks into
how widespread the problem might be. Last year she also reported that nurses
had found that some types of skin patches could catch on fire when patients
receive magnetic resonance imaging (MRI) scans.
Drugs that Interact with Grapefruit Juice:
(from the December 2004 issue of the American Journal of Nursing)
Antibiotics: clarithromycin, erythromycin, troleandomycin
Anxiolytics: alprazolam, buspirone, midazolam, triazolam
Antiarrhythmics: amiodarone, quinidine
Anticoagulant: warfarin
Antiepileptic: carbamazepine
Antifungal: itraconazole
Anthelmintic: albendazole
Antihistamine: fexofenadine
Antineoplastics: cyclophosphamide, etoposide, ifosfamide, tamoxifen,
vinblastine, vincristine
Antitussive: dextromethorphan
Antivirals: amprenavir, indinavir, nelfinavir, ritonavir, saquinavir
Benign prostatic hyperplasia treatment: finasteride
â-blockers: carvedilol
Calcium channel blockers: diltiazem, felodipine, nicardipine, nifedipine,
nimodipine, nisoldipine, verapamil
Erectile dysfunction drugs: sildenafil, tadalafil
Hormone replacement: cortisol, estradiol, methylprednisolone, progesterone,
testosterone
Immunosuppressants: cyclosporine, sirolimus, tacrolimus
HMG-CoA reductase inhibitors: atorvastatin, fluvastatin, lovastatin,
simvastatin
Opioids: alfentanil, fentanyl, sufentanil
Selective serotonin reuptake inhibitors: fluvoxamine, sertraline
Xanthine: theophylline
SOURCE: University of Rochester Medical Center
Re: Grapefruit Juice and Medication Can Be a Deadly Mix -- Posted by dwacon on 02-02-05 16:51
I'll miss drinking it...
--
It rubs the lotion on its skin...
Or else it gets the hose again...
www.dwacon.com
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