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The Effects of Grapefruit on Your Opioid Medications

February 1, 2018
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Did you know that February is National Grapefruit Month? Well, now you do.


Naturally loaded with the antioxidant vitamin C, grapefruits boost your immune system. Lycopene, a powerful antioxidant in pink and red grapefruit juice may actually help prevent certain types of cancer, heart disease, and stroke. In juice form, each glass you consume provides your body a full serving of fruit. Plus, it's considered one of the lowest calorie and nutrient dense juice options on the market and one simple glass is a fat-free and cholesterol-free ingredient needed to maintain a healthy diet.

As wholesome as grapefruit and other citrus fruits are, you'll want to discuss grapefruit with your doctor if you consume opioids for pain relief. Ironically, grapefruit and grapefruit juice may interact with oxycodone and can lead to unwanted side effects. In addition, drinking it may stop your medication from working altogether, according to scientists—and it's not just opioids. 

"Twenty-six new drugs that can cause serious harm when mixed with grapefruit have been introduced in the past four years alone, bringing the total to 43," announced the lead author on this study published in the Canadian Medical Association Journal, Dr. David Bailey.

Those numbers average to more than six new drugs annually. To see a complete list of drugs that interact with grapefruit, click here

“What I’ve seen has been disturbing,” Bailey added, who is also Lead Clinical Pharmacologist at the Lawson Health Institute Research Center in London, Ontario, Canada. “It’s hard to avoid putting a drug out on the market that is not affected by grapefruit juice.”

Fibromyalgia patient Jessica Zapadka, who has a harsh sensitivity to narcotics, shared,  “I literally cannot take opioids. They make me violently ill...and I've even stopped drinking and eating grapefruit, which poses a whole other set of symptoms in itself.”


Side Effects

Consuming grapefruit (http://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/food-and-nutrition/faq-20057918) with certain medications can cause problems such as dizziness, headache, nausea, skin rash, respiratory depression, acute kidney failure, respiratory failure, gastric bleeding — and even death in some cases.

“When I say sudden death, I’m not being sensational,” replied Bailey.

Sadly though, the intake amount or length of time since your last grapefruit consumption is irrelevant to the effects. Bailey and his research team say that drinking less than a cup of grapefruit juice once a day for three days, can lead to a 330 percent concentration of simvastatin, which is used to treat high cholesterol and coronary artery disease.

The issue stems from an active ingredient in varying citrus fruits, including grapefruit.

"The fruits produce organic chemical compounds called furanocoumarins, which interfere with a human digestive enzyme," Bailey explained. "That enzyme, called CYP3A4, helps metabolize toxic substances to keep them from getting into the bloodstream. Typically, that means the enzyme inactivates the effects of about 50 percent of all medications."

On the contrary, when furanocoumarins in citrus are activated, the drugs can also become so concentrated that it can be like getting a triple dose of medication.


Warnings

Doctors should make sure to ask about grapefruit consumption when prescribing drugs to their patients. Drugs known to interact with grapefruit do carry warnings on their labels, yet as Bailey revealed, “I believe that neither doctors nor patients take the threat seriously enough.”

It’s unclear the exact amount of people who are actually harmed by grapefruit interactions, partly because the side effects are not fully recognized as stemming from citrus. Bailey also included eight case reports on this matter in his published study.

“For every case report, there are at least 100 that have never been reported,” Bailey affirmed.

A majority of his concern lies with the elderly community, people who are older than 45 are most likely to consume grapefruit juice and take prescription drugs. 

“Seniors older than 70 have the most trouble tolerating excessively high levels of drugs,” he notated. “These are the individuals with the greatest chance of exposure.”


The Juice

Officials say that even though several drugs do negatively interact with grapefruit, there are others that do not

“In most cases, doctors can prescribe drugs in the same class that don’t interact,” Karen Mathis, former spokeswoman and director of public relations at the Florida Department of Citrus, relayed. “These medications often can provide the same therapeutic effect with no need to avoid grapefruit juice.”

Remember, not all citrus poses a problem. Sweet oranges, such as navel and Valencia varieties, do not contain the damaging compound.

“You have an alternative there,” Bailey concluded. “If you want to take your medications with orange juice, you’re home free.”

Assortment of fruits.

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