Someone on antibiotics might end up with diarrhea or could be ill longer than usual because the some drugs won’t work as well as they should. A person on an anti-depressant might have too much or too little energy, depending on the specific medication. The consequences of an interaction depend on the drug involved. 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. 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. The list consists of more than 50 medications, including some drugs used to treat high cholesterol, depression, high blood pressure, cancer, depression, pain, impotence, and allergies. 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.ĭrugs that use the same pathway and interact with grapefruit juice target some of the most common health problems doctors see today. The cytochrome P-450 3A4 enzyme breaks down grapefruit juice into useful components for body, just like it breaks down dozens of medications. 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 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. The patient ended up going into kidney failure and ultimately died. 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 doctor put the patient on atorvastatin (Lipitor), and the patient began dieting and exercising. The patient profiled in Karch’s article had high cholesterol and other risk factors for cardiac disease. But the problems can be life-threatening.” “There is so much information bombarding people all the time, that a lot of people may have heard this but forgotten it. “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. Nevertheless, Karch says many health-care professionals and patients don’t know about the risk. And a warning about grapefruit juice is included in the “food-drug interactions” that come with dozens of medications. Food & Drug Administration requires all prospective new drugs that are thought to interact with this enzyme system to be tested for interactions with grapefruit juice. Last year, the Medical Letter on Drugs and Therapeutics devoted an entire issue to grapefruit juice and the dangerous drug interactions that can result. Interactions between grapefruit juice and medications have long been recognized. 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. The man became critically ill as a result of an interaction between grapefruit juice and his cholesterol-lowering medication. 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.
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