Prescription drugs and grapefruit a 'deadly mix' (2012)

[myself248]

This killed my friend's dad. He was on a bunch of heart drugs and had a pacemaker and everything, but was generally stable. One day, grapefruit comes up in conversation with his doctor, who sternly advises him "never eat grapefruit, it'll mess with your meds!", so he stops eating the grapefruit he'd been having for breakfast every morning for years.

Which promptly hoses up the finely-adjusted dosages, his symptoms suddenly get real weird, the situation spirals out of control, and he's dead in 4 days.

Doctors, please don't rush out of the room. Take time to talk to your patients, and take twice as much time to listen to them. I'm sure he would've mentioned that detail if he'd had time to find the English words.

[corey_moncure]

Doctors want you in and out of the room in 5 minutes or less so they can pull the insurance money dispensing lever again.

The last physician I had any respect for was my own pediatrician and I had consulted him on various issues having gone through several GPs that got even simple diagnoses disastrously, hilariously wrong. Such as telling me the tiny red lump in my finger was an anthrax infection and notifying the health department when it was really a small benign vascularity that was removed in a fifteen minute procedure.

Since my pediatrician retired I just do all my own medical research and order my own lab tests. The advantage I have is that I have all the insight into my own body, history, and habits that no doctor these days ever takes the time to find out. You're just a money pinata. Thank you, here are some antibiotics for an unspecified pathogen I didn't culture, Alisha will see you at checkout. Examining the patient? Ain't nobody got time for that.

[lonelappde]

That's a malpractice case. The doctor gave advice that he knew was potentially fatal.

[2rsf]

> Take time to talk to your patients

I agree that most doctors rush things (for whatever reason). But what does it have to do with this case ? the advice was solid- stop eating grapefruit.

[presidentender]

This bit my brother once, on a trip to visit our grandparents. Grandpa would eat a half grapefruit every morning, believing that the acidity would alkalize one's system in response and lead (along with frequent alternative chelation treatments) to better health. We didn't drink the chelation shakes, but we did eat the grapefruits, since they were there and prepared.

Over the two-week visit, my brother got harder and harder to be around - he'd always been surly, and he struggled with grandpa's wife, but we'd never experienced the level of emotional turmoil he went through on that trip. He self-harmed, sliced his arms up deeply. I stitched him up with the sewing kit that the resort had mercifully left in the room for us, and we kept the wounds dressed with neosporin until they healed.

The next stop on the trip was a visit to grandpa's wife's sister, a professor of neuroscience. She just happened to mention the interaction between antipsychotics and grapefruit, and it was like a light went on in my brother's mind. He stopped eating grapefruit and returned to his usual mental state within a few days.

[loceng]

Did none of the doctors prescribing the antipsychotics highlight and caution against eating grapefruit - hopefully to not consume alcohol either?

[ziroshima]

Interesting to see this now. As a teenager I experimented with DXM (https://en.wikipedia.org/wiki/Dextromethorphan) as a hallucinogen. You could buy it in powdered form over the internet for a while, or one could just take corricidin pills or find certain cough syrups that didn't have acetaminophen. Anyways, it was well known on usenet/IRC at the time that drinking grapefruit juice prior to ignesting the drug would enhance its effects.

[quaquaqua1]

Not related to grapefruit but moving to North Carolina for college in 2010 re-ignited my love affair with DXM in the form of Vicks 44 Berry Blast, which was about 300mg of DXM in a refreshingly horrible syrup form factor with 0 guafenesin, acetominophen or any other things that would get in the way of pure rolling.

Coupled with whatever substance du jour that college me was able to lay hands on, DXM was guaranteed to have me stumbling and hallucinating like the true futureless human I aspired to be, for the low low price of $7.65.

So, hats off to the NC state legislature for giving me some cheap thrills through college just outside my dorm room, while the state liquor store was a few miles away. You saved my liver, non-sarcastically, and allowed me to experience first hand the precipice of drug culture so I could willingly walk away from it based on personal exposure.

I also can't stand the sight of cherry flavored anything anymore :)

[hombre_fatal]

I had just come out of the peak of an acid trip so intense that I was in the fetal position under my covers. 1-2 hours had passed but it felt like an entire day. And it took me 10 minutes just to finally message my friend the profound admission: "im trippin".

I was pretty hungry after all this and glad the peak was behind me. Got a grapefruit out of the fridge. Wasn't even halfway through when I found myself back in the peak. Had to crawl back into my bed where the curtains were closed and endured another 20 minutes of that.

Grapefruit + <drug> has always been the source of superstitious arguments in uni among my drug-using friends. Does it enhance the effect? Kill the effect? Do anything at all? But my acid experience confirmed one pairing beyond all doubt.

[cwkoss]

Similarly, piperdine in black pepper can function as a bioavailability enhancer

https://www.ncbi.nlm.nih.gov/pubmed/21434835

I read an interesting online report that claimed co-administration of black pepper and certain essential oils would produce psychoactive effects.

[xtracto]

Oooh I read that they use this with tumeric to enhance its absorption. I wonder if grapefruit would work similarly.

[adrianmonk]

I might have expected colchicine (https://en.wikipedia.org/wiki/Colchicine) to be on the list.

It's a fairly harsh drug with a narrow therapeutic window. Getting the right dosage is already hard enough, as there are some unpleasant (and common) side effects, and it can also be pretty dangerous to your health. Add something like grapefruit that throws off the concentration, and things get that much worse.

EDIT: This HN story link was updated. The list I was referring to above is the old link: https://en.wikipedia.org/wiki/Grapefruit–drug_interactions

[drefanzor]

I take atorvastatin for high cholesterol; it says don't eat grapefruit on the side of my medication bottle. I never really thought about why, but this gives me more reasons to avoid it. Although now I have a huge craving for grapefruit juice, of course.

[fhars]

Then read this article instead: https://www.ncbi.nlm.nih.gov/pubmed/26299317

[da02]

Did you ever find out why you have high cholesterol? Are you above or under 30?

[HarryHirsch]

I wonder why it took the medical profession so long to become aware of the effect. Piperonyl butoxide, another cytochrome C inhibitor, has been used as synergist in insecticides since before the war, so it should have occurred to someone that the plentiful polyphenols in citrus juice could act as cytochrome C inducers/inhibitors and would have a measurable influence on the pharmacokinetics of stuff.

[arkades]

Just because the article says that the healthcare community is ignorant of it, doesn’t mean that it’s ignorant of it.

We had to memorize major CYP4503A4 inducers and inhibitors for step exams back when I was in med school, and memorized metabolic pathways and involved cytochromes for most major drugs.

Granted, most docs don’t remember all the details long out of med school (because that’s literally what pharmacists are -for-), but we retain the broad brushstrokes.

Ain’t new. Just editorializing bs.

[Wistar]

I distinctly remember being told to avoid grapefruit with certain antibiotics in the early 90s. I know that, in about 2000, my father was told to avoid grapefruit all the time because he was taking drugs for gout. He loved grapefruit and complained bitterly about the restriction.

[imroot]

If you've had a liver transplant, grapefruit is on the list of things that you can never eat again -- it messes with the anti-rejection drugs that you have to take to suppress your immunological system.

[benj111]

Caffeine is on the list.

So a breakfast of coffee and grapefruit is a medically proven stimulating start to the day?

[throwaway8941]

Sadly, no.

>One study, by Maish and colleagues in Pharmacotherapy 1996, looked at whether grapefruit juice increased caffeine effects and found little or no difference in blood concentrations and blood pressure when caffeine was given with and without GFJ. Other research has confirmed these results. Since specific enzyme systems most often metabolize similar chemicals, one would not necessarily expect GFJ to affect other stimulants, but this is far from conclusive.

https://erowid.org/ask/ask.php?ID=2726

[ghettoimp]

It would certainly be a horrific jolt to your taste buds... geish.

[dr_dshiv]

Alcohol? In student days, I was always fond of a greyhound: vodka and grapefruit juice. Placebo effect, or diminished liver capacity?

[bjornsing]

My hay fever medication (called Teldanex in Sweden) was withdrawn from the market in 1998 due to some fatalities when combined with grapefruit. So it must have been well known long before 2012. I remember feeling quite lucky I wasn’t into that particular fruit... :P

[mirimir]

Also, I know that *mycin antibiotics can decrease liver metabolism of statins, and increase their side effects. In particular, rhabdomyolysis (muscle damage).[0]

So I suspect that grapefruit isn't the only issue. In that there may well be interactions among the drug classes listed.

0) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006404/

[indziektor]

And yet it never seems to get enough coverage. The last time I was prescribed something important, I had no idea I wasn't supposed to have grapefruit or marmalade with Seville oranges. Luckily it's not my usual fare. The leaflet did have all sorts of other warnings though, like even for St. John's Wort. I only found out by a chance comment from a different physician.

[neom]

I usually Lemon Tek when I take psilocybe: https://www.mushmagic.com/blog-magic-mushroom-lemon-tek-a-wa...

[collyw]

That's different, that converts the psilocybin to psilocin - something that would go on in your stomach anyway. Adding lemon gets that step out of the way so it all hits you faster.

[amelius]

Shouldn't there be a warning label in the Grapefruit section of supermarkets?

[unparagoned]

No, because the warning comes with the medecine

[hmx48]

Its useful for getting the most bang for your buck ouy of expensive medications.

[burk96]

Hah I know right? I do wonder however, is there a use case for these furanocoumarins found in grapefruit? Perhaps it could make for more efficient drugs that could (potentially) be cheaper? Or perhaps doctors prescribing ludicrously expensive drugs (like the cancer drugs listed) could prescribe a lower dose and a grapefruit concentrate?

[peteretep]

Back when I was dependant on Valium, which was hard to acquire, it was a great way to rocket up the effects

[hnick]

LSD too apparently, so the wisdom goes.

I guess that might be medication depending how you view it.

[Scoundreller]

One thing glossed over in these articles is that the impact is mostly on this enzyme as it exists in the intestines.

There’s less impact on this enzyme as it exists elsewhere in the body (primarily the liver).

[journalctl]

I avoid grapefruit-anything. I’m on two pretty standard drugs, and they shouldn’t have any reactions, but I’d rather not take that chance anyway.

[brianpgordon]

There's no need to guess; you can look up specifically whether CYP450 enzymes metabolize your medications (and its metabolites). If not then the answer is almost certainly that you're safe.

[open-source-ux]

Here's a 2012 article from the NHS website on this topic which I think is more readable than the Wikipedia entry:

https://www.nhs.uk/news/medication/prescription-drugs-and-gr...

[antsoul]

I'd even prefer the Erowid page : https://erowid.org/ask/ask.php?ID=2726

[dang]

Thanks! Changed from https://en.wikipedia.org/wiki/Grapefruit%E2%80%93drug_intera...

[guscost]

Thanks - but also check out the “citrus genetics and interactions” section further down in the wiki, it’s fascinating.

[british_india]

Also Fresca is packed with grapefruit juice.