Grapefruit Juice

What is it?
Grapefruit juice has been used for itching associated with liver disease and for treatment of diabetes. It is also used for lowering cholesterol in your blood, protecting against cancer, and treating low potassium levels in blood.

Other names for Grapefruit Juice include: Citrus Paradisi Macfad and Rutaceae.

Ask your doctor, nurse, or pharmacist if you need more information about this medicine or if any information in this leaflet concerns you.

Before Using:
Tell your doctor if you

• are taking medicine or are allergic to any medicine (prescription or over-the-counter (OTC) or dietary supplement)
• are pregnant or plan to become pregnant while using this medicine
• are breast feeding
• have a history of depression, breast cancer, have pheochromocytoma, or ulcers
• have any other health problems, such as high blood pressure or heart or blood vessel disease

Dosage:
Talk with your caregiver about how much Grapefruit juice you should take. The amount depends on the strength of the medicine and the reason you are taking Grapefruit juice. If you are using this medicine without instructions from your caregiver, follow the directions on the medicine bottle. Do not take more medicine or take it more often than the directions tell you to.

To store this medicine:
Keep all medicine locked up and away from children. Store medicine away from heat and direct light. Do not store your medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down and not work the way it should work. Throw away medicine that is out of date or that you do not need. Never share your medicine with others.

Drug and Food Interactions:
Do not take Grapefruit Juice without talking to your doctor first if you are taking:

• Albendazole (Albenza(R))
• Alfuzosin (Uroxatral(TM))
• Amiodarone (Cordarone(R), Pacerone(R))
• Buspirone (Buspar(R))
• Carbamazepine (Tegretol(R))
• Cisapride (Propulsid(R))
• Clomipramine (Anafranil(R))
• Etoposide (Vepesid(R))
• Fexofenadine (Allegra(R))
• Fluvoxamine (Luvox(R))
• Itraconazole (Sporanox(R))
• Quinidine (Quinidex(R))
• Saquinavir (Invirase(R))
• Sertraline (Zoloft(R))
• Sildenafil (Viagra(R))
• High blood pressure medicine (examples: amlodipine (Norvasc(R)), felodipine (Plendil(R)), nifedipine (Adalat (R)), diltiazem (Cardizem(R), Dilacor(R)), verapamil (Calan(R), Isoptin(R)))
• Medicine to help you relax or sleep (examples: diazepam (Valium(R)), midazolam (Versed(R)), triazolam (Halcion(R)))
• Medicines used after organ transplant (examples: cyclosporine (Neoral(R), Sandimmune(R)), sirolimus (Rapamune(R)), tacrolimus (Prograf(R)))
• Medicines used for migraine headaches (examples: ergotamine (Cafergot(R)), eletriptan (Relpax(R)
• High cholesterol medicine (examples: lovastatin (Mevacor(R)), simvastatin (Zocor(R)), atorvastatin (Lipitor(R)))
• Estrogen (examples: conjugated estrogens (Premarin(R)), birth control pills)

Warnings:

• Before taking Grapefruit Juice, tell your doctor if you are pregnant or breast feeding
• Before taking Grapefruit Juice, tell your doctor if you are taking any other medicines

Side Effects:
Stop taking your medicine right away and talk to your doctor if you have any of the following side effects. Your medicine may be causing these symptoms which may mean you are allergic to it.

• Breathing problems or tightness in your throat or chest
• Chest pain
• Skin hives, rash, or itchy or swollen skin

Other Side Effects:
You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine.

• Low blood pressure (also called hypotension) (2)
• Kidney stones (2)

References:
1. Cadranel JF, DiMarino V & Devergie B: Grapefruit juice for the pruritis of cholestatic liver disease. Ann Intern Med 1997; 126(11): 920-921.
2. Curhan GC, Willett WC, Speizer FE et al: Beverage use and risk for kidney stones in women. Ann Intern Med 1998; 128(7): 534-540.
3. Gross AS, Lilja JJ, Backman JT et al: Repeated consumption of grapefruit juice on cisapride pharmacokinetics. Clin Pharmacol Ther 1999; 65(4): 395-401.
4. Kivisto KT, Lilja JJ, Backman JT et al: Repeated consumption of grapefruit juice considerably increases plasma concentrations of cisapride. Clin Pharmacol Ther 1999; 66(5): 448-453.
5. Anon: Grapefruit juice can interact with medications. Harv Health Lett 1999; 9(8):4.
6. Bailey DG, Malcolm J, Arnold O et al: Grapefruit juice-drug interactions. Br J Clin Pharmacol 1998; 46(2):101-110.
7. Menke J: Grapefruit juice: the untold story. SDJ Med 1998; 51(11):421-422.
8. Roller L: Drugs and grapefruit juice. Clin Pharmacol Ther 1998; 63(1):87.
9. Anon: The grapefruit juice effect. Harv Health Lett 1997; 22(12):8.
10. Feldman EB: How grapefruit juice potentiates drug bioavailability. Nutr Rev 1997; 55(11): 398-400.
11. Lilja J, Backman J, Laitila J et al: Itraconazole increases but grapefruit juice greatly decreases plasma concentrations of celiprolol. Clin Pharmacol Ther 2003; 73:192-198.
12. Libersa CC, Brique SA, Motte KB et al: Dramatic inhibition of amiodarone metabolism induced by grapefruit juice. Br J Pharmacol 2000; 49:373-378.
13. Hori H, Yoshimura R, Ueda N et al: Grapefruit juice-fluvoxamine interaction. Is it risky or not? J Clin Psychopharmacol 2003; 23(3):422-424.