![]() ![]() Grapefruit juice (Minute Maid®, The Coca-Cola company Houston, TX, USA) was given at normal strength after reconstitution from frozen concentrate. All beverages were purchased as a single lot with the exception of Fresca®. ![]() The study utilized an open, randomized, four-way crossover design. Accordingly, we studied the effect of two different bergamottin-containing citrus sodas, Sun Drop® and Fresca®, relative to grapefruit juice and water in healthy volunteers on oral ciclosporin pharmacokinetics. ![]() It was hypothesized that Sun Drop® and Fresca® would enhance systemic ciclosporin availability by a grapefruit juice-like CYP3A4-mediated interaction as a potential mechanism. Our analysis of Sun Drop® and Fresca®, two of 15 citrus soda drinks screened for furanocoumarins, confirmed that both drinks potentially possessed concentrations of bergamottin capable of inhibiting CYP3A4 metabolism. Indeed, the makers confirmed that this citrus soda contained furanocoumarins. Moreover, intentional avoidance of this soft drink prevented the recurrence of this problem. Ĭonsumption of the carbonated soft drink Sun Drop® was recently reported to be temporally associated with clinically relevant doubling of serum ciclosporin trough levels in a lung transplant patient on Neoral® maintenance therapy on two occasions. In addition, dietary constituents including grapefruit juice can augment blood ciclosporin concentrations via inhibition of intestinal CYP3A4, probably through irreversible enzyme inactivation mediated by furanocoumarins such as bergamottin and/or 6′,7′-dihydroxybergamottin. There have been numerous reports of clinically relevant drug–ciclosporin interactions. Ciclosporin oral bioavailability is highly variable and significantly dependent on multiple factors such as drug formulation, metabolism by cytochrome P450 3A4 (CYP3A4) and active transport by the efflux pump P-glycoprotein in the intestine and liver. Because it has a narrow therapeutic concentration range, continuous monitoring of drug level and adjustment of dose are required to prevent suboptimal concentrations that result in loss of desired immunosuppression or to avoid excessive levels associated with organ toxicities. This interaction partially inactivates a number of medications under normal circumstances.Ciclosporin, a calcineurin immunosuppressant, is widely used in the setting of organ transplantation. Patients should avoid eating grapefruit or drinking grapefruit juice while taking some medications, in particular statins.Ĭompounds in grapefruit called furanocoumarin chemicals cause an increase in medication potency by interacting with enzymes in the small intestine and liver. Grapefruit and Grapefruit Juice + Statins ![]() This is especially true when the stimulant is being abused, but it can also happen when the patient takes the drug as prescribed.ĥ. Patients should always be wary of mixing any medication with alcohol, but some interactions are more serious than others.įor instance, ingesting alcohol while taking a prescription stimulant could cause the patient to not fully realize how intoxicated they are. Therefore, an increased intake of the nutrient can antagonize the anticoagulant effect and prevent the drug from working. Vitamin K is vital for the production of clotting factors that help prevent bleeding, but anticoagulants like warfarin exert their effect by inhibiting vitamin K. Pharmacists should counsel patients taking warfarin to maintain a consistent intake of vitamin K and avoid introducing kale, spinach, and other leafy greens to their diets. This food category contains tyramine, which has been associated with a dangerous increase in blood pressure among patients taking monoamine oxidase inhibitors (MAIOs) and certain medications for Parkinson’s disease. Pickled, Cured, and Fermented Foods + MAIOs These antibiotics may bind to the calcium in milk, forming an insoluble substance in the stomach and upper small intestine that the body is unable to absorb.Ģ.
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