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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 grandis, 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 Throw away medicine that is out of date or that you do not need.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)) (14)
  • Alfuzosin (Uroxatral(TM)) (15,16)
  • Aliskiren (Tekturna(R)) (113)
  • Amiodarone (Cordarone(R), Pacerone(R)) (12,17,125,126)
  • Artemether (Coartem(R)) (100)
  • Axitinib (Inlyta(R)) (121)
  • Bexarotene (Targretin(R)) (75)
  • Bosentan (Tracleer(R)) (108)
  • Budesonide (Entocort(R), Pulmicort(R), Rhinocort(R)) (92)
  • Buspirone (Buspar(R)) (18)
  • Cabazitaxel (Jevtana(R)) (112)
  • Carbamazepine (Tegretol(R)) (19)
  • Cilostazol (Pletal(R)) (81)
  • Cisapride (Propulsid(R)) (3,4)
  • Clomipramine (Anafranil(R)) (20)
  • Clozapine (Clozaril(R)) (118)
  • Colchicine (69)
  • Crizotinib (Xalkori(R)) (117)
  • Dasatanib (Sprycel(R)) (97)
  • Dextromethorphan (Pediacare(R), Robitussin(R)) (95)
  • Dofetilide (Tikosyn(R)) (74)
  • Dronedarone (Multaq(R)) (99)
  • Erlotinib (Tarceva(R)) (70)
  • Erythromycin (Ery-tab(R), Eryc(R)) (83)
  • Estrogens (examples: birth control pills, conjugated estrogens (Premarin(R)), estradiol (Climara(R))) (58,59)
  • Etoposide (Vepesid(R)) (21)
  • Fentanyl (Actiq(R), Duragesic(R)) (71)
  • Fexofenadine (Allegra(R)) (22-24)
  • Fluvoxamine (Luvox(R)) (13)
  • Heart medicines (examples: digitoxin (Crystodigin(R)), digoxin (Lanoxicaps(R), Lanoxin(R))) (93)
  • High blood pressure medicines (examples: diltiazem (Cardizem(R), Dilacor(R)), felodipine (Plendil(R)), nicardipine (Cardene(R)), nifedipine (Adalat (R)), nisoldipine (Sular(R)), verapamil (Calan(R), Isoptin(R))) (32-48,87,88)
  • High cholesterol medicines (examples: atorvastatin (Lipitor(R)), lovastatin (Mevacor(R)), simvastatin (Zocor(R))) (60-66)
  • Imatinib (Gleevec(R)) (114)
  • Itraconazole (Sporanox(R)) (25)
  • Ivacaftor (Kalydeco(TM)) (122)
  • Ixabepilone (Ixempra(TM)) (111)
  • Lapatinib (Tykerb(R)) (73)
  • Losartan (Cozaar(R)) (84)
  • Medicines to help you relax or sleep (examples: alprazolam (Niravam(R), Xanax(R)), diazepam (Valium(R)), midazolam (Versed(R)), triazolam (Halcion(R))) (49-51,91)
  • Medicines used after organ transplant (examples: cyclosporine (Neoral(R), Sandimmune(R)), sirolimus (Rapamune(R)), tacrolimus (Prograf(R))) (52-57,89,103-107)
  • Medicines used for migraine headaches (examples: dihydroergotamine mesylate, eletriptan (Relpax(R)), ergotamine (Cafergot(R), Ergomar(R))) (15,67,68,119,120)
  • Medicines used for problems with urination caused by an enlarged prostate (benign prostatic hyperplasia or BPH) (example: tamsulosin (Flomax(R)) (102)
  • Medicines used for late-stage kidney cancer (examples: everolimus (Zortress(R)), temsirolimus (Torisel(TM))) (109,110)
  • Methadone (Dolophine(R), Methadose(R)) (85)
  • Methylprednisolone (A-Methapryd(R), Medrol(R)) (86)
  • Mifepristone (Mifeprex(R), Korlym(TM)) (77,123)
  • Nilotinib (Tasigna(R)) (96)
  • Nimodipine (Nimotop(R)) (82,124)
  • Pazopanib (Votrient(R)) (101)
  • Pimozide (Orap(R)) (78)
  • Primaquine (72)
  • Quinidine (Quinidex(R)) (26-28)
  • Ranolazine (Ranexa(R)) (79)
  • Repaglinide (Prandin(R)) (76)
  • Saquinavir (Invirase(R)) (29)
  • Sertraline (Zoloft(R)) (30)
  • Sildenafil (Viagra(R)) (31)
  • Sunitinib (Sutent(R)) (80)
  • Tadalafil (Cialis(R)) (90)
  • Tolvaptan (Samsca(TM)) (98)
  • Toremifene (Fareston(R)) (116)
  • Vilazodone (Viibryd(R)) (115)
  • Wormwood (100)

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:

Call your doctor right away if you have any of these side effects:

  • Allergic reaction: Itching or hives, swelling in your face or hand, swelling or tingling in your mouth or throat, chest tightness, trouble breathing, or rash
  • Feel dizzy or lightheaded (100, 112)

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)
  • Chest pain (101)
  • Dizzy or lightheadedness (101,102)
  • Racing heartbeat (102)

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.

14. Nagy J, Schipper HG, Koopmans RP, et al: Effect of grapefruit juice or cimetidine coadministration on albendazole bioavailability. Am J Trop Med Hyg 2002; 66(3):260-263.

15. Lohezic-Le Devehat F, Marigny K, Doucet M, et al: Grapefruit juice and drugs: a hazardous combination?. Therapie 2002; 57(5):432-445.

16. Product Information: UROXATRAL(R) oral extended-release tablets, alfuzosin HCl oral extended-release tablets. Sanofi-Aventis US LLC, Bridgewater, NJ, 2008.

17. Product Information: Cordarone(R) oral tablets, amiodarone hydrochloride tablets. Wyeth Pharmaceuticals, Philadelphia, PA, 2011.

18. Lilja JJ, Kivisto KT, Backman JT, et al: Grapefruit juice substantially increases plasma concentrations of buspirone. Clin Pharmacol Ther 1998; 64:655-660.

19. Garg SK, Kumar N, Bhargava VK, et al: Effect of grapefruit juice on carbamazepine bioavailability in patients with epilepsy. Clin Pharmacol Ther 1998; 64:286-288.

20. Oesterheld J & Kallepalli BR: Grapefruit juice and clomipramine: shifting metabolic ratios (letter). J Clin Psychopharmacol 1997; 17:62-63.

21. Reif S, Nicolson MC, Bisset D, et al: Effect of grapefruit juice intake on etoposide bioavailability. Eur J Clin Pharmacol 2002; 58(7):491-494.

22. Dresser GK, Kim RB, & Bailey DG: Effect of grapefruit juice volume on the reduction of fexofenadine bioavailability: possible role of organic anion transporting polypeptides. Clin Pharmacol Ther 2005; 77(3):170-177.

23. Dresser GK, Bailey DG, Leake BF, et al: Fruit juices inhibit organic anion transporting polypeptide-mediated drug uptake to decrease the oral availability of fexofenadine. Clin Pharmacol Ther 2002; 71(1):11-20.

24. Banfield C, Gupta S, Marino M, et al: Grapefruit juice reduces the oral bioavailability of fexofenadine but not desloratadine. Clin Pharmacokinet 2002; 41(4):311-318.

25. Penzak SR, Gubbins PO, Gurley BJ, et al: Grapefruit juice decreases the systemic availability of itraconazole capsules in healthy volunteers. Ther Drug Monit 1999; 21:304-309.

26. Min DI, Ku YM, Geraets DR, et al: Effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of quinidine in healthy volunteers. J Clin Pharmacol 1996; 36:469-476.

27. Damkier P, Hansen L, & Brosen K: Effect of diclofenac, disulfuram, itraconazole, grapefruit juice and erythromycin on the pharmacokinetics of quinidine. J Clin Pharmacol 1999; 48:829-838.

28. Product Information: Quinaglute Dura-Tabs(R), quinidine gluconate, extended release tablets. Berlex Laboratories, Wayne, NJ, 1999.

29. Kupferschmidt HHT, Fattinger KE, Ha HR, et al: Grapefruit juice enhances the bioavailability of the HIV protease inhibitor saquinavir in man. Br J Clin Pharmacol 1998; 45:355-359.

30. Lee AJ, Chan WK, Harralson AF, et al: The effects of grapefruit juice on sertraline metabolism: an in vitro and in vivo study. Clin Ther 1999; 21:1890-1899.

31. Jetter A, Kinzig-Schippers M, Walchner-Bonjean M, et al: Effects of grapefruit juice on the pharmacokinetics of sildenafil. Clin Pharmacol Ther 2002; 71(1):21-29.

34. Edgar B, Bailey D, Bergstrand R, et al: Acute effects of drinking grapefruit juice on the pharmacokinetics and dynamics on felodipine - and its potential clinical relevance. Eur J Clin Pharmacol 1992; 42:313-317.

35. Bailey DG, Dresser G, Kreeft J, et al: Grapefruit-felodipine interaction: effect of unprocessed fruit and probable active ingredients. Clin Pharmacol Ther 2000; 68:468-477.

36. Bailey D, Arnold J, Bend J, et al: Grapefruit juice-felodipine interaction: reproducibility and characterization with the extended release drug formulation. Br J Clin Pharmacol 1995; 40:135-140.

37. Bailey DG, Spence JD, Munoz C, et al: Interaction of citrus juices with felodipine and nifedipine. Lancet 1991; 337:268-269.

38. Lown KS, Bailey DG, Fontana RJ, et al: Grapefruit juice increases felodipine oral availability in humans by decreasing intestinal CYP3A4 protein expression. J Clin Invest 1997; 99(10):2545-2553.

39. Lundahl J, Regardh CG, Edgar B, et al: Relationship between time of intake of grapefruit juice and its effect on pharmacokinetics and pharmacodynamics of felodipine in healthy subjects. Eur J Clin Pharmacol 1995; 49(1-2):61-67.

40. Lundahl J, Regardh CG, Edgar B, et al: Effects of grapefruit juice ingestion-pharmacokinetics and haemodynamics of intravenously and orally administered felodipine in healthy men. Eur J Clin Pharmacol 1997; 52(2):139-145.

41. Takanaga H, Ohnishi A, Matsuo H, et al: Pharmacokinetic analysis of felodipine-grapefruit juice interaction based on an irreversible enzyme inhibition model. Br J Clin Pharmacol 2000; 49:49-58.

42. Product Information: Plendil(R), felodipine. Merck & Co., Inc., West Point, PA, 1998.

43. Odou P, Ferrari N, Barthelemy C, et al: Grapefruit juice-nifedipine interaction: possible involvement of several mechanisms. J Clin Pharm Ther 2005; 30(2):153-158.

44. Christensen H, Asberg A, Holmboe AB, et al: Coadministration of grapefruit juice increases systemic exposure of diltiazem in healthy volunteers. Eur J Clin Pharmacol 2002; 58(8):515-520.

45. Sigusch H, Henschel L, Kraul H, et al: Lack of effect of grapefruit juice on diltiazem bioavailability in normal subjects. Pharmazie 1994; 49(9):675-679.

46. Ho P, Ghose K, Saville D, et al: Effect of grapefruit juice on pharmacokinetics and pharmacodynamics of verapamil enantiomers in healthy volunteers. Eur J Clin Pharmacol 2000; 56:693-698.

47. Fuhr U, Muller-Peltzer H, Kern R, et al: Effects of grapefruit juice and smoking on verapamil concentrations in steady state. Eur J Pharmacol 2002; 58(1):45-53.

48. Fuhr U, Harder S, Lopez-Rojas H, et al: Increase of verapamil concentrations in steady state by coadministration of grapefruit juice. Arch Pharmacol 1994; 349:134.

49. Ozdemir M, Aktan Y, Boydag B, et al: Interaction between grapefruit juice and diazepam in humans. Eur J Drug Metab Pharmacokinet 1998; 23:55-59.

50. Kupferschmidt HHT, Ha HR, Ziegler WH, et al: Interaction between grapefruit juice and midazolam in humans. Clin Pharmacol Ther 1995; 58:20-28.

51. Hukkinen SK, Varhe A, Olkkola KT, et al: Plasma concentrations of triazolam are increased by concomitant ingestion of grapefruit juice. Clin Pharmacol Ther 1995; 58:127-131.

52. Ducharme MP, Provenzano R, Dehoorne-Smith M, et al: Trough concentrations of cyclosporine in blood following administration with grapefruit juice. Br J Clin Pharmacol 1993; 36:457-459.

53. Yee GC, Stanley DL, Pessa LJ, et al: Effect of grapefruit juice on blood cyclosporin concentration. Lancet 1995; 345:955-956.

54. Ioannides-Demos LL, Christophidis N, Ryan P, et al: Dosing implications of a clinical interaction between grapefruit juice and cyclosporine and metabolite concentrations in patients with autoimmune diseases. J Rheumatol 1997; 24:49-54.

55. Brunner LJ, Munar MY, Vallian J, et al: Interaction between cyclosporine and grapefruit juice requires long-term ingestion in stable renal transplant recipients. Pharmacotherapy 1998; 18:23-29.

56. Edwards DJ, Fitzsimmons ME, Schuetz EG, et al: 6',7'-dihydroxybergamottin in grapefruit juice and seville orange juice: effects on cyclosporine disposition, enterocyte CYP3A4, and p-glycoprotein. Clin Pharmacol Ther 1999; 65:237-244.

57. Product Information: Prograf(R) oral capsules, IV injection, tacrolimus oral capsules, IV injection. Astellas Pharm US,Inc, Deerfield, IL, 2006.

58. Schubert W, Cullberg G, Edgar B, et al: Inhibition of 17 beta-estradiol metabolism by grapefruit juice in ovariectomized women. Maturitas 1994; 20(2-3):155-163.

59. Weber A, Jager R, Borner A, et al: Can grapefruit juice influence ethinylestradiol bioavailability. Contraception 1996; 53(1):41-47.

60. Lilja JJ, Kivisto KT, & Neuvonen PJ: Grapefruit juice increases serum concentrations of atorvastatin and has no effect on pravastatin. Clin Pharmacol Ther 1999; 66:118-127.

61. Product Information: Altocor(R), lovastatin extended-release. Andrx Laboratories, Inc., Weston, FL, 2003.

62. Kantola T, Kivisto KT, & Neuvonen PJ: Grapefruit juice greatly increases serum concentrations of lovastatin and lovastatin acid. Clin Pharmacol Ther 1998; 63:397-402.

63. Rogers JD, Zhao J, Liu L, et al: Grapefruit juice has minimal effects on plasma concentrations of lovastatin-derived 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. Clin Pharmacol Ther 1999; 66:358-366.

64. Lilja JJ, Neuvonen M, & Neuvonen PJ: Effects of regular consumption of grapefruit juice on the pharmacokinetics of simvastatin. Br J Clin Pharmacol 2004; 58(1):56-60.

65. Lilja JJ, Kivisto KT, & Neuvonen PJ: Duration of effect of grapefruit juice on the pharmacokinetics of the CYP3A4 substrate simvastatin. Clin Pharmacol Ther 2000; 68:384-390.

66. Product Information: Zocor(R), simvastatin. Merck & Co., Inc., Whitehouse Station, NJ, 2002.

67. Product Information: Relpax(R), eletriptan hydrobromide tablets. Pfizer Inc., NY, NY, 2002.

68. Product Information: Cafergot(R), ergotamine tartrate and caffeine. Novartis Phamaceuticals Corporation, East Hanover, NJ, 2002.

69. Goldbart A, Press J, & Sofer S: Near fatal acute colchicine intoxication in a child. A case report. Eur J Pediatr 2000; 159:895-897.

70. Product Information: Tarceva(R) oral tablets, erlotinib oral tablets. OSI Pharmaceuticals,Inc, Melville, NY, 2007.

71. Product Information: Actiq(R) oral transmucosal lozenge, fentanyl citrate oral transmucosal lozenge. Cephalon, Inc, Salt Lake City, UT, 2007.

72. Cuong BT, BinhVU Q, Dai B, et al: Does gender, food or grapefruit juice alter the pharmacokinetics of primaquine in healthy subjects?. Br J Clin Pharmacol 2006; 61(6):682-689.

73. Product Information: Tykerb(R) oral tablets, lapatinib oral tablets. GlaxoSmithKline, Research Triangle Park, NC, 2007.

74. Product Information: Tikosyn(R) oral capsules, dofetilide oral capsules. Pfizer,Inc, New York, NY, 2004.

75. Product Information: Targretin(R), bexarotene. Ligand Pharmaceuticals Incorporated, San Diego, CA, 2003.

76. Bidstrup TB, Damkier P, Olsen AK, et al: The impact of CYP2C8 polymorphism and grapefruit juice on the pharmacokinetics of repaglinide. Br J Clin Pharmacol 2006; 61(1):49-57.

77. Product Information: Mifeprex(R) oral tablets, mifepristone oral tablets. Danco Laboratories, New York, NY, 2009.

78. Product Information: Orap(R) pimozide. TEVA Pharmaceuticals, Sellersville, PA, 1999.

79. Product Information: Ranexa(R) extended-release oral tablets, ranolazine extended-release oral tablets. CV Therapeutics Inc, Palo Alto, CA, 2008.

80. Product Information: Sutent(R) oral capsules, sunitinib malate oral capsules. Pfizer Labs, New York, NY, 2006.

81. Product Information: Pletal(R), cilostazol. Otsuka Pharmaceuticals, Inc., Rockville, MD, 1999.

82. Fuhr U, Maier-Bruggemann A, Blume H, et al: Grapefruit juice increases oral nimodipine bioavailability. Int J Clin Pharmacol Ther 1998; 36:126-132.

83. Kanazawa S, Ohkubo T, & Sugawara K: The effects of grapefruit juice on the pharmacokinetics of erythromycin. Eur J Clin Pharmacol 2001; 56(11):799-803.

84. Zaidenstein R, Soback S, Gips M, et al: Effect of grapefruit juice on the pharmacokinetics of losartan and its active metabolite E3174 in healthy volunteers. Ther Drug Monit 2001; 23(4):369-373.

85. Benmebarek M, Devaud C, Gex-Fabry M, et al: Effects of grapefruit juice on the pharmacokinetics of the enantiomers of methadone. Clin Pharmacol Ther 2004; 76:55-63.

86. Varis T, Kivisto T, & Neuvonen PJ: Grapefruit juice can increase the plasma concentrations of oral methylprednisolone. Eur J Clin Pharmacol 2000; 56(6-7):489-493.

87. Uno T, Ohkubo T, Sugawara K, et al: Effects of grapefruit juice on the stereoselective disposition of nicardipine in humans: evidence for dominant presystemic elimination at the gut site. Eur J Clin Pharmacol 2000; 56:643-649.

88. Bailey DG, Arnold JMO, Strong HA, et al: Effect of grapefruit juice and naringin on nisoldipine pharmacokinetics. Clin Pharmacol Ther 1993; 54:589-594.

89. Product Information: Rapamune(R), sirolimus. Wyeth Laboratories, Philadelphia, PA, 1999.

90. Product Information: Cialis (R), tadalafil. Lilly ICOS LLC, 2003.

91. Product Information: Niravam(TM) orally disintegrating tablet, alprazolam orally disintegrating tablet. Schwarz Pharma, Milwaukee, WI, 2003.

92. Product Information: Entocort(TM) EC, budesonide capsules. AstraZeneca, Wilmington, DE, USA, 2002.

93. Libersa CC, Brique SA, Motte KB et al: Dramatic inhibition of amiodarone metabolism induced by grapefruit juice. Br J Clin Pharmacol 2000; 49:373-378.

94. Product Information: Cordarone(R), amiodarone, 2003. Wyeth Laboratories, Philadelphia, PA (PI revised 08/2003), reviewed 12/2003.

95. Di Marco MP, Edwards DJ, Wainer IW, et al: The effect of grapefruit juice and seville orange juice on the pharmacokinetics of dextromethorphan: the role of gut CYP3A and P-glycoprotein. Life Sci 2002; 71:1149-1160.

96. Product Information: Tasigna(R) oral capsules, nilotinib oral capsules. Novartis Pharmaceuticals Corporation, East Hanover, NJ, 2007.

97. Product Information: Sprycel(R) oral tablets, dasatinib oral tablets. Bristol-Myers Squibb, Princeton, NJ, 2008.

98. Product Information: Samsca(TM) oral tablets, tolvaptan oral tablets. Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan, 2009.

99. Product Information: Multaq(R) oral tablets, dronedarone oral tablets. sanofi-aventis U.S. LLC, Bridgewater, NJ, 2009.

100. Product Information: Coartem(R) oral tablets, artemether lumefantrine oral tablets. Novartis Pharmaceuticals Corporation, East Hanover, NJ, 2009.

101. Product Information: Voltrient(R) oral tablets, pazopanib oral tablets. GlaxoSmithKline, Research Triangle Park, NC, 2009.

102. Product Information: Flomax(R) oral capsules, tamsulosin HCl oral capsules. Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, 2009.

103. Ducharme MP, Provenzano R, Dehoorne-Smith M, et al: Trough concentrations of cyclosporine in blood following administration with grapefruit juice. Br J Clin Pharmacol 1993; 36:457-459.

104. Yee GC, Stanley DL, Pessa LJ, et al: Effect of grapefruit juice on blood cyclosporin concentration. Lancet 1995; 345:955-956.

105. Ioannides-Demos LL, Christophidis N, Ryan P, et al: Dosing implications of a clinical interaction between grapefruit juice and cyclosporine and metabolite concentrations in patients with autoimmune diseases. J Rheumatol 1997; 24:49-54.

106. Brunner LJ, Munar MY, Vallian J, et al: Interaction between cyclosporine and grapefruit juice requires long-term ingestion in stable renal transplant recipients. Pharmacotherapy 1998; 18:23-29.

107. Edwards DJ, Fitzsimmons ME, Schuetz EG, et al: 6',7'-dihydroxybergamottin in grapefruit juice and seville orange juice: effects on cyclosporine disposition, enterocyte CYP3A4, and p-glycoprotein. Clin Pharmacol Ther 1999; 65:237-244.

108. Product Information: Tracleer(R) oral tablets, bosentan oral tablets. Actelion Pharmaceuticals US, Inc., South San Francisco, CA, 2009.

109. Product Information: Zortress(R) oral tablets, everolimus oral tablets. Novartis Pharma Stein AG, Stein, Switzerland, 2010.

110. Product Information: Torisel(TM) Kit IV injection, temsirolimus IV injection. Wyeth Pharmaceuticals,Inc, Philadelphia, PA, 2007.

111. Product Information: Ixempra(TM) IV injection, ixabepilone IV injection. Bristol-Myers Squibb Company, Princeton, NJ, 2007.

112. Product Information: Jevtana(R) IV infusion, cabazitaxel IV infusion. Sanofi-Aventis US LLC, Bridgewater, NJ, 2010.

113. Tapaninen T, Neuvonen PJ, & Niemi M: Grapefruit juice greatly reduces the plasma concentrations of the OATP2B1 and CYP3A4 substrate aliskiren. Clin Pharmacol Ther 2010a; 88(3):339-342.

114. Product Information: Gleevec(R) oral tablets, imatinib mesylate oral tablets. Novartis Pharmaceuticals Corporation, East Hanover, NJ, 2010.

115. Product Information, Viibryd(R) oral tablets, vilazodone hydrochloride oral tablets. Trovis Pharmaceuticals LLC, New Haven, CT, 2011.

116. Product Information: FARESTON(R) oral tablets, toremifene citrate oral tablets. GTx, Inc, Memphis, TN, 2011.

117. Product Information: XALKORI(R) oral capsules, crizotinib oral capsules. Pfizer Labs, New York, NY, 2011.

118. Product Information: Clozaril(R) clozapine oral tablets. Novartis Pharmaceuticals Corporation, East Hanover, NJ, 2011.

119. Product Information: Dihydroergotamine mesylate injection, Paddock Laboratories, Minneapolis, MN, 2006.

120. Product Information: ERGOMAR(R) sublingual oral tablets, ergotamine tartrate sublingual oral tablets. Rosedale Therapeutics, Bristol, TN, 2003.

121. Product Information: Inlyta(R) oral tablets, axitinib oral tablets. Pfizer Labs, New York, NY, 2012.

122. Product Information: Kalydeco(R) oral tablets, ivacaftor oral tablets. Vertex Pharmaceuticals, Cambridge, MA, 2012.

123. Product Information: Korlym(TM) oral tablets, mifepristone oral tablets. Corcept Therapeutics, Menlo Park, CA, 2012.

124. Product Information: Nimodipine oral tablets. Caraco Pharmaceuticals Laboratories, Detroit, MI, 2012.

125. Agosti S, Casalino L, Bertero G, et al: A dangerous fruit juice. Am J Emerg Med 2012; 30(1): 248.e5-248.e8

126. Piccirillo G, Magri D, Matera S, et al: Effects of pink grapefruit juice on QT variability in patients with dilated or hypertensive cardiomyopathy and in healthy subjects. Transl Res 2008; 151(5): 267-272.


Last Updated: 7/9/2012

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