What\u2019s the deal with grapefruit and drug interactions? A friend who takes some unnamed medication recently told me, rather dramatically, \u201cIf I eat grapefruit, I\u2019ll die.\u201d Another friend says grapefruit juice \u201cmakes your molly hit harder.\u201d Is this yet more MAHA misinformation, or is there something to it? And do all citrus fruits do this, or is grapefruit special somehow? <\/b>\u2014Pummeled by Pomelo<\/b> <\/b><\/p>\n
Given the current information environment, Pummeled, I can\u2019t blame you for being suspicious\u2014the grapefruit\/drug connection is exactly the kind of farfetched claim you\u2019d expect to hear sandwiched in between the colloidal silver ads on some vaccine-skeptical podcast about the dangers of seed oils. This time, though, the tale is true: Grapefruit has been documented\u2014not just by somebody\u2019s brother-in-law, but in peer-reviewed studies\u2014as affecting the way your body absorbs over 100 different drugs.<\/p>\n
Which ones? You name it! The list includes cholesterol drugs, blood pressure medications, post-transplant immune suppressors, anti-arrhythmia drugs, antihistamines, antidepressants\u2014the list goes on and on. And since I know you\u2019re wondering: Yes, the list also contains plenty of items from the unscientific but easily understood category of \u201cfun\u201d drugs. Amphetamines, orally administered narcotics, benzodiazepines, ketamine and the aforementioned molly (known to us old-timers as MDMA or, embarrassingly, ecstasy) are all affected.<\/p>\n
Here\u2019s one example of how it works: Grapefruit (and some other citrus fruits, although to a lesser extent) contains compounds called furanocoumarins\u2014a word you almost certainly won\u2019t remember\u2014which evolved to protect the primordial proto-grapefruit from marauding insects. In humans, furanocoumarins block the digestive enzyme CYP3A4\u2014are you writing this down?\u2014that normally starts breaking down all these drugs in the gut. Without the action of CYP3A4, the drugs don\u2019t break down as quickly. Instead, they hang around in the digestive tract for long enough to be absorbed into the bloodstream in greater concentrations than usual. <\/p>\n
I realize it\u2019s in questionable taste to talk about \u201cfun\u201d drugs in the context of an effect that substantially increases the risk of toxicity and overdose. That said, if the 25-year-old Dr. Know had known about this effect he\u2019d have been guzzling grapefruit juice every day: Toxicity and overdose? What\u2019s the catch? <\/p>\n
These days, however, I would assume people who still read newspapers are, like me, well past (past, anyway) the young-and-stupid phase of life when trying a sketchy biochemical hack in hopes of getting more bang for your street-drug buck might sound like a good idea. Just to be clear, however: Don\u2019t try this at home.<\/p>\n