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Grapefruit & Certain Prescription Medications Don't Mix

According to an article published in the Canadian Medical Association Journal in November 2012, as many as 85 prescription drugs may interact with substances found in grapefruit, grapefruit juice and other citrus fruits such as limes and Seville oranges (used in marmalade), causing adverse health effects. Forty-three of these drugs—a number that's more than doubled since 2008 possibly due to newer chemical formations—may cause serious, potentially life-threatening, reactions.

Substances in grapefruit and some other citrus fruits can change the way certain drugs are metabolized by the body, increasing the amount of medication that enters the bloodstream to dangerous levels. Acute kidney failure or respiratory failure, gastrointestinal (GI) bleeding, other symptoms, and in some cases, sudden death, can result from the interaction. Even small amounts of grapefruit or grapefruit juice consumed hours before taking the medication can cause an adverse reaction. The effects can build up when the drug is taken repeatedly over time.

Medications that may interact with grapefruit include the following:

  • Antibiotics (erythromycin)
  • Cardiovascular (heart) drugs (amiodarone [Cordarone, Nexterone], clopidogrel, apixaban)
  • Blood pressure medications (nifedipine [Nifediac, Afeditab])
  • Cholesterol-lowering statin drugs (atorvastatin [Lipitor], simvastatin [Zocor], pravastatin [Pravachol])
  • Organ transplant rejection drugs (cyclosporine [Sandimmune, Neoral])

Because these medications are prescribed more often in people over the age of 45, the risk for grapefruit-drug interactions is higher in people middle aged and older. Older people also may be more vulnerable to harmful drug reactions.

More research about the effects of grapefruit, grapefruit juice, other citrus fruits and prescription drugs is needed. If you take a prescription medication, talk to your health care provider about whether you can safely consume grapefruit products. It's also a good idea to make sure you know about any potential interactions—related to prescription drugs, over-the-counter (OTC) medications, dietary supplements, herbal products or food products.

The experts at the University of California, Berkeley, Wellness Letter offer these three tips for avoiding dangerous interactions:

  • Check the list If you take prescription meds, check with your health care provider or pharmacist before eating any of the fruits mentioned above.
  • Choose other fruits Try orange or tangerine juice, or sweet oranges such as navels and Valencias. Use lemons instead of limes.
  • Switch drugs If you don't want to give up grapefruit, ask your doctor about switching to another drug in the same category that is metabolized differently by the body—and thus doesn't cause interactions.

Source: U.S. National Library of Medicine (National Institutes of Health; NIH); updated courtesy of our sister publication Diabetes Focus Winter 2013

Publication Review By: the Editorial Staff at

Published: 28 Nov 2012

Last Modified: 17 Sep 2015