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The fruit can cause overdoses of some drugs by stopping the medicines being broken down in the intestines and the liver. The researchers who first identified the link said the number of drugs that became dangerous with grapefruit was increasing rapidly. They were writing in the Canadian Medical Association Journal.
The team at the Lawson Health Research Institute in Canada said the number of drugs which had serious side effects with grapefruit had gone from 17 in 2008 to 43 in 2012. They include some drugs for a range of conditions including blood pressure, cancer and cholesterol-lowering statins and those taken to suppress the immune system after an organ transplant. Chemicals in grapefruit, furanocoumarins, wipe out an enzyme which breaks the drugs down. It means much more of the drug escapes the digestive system than the body can handle.
Toxic
Three times the levels of one blood pressure drug, felodipine, was reported after patients had a glass of grapefruit juice compared with a glass of water. The side effects are varied depending on the drug, but include stomach bleeds, altered heart beat, kidney damage and sudden death. Dr David Bailey, one of the researchers, told the BBC: "One tablet with a glass of grapefruit juice can be like taking five or 10 tablets with a glass of water and people say I don't believe it, but I can show you that scientifically it is sound. "So you can unintentionally go from a therapeutic level to a toxic level just by consuming grapefruit juice."
The report said: "We contend that there remains a lack of knowledge about this interaction in the general health care community." They added: "Unless health care professionals are aware of the possibility that the adverse event they are seeing might have an origin in the recent addition of grapefruit to the patient's diet, it is very unlikely that they will investigate it." Other citrus fruits such as Seville oranges, often used in marmalade, and limes have the same effect.
Neal Patel, from the Royal Pharmaceutical Society said: "Grapefruit isn't the only food that can cause issues, for example milk can stop the absorption of some antibiotics if taken at the same time. "Although some of these interactions may not be clinically significant, some may lead to more serious outcomes. "Pharmacists are the best port of call for anyone concerned about how their diet may affect their medication. Information about any interactions would always be included in the patient information leaflet that comes with the medicine."
BBC News - Grapefruit and pills mix warning
Between 2008 and 2012, researchers say, new drugs capable of adverse interactions arrived on the market annually, driving the total number of medications now known to have side effects when taken with grapefruit from 17 to 43. According to David Bailey, a clinical pharmacologist at the Ontario-based Lawson Health Research Institute, grapefruit contains an enzyme called CYP23A4, which can interact with some medications in the gastrointestinal tract, reducing their effectiveness or raising their potency in the blood stream to dangerously high levels.
Drugs affected by the interaction with grapefruit include cholesterol-lowering medications and some that reduce high blood pressure. Although many drug manufacturers put warnings about interactions with grapefruit on their labels, Bailey says many doctors are not aware of them. Thats our big concern," he said, "that this information needs to get out to the practicing clinicians so that they manage use of these drugs properly in their clinical practice.
All of the drugs that can be affected by grapefruit juice are taken by mouth. Normally, says Bailey, only a small amount of the pills active ingredients enters the bloodstream after theyre swallowed. But he says the drug levels can rise dangerously if grapefruit is consumed, because of the interaction with CY23A4 in the stomach. This is a normal amount of grapefruit juice, were not talking about liters of grapefruit juice here," he says. "But levels can be boosted from the level we want in the body to therapeutic levels that are what we would consider to be high and toxic.
According to Bailey, the interactions between grapefruit juice and some drugs can cause bleeding in the gastrointestinal tract, respiratory failure and sudden death even a long time after the fruit or fruit juice is consumed. Bailey says people should ask their doctor or pharmacists whether its OK to consume grapefruit or grapefruit juice with a particular drug.
Source
When seven people arrived at a Delaware hospital in March with drug-resistant MRSA infections, the similarities were alarming. All of the patients had the same strain of MRSA, all had the infections in joints, and all had gotten injections in those joints at the same orthopedic clinic in a three-day span. State health officials found that the clinic had injected multiple patients with medication from a vial that was meant to be used only once, spreading the MRSA bacteria to a new patient with each shot. A month later, three patients in Arizona were hospitalized with MRSA infections, also following shots at a pain clinic. Again, state and county health officials tied the cases to the injection of multiple patients from a single-dose vial. A fourth shot recipient died; investigators noted that MRSA "could not be ruled out" as a cause.
In July, more than 8,000 patients of an oral surgeon in Colorado were advised to get tested for HIV, the virus that causes AIDS, and hepatitis after state health investigators found that his office reused syringes to inject medication through patients' IV lines. Six patients have tested positive for one of the diseases. As drug-resistant superbugs and increasingly virulent viruses menace the medical community, health officials still face a quiet threat that was supposed to die with the advent of the disposable syringe 50 years ago: dirty needles. Since 2001, more than 150,000 patients nationwide have been victims of unsafe injection practices, and two-thirds of those risky shots were administered in just the past four years, according to data from the U.S. Centers for Disease Control and Prevention. The errors led to at least 49 disease outbreaks, a USA TODAY examination shows, and a trail of victims suffering with potentially life-threatening bacterial infections, such as MRSA, and sometimes fatal viruses, such as hepatitis.
"You just feel betrayed, vulnerable," says Evelyn McKnight, 57, who contracted hepatitis C a decade ago while being treated for cancer at a Nebraska oncology clinic. The virus required six months of debilitating drug treatment on top of her chemotherapy, and it could re-emerge at any time. "People think, 'This can't happen in the United States; this is a Third World thing,' " adds McKnight, who heads HONOReform, a foundation that advocates safe injection practices. "Unfortunately, it happens on a regular basis, and it affects a lot of people, families, communities."
Without question, the overwhelming majority of the hundreds of millions of injections administered annually in hospitals, nursing homes, clinics and doctors' offices are done safely and without incident. But a significant percentage of clinicians -- some studies suggest more than 5% -- don't follow accepted safety standards. That translates into a lot of bad shots. "It's a huge issue. It makes us crazy," says Michael Bell, the CDC's associate director for infection control. "We're trying to eliminate a range of harms in health care -- high-level, complex challenges -- and we look behind us and these basic, obvious, completely preventable problems are still occurring. ... It really comes down to a matter of greed, ignorance or laziness."
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