Grapefruit-Drug Interactions Can Be Deadly

Researchers are now finding an increasing number of instances of dangerous drug interactions between various medications and grapefruit. The more serious side effects range from internal bleeding to kidney failure, heart abnormalities and sudden death. (A full list of susceptible drugs appears at the end of this article.)

In a paper published Monday in the Canadian Medical Association Journal, three Ontario-based researchers review recent case studies and articles examining grapefruit-drug interactions and call upon doctors to be aware of the potentially dangerous mixture of certain drugs and citrus fruits.

"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," the authors wrote. "In addition, the patient may not volunteer this information. Thus, we contend that there remains a lack of knowledge about this interaction in the general healthcare community."

Between 2008 and 2012, the introduction of new medications and new formulations of existing drugs increased the number of substances with the potential for seriously dangerous interactions with grapefruit from 17 to 43. Overall, more than 85 drugs in circulation have the potential to interact with the fruit.

There are several factors common to drugs that interact with grapefruit: They are all taken by mouth, the have low to intermediate bioavailability -- meaning that only a fraction of the drug will circulate in the bloodstream, with the rest digested -- and all of them are broken down by an enzyme called cytochrome P450 3A4, also known as CYP3A4.

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Grapefruit-Drug Interactions Can Be Deadly