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Healthy Living
Food and Prescription Medicine: A Potentially Dangerous Cocktail
Date: 17/06/10
Keywords: adverse side effects, Crestor, Gingko Biloba, cranberry, drug interactions, grapefruit, Statins
Check the fine print on all your prescription medicine. It may have dangerous interactions with certain types of food. For instance, grapefruit juice inhibits a liver enzyme which is crucial for drug metabolism. If you eat grapefruit or drink grapefruit juice regularly, there is a risk that you will have raised levels of statins in your bloodstream. Let’s say you have a medical condition, which requires high strength prescription medication. Your condition also requires you to change your diet and lifestyle. What if your doctor then refers you to a dietician but fails to inform him or her about what medication you are on? Or the dietician fails to ask you?
Do you think there's potential for problems to arise?
Food and medicine
After a series of heart-related health issues, my father was put on cholesterol lowering statins. Recently, his doctor sent him to a dietician to review his diet and to make further dietary recommendations to improve his health. The dietician suggested a grapefruit diet – specifically red grapefruit – since it has been shown to reduce cholesterol levels.
Great stuff!!!
Or, on further inspection, perhaps not.
Within a week of starting his grapefruit diet my father started experiencing severe lethargy, fatigue and muscle pain. These are all known side effects of statins, but when I spoke to him, he said that he felt worse than ever.
Of course, I told him to speak to his doctor immediately and have his statin dosage adjusted.
However, for once it wasn’t the satins that were the main culprit. It turned out that grapefruit is a no-go-zone when you are taking certain statins.
Apparently, grapefruit juice inhibits a liver enzyme which is crucial for drug metabolism. If you eat grapefruit or drink grapefruit juice regularly, there is a risk that you will have raised levels of statins in your bloodstream. This is especially true when you’re taking statins such as Crestor, Zocor and Lipitor. Official guidelines also recommend that you avoid grapefruit if you are taking the cardiac medicine felodipine, verapamil or nicardipine.
Did my father’s dietician not know this?!
Meddling fruit medley
Grapefruit seems to be a notorious offender. The popular hay fever drug terfenadine, now only available on prescription in the UK, has shown to be lethal when combined with grapefruit. A perfect example of this is a patient who died of a cardiac arrhythmia after drinking two glasses of grapefruit juice whilst taking terfenadine. Clinical studies have also shown that grapefruit can reduce the effects of other antihistamine drugs like fexofenadine.
Other well recognised grapefruit interactions include the drugs cyclosporine (an immune-suppressing drug) and saquinavir (an HIV drug).
But grapefruit is not the only bad apple in the basket. Some research suggests that garlic capsules, gingko biloba and fish oil may interact with warfarin, the blood thinner. Warfarin users are also advised to avoid drinking cranberry juice because it thins the blood even more. Consumption of large amounts of mango fruit has been associated with enhanced effects of warfarin and soy protein seems to negatively effect how well warfarin works too.
Paracetamol interacts with alcohol. In cases of ruthless alcohol consumption whilst taking paracetamol patients can develop fatal hepatitis and frank hepatic failure which will require a liver transplant.
Bottom line: Check the fine print
Until a drug is developed that doesn't have a long list of interactions with foods or nutritional supplements, we should all remember to read the fine print on all our prescription medicine. Clearly, and very worryingly, we cannot rely on our doctors, and even dieticians, to consult us on the possible side effects and interactions we may experience with the drugs we take along with the food we eat...
Sources:
‘Red Grapefruit Appears To Lower Cholesterol, Fight Heart Disease’ published online, 15.02.2006, medicalnewstoday.com
‘Grapefruit juice and some statins do not mix, say British regulators’ published online, 02.11.2004, medicalnewstoday.com
‘A Dangerous Cocktail’ by Margaret McCartney, FT Weekend Magazine 12.06.2010 page 43
‘Terfenadine’ published online General Practice Notebook, gpnotebook.co.uk
Drugs.com – drug information online
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