food drug interaction
9 interactions related to food drug interaction
tacrolimus + grapefruit
Grapefruit furanocoumarins irreversibly inhibit intestinal CYP3A4, increasing tacrolimus AUC by roughly 28% and Cmax by up to 73%. Case reports describe trough levels tripling after grapefruit ingestion, producing nephrotoxicity and neurotoxicity.
grapefruit + sildenafil
Sildenafil is metabolized primarily by CYP3A4. Grapefruit juice inhibits intestinal CYP3A4 and modestly increases sildenafil AUC by about 23 percent while delaying peak concentration, which can worsen the headache, flushing, dizziness, and hypotension typical of PDE5 inhibitors.
grapefruit + carbamazepine
Grapefruit juice irreversibly inhibits intestinal CYP3A4, reducing first-pass metabolism of carbamazepine and increasing its bioavailability. Clinical study in epilepsy patients showed AUC rose by roughly 40 percent with concomitant grapefruit juice, pushing plasma levels toward the toxic range.
grapefruit + oxycodone
Oxycodone undergoes CYP3A4-mediated metabolism to noroxycodone. A controlled crossover study in healthy volunteers showed grapefruit juice increased oxycodone AUC 1.7-fold, peak concentration 1.5-fold, and half-life 1.2-fold, while reducing formation of inactive noroxycodone, raising the risk of sedation and respiratory depression.
broccoli + warfarin
Broccoli is rich in vitamin K1 (phylloquinone), the very cofactor warfarin blocks to suppress clotting factor synthesis. Large or wildly inconsistent intake can lower the INR and reduce warfarin's anticoagulant effect, raising clot risk.
grapefruit + lurasidone
Lurasidone is primarily metabolized by CYP3A4 and is highly sensitive to CYP3A4 inhibitors. The FDA-approved Latuda prescribing information specifically states that grapefruit and grapefruit juice should be avoided in patients taking lurasidone because they inhibit CYP3A4 and can substantially raise lurasidone concentrations.
grapefruit + quetiapine
Quetiapine is metabolized primarily by CYP3A4. Grapefruit juice inhibits intestinal CYP3A4 and can substantially increase quetiapine plasma concentrations; a documented case report describes quetiapine toxicity in a young woman who consumed a gallon of grapefruit juice over 24 hours while on a stable dose.
cyclosporine + grapefruit
Grapefruit juice contains furanocoumarins that irreversibly inhibit intestinal CYP3A4, raising cyclosporine bioavailability by 35-60% and increasing the risk of nephrotoxicity, hypertension, and neurotoxicity. The effect can persist for 24 hours or longer after a single glass.
grapefruit + buspirone
Buspirone undergoes extensive first-pass metabolism by intestinal and hepatic CYP3A4. A controlled study showed grapefruit juice increased buspirone AUC 9.2-fold and peak plasma concentration 4.3-fold, dramatically amplifying sedation, dizziness, and serotonergic effects.