Potential clinically significant drug interactions of drugs with fruit and berry juices

Any drug can potentially cause adverse drug reactions (ADRs), including serious and fatal. Some of them are caused by interactions with food, in particular, fruit and berry juices. Juices have a complex chemical composition and each of the chemicals can interact with drugs. Grapefruit juice is one of the most popular and well-studed in terms of potential drug interactions juices. Grapefruit juice is an inhibitor of CYP3A enzymes in the intestine involved in the presystemic metabolism of drug substrates. Therefore, it can increase their absorption. Apple juice at a concentration of 5% significantly reduces the activity of OATP, but not the activity of P-glycoprotein, which, for example, leads to a decrease in AUC and Cmax of fexofenadine to 30- 40% relative to the concentration of fexofenadine in patients drinking only water. Taking 200 ml of grape juice can reduce the concentration of phenacetin in blood plasma and increase the ratio of AUC of paracetamol to phenacetin due to the induction of CYP1A2 activity by grape juice flavonoids or by reducing the rate of absorption of phenacetin. To prevent ADRs, it is recommended to take drugs with water and and not consume simultaneously juices that are known to interact with drugs.

Download Full-text

Erratum to: No clinically significant drug interactions between lenalidomide and P-glycoprotein substrates and inhibitors: results from controlled phase I studies in healthy volunteers

Cancer Chemotherapy and Pharmacology ◽

10.1007/s00280-014-2516-7 ◽

2014 ◽

Vol 74 (3) ◽

pp. 659-660 ◽

Cited By ~ 1

Author(s):

Nianhang Chen ◽

Daniel Weiss ◽

Josephine Reyes ◽

Liangang Liu ◽

Claudia Kasserra ◽

...

Keyword(s):

Drug Interactions ◽

Phase I ◽

Healthy Volunteers ◽

Phase I Studies ◽

P Glycoprotein ◽

Clinically Significant

Download Full-text

Posaconazole–digoxin drug–drug interaction mediated by inhibition of P-glycoprotein

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155218801055 ◽

2018 ◽

Vol 25 (7) ◽

pp. 1758-1761 ◽

Cited By ~ 2

Author(s):

Abby C Shumaker ◽

Heather M Bullard ◽

Jane Churpek ◽

Randall W Knoebel

Keyword(s):

Atrial Fibrillation ◽

Drug Interactions ◽

Antifungal Agents ◽

Polymorphic Ventricular Tachycardia ◽

Glycoprotein P ◽

P Glycoprotein ◽

Ventricular Response ◽

Clinically Significant ◽

P450 Isozymes ◽

Cytochrome P450 Isozymes

Drug–drug interactions between digoxin and the triazole antifungal agents, mediated via various cytochrome P450 isozymes, have been described in the literature. Posaconazole is not extensively metabolized by these isozymes but is both a p-glycoprotein (P-gp) substrate and inhibitor. To our knowledge, there have been no published cases of clinically significant posaconazole-digoxin drug–drug interactions. We report an interaction between posaconazole (300 mg by mouth daily) and digoxin (0.25 mg by mouth daily, Monday through Friday) resulting in atrial fibrillation with slow ventricular response and degenerating into polymorphic ventricular tachycardia.

Download Full-text

Clinically Significant Grapefruit Juice-Drug Interactions

Nutrition Today ◽

10.1097/01.nt.0000303310.36663.70 ◽

2008 ◽

Vol 43 (1) ◽

pp. 27-28

Author(s):

&NA;

Keyword(s):

Drug Interactions ◽

Grapefruit Juice ◽

Clinically Significant

Download Full-text

Drug–Drug Interactions of 257 Antineoplastic and Supportive Care Agents With 7 Anticoagulants: A Comprehensive Review of Interactions and Mechanisms

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620936325 ◽

2020 ◽

Vol 26 ◽

pp. 107602962093632 ◽

Cited By ~ 1

Author(s):

Érique José F. Peixoto de Miranda ◽

Thamy Takahashi ◽

Felipe Iwamoto ◽

Suzete Yamashiro ◽

Eliana Samano ◽

...

Keyword(s):

Tyrosine Kinase ◽

Supportive Care ◽

Drug Interactions ◽

Tyrosine Kinase Inhibitors ◽

Kinase Inhibitors ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

P Glycoprotein ◽

Clinically Significant ◽

Potentially Clinically Significant

Data on drug–drug interactions (DDI) of antineoplastic drugs with anticoagulants is scarce. We aim to evaluate factors associated with DDI of antineoplastic and supportive care drugs with anticoagulants resulting in modification of pharmacokinetics of these last mentioned. A literature review on DDI databases and summaries of products characteristics (SmPC) was done. Drug–drug interactions of 257 antineoplastic and supportive care drugs with direct oral anticoagulants (DOACs), warfarin, enoxaparin, or fondaparinux were categorized as no clinically significant expected DDI, potentially weak DDI, potentially clinically significant DDI, and recommendation against coadministration. Logistic regression models were performed to analyze the association between the dependent variable potentially clinically significant interaction/recommendation against coadministration and the mechanisms of DDI. Of the 1799 associations, 84.4% were absence of DDI, 3.6% potentially weak DDI, 10.2% potentially clinically relevant DDI, and 2.0% recommendation against coadministration. Warfarin has higher DDI potential than other anticoagulants. Enoxaparin and fondaparinux have fewer DDI than others. There was no difference between DOACs. Drug–drug interactions with apixaban and rivaroxaban was independently associated with the absence of CYP3A4 competition, P-glycoprotein inhibition, CYP3A4 induction, and drug class of tyrosine kinase inhibitors. Drug–drug interactions with dabigatran and edoxaban was associated with inhibition of P-glycoprotein and tyrosine kinase inhibitors. Warfarin, induction of CYP3A4, and inhibition of CYP2C9. Enoxaparin and fondaparinux, only tyrosine kinase inhibitors. Direct oral anticoagulants did not differ regarding DDI with antineoplastic agents. Warfarin presented more DDI than other anticoagulants. P-glycoprotein inhibition and CYP3A4 induction were independently associated with DDI of antineoplastic agents with DOACs.

Download Full-text

Grapefruit Juice–Drug Interactions: Grapefruit Juice and Its Components Inhibit P‐Glycoprotein (ABCB1) Mediated Transport of Talinolol in Caco‐2 Cells

Journal of Pharmaceutical Sciences ◽

10.1002/jps.20975 ◽

2007 ◽

Vol 96 (10) ◽

pp. 2808-2817 ◽

Cited By ~ 62

Author(s):

Whocely Victor de Castro ◽

Susanne Mertens‐Talcott ◽

Hartmut Derendorf ◽

Veronika Butterweck

Keyword(s):

Drug Interactions ◽

Grapefruit Juice ◽

P Glycoprotein

Download Full-text

Clinically Significant Grapefruit Juice-Drug Interactions

Nutrition Today ◽

10.1097/01.nt.0000303302.08847.02 ◽

2008 ◽

Vol 43 (1) ◽

pp. 19-26 ◽

Cited By ~ 1

Author(s):

William W. McCloskey ◽

Kathy Zaiken ◽

R. Rebecca Couris

Keyword(s):

Drug Interactions ◽

Grapefruit Juice ◽

Clinically Significant

Download Full-text

No clinically significant drug interactions between lenalidomide and P-glycoprotein substrates and inhibitors: results from controlled phase I studies in healthy volunteers

Cancer Chemotherapy and Pharmacology ◽

10.1007/s00280-014-2438-4 ◽

2014 ◽

Vol 73 (5) ◽

pp. 1031-1039 ◽

Cited By ~ 15

Author(s):

Nianhang. Chen ◽

Daniel Weiss ◽

Josephine Reyes ◽

Liangang Liu ◽

Claudia Kasserra ◽

...

Keyword(s):

Drug Interactions ◽

Phase I ◽

Healthy Volunteers ◽

Phase I Studies ◽

P Glycoprotein ◽

Clinically Significant

Download Full-text

Drug interactions: a review of the unseen danger of experimental COVID-19 therapies

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa340 ◽

2020 ◽

Vol 75 (12) ◽

pp. 3417-3424 ◽

Cited By ~ 1

Author(s):

Catherine Hodge ◽

Fiona Marra ◽

Catia Marzolini ◽

Alison Boyle ◽

Sara Gibbons ◽

...

Keyword(s):

Drug Interactions ◽

Herbal Medicines ◽

Qt Prolongation ◽

Critically Ill Patient ◽

Experimental Drugs ◽

Mesh Terms ◽

Experimental Therapies ◽

Clinically Significant ◽

Novel Coronavirus

Abstract As global health services respond to the coronavirus pandemic, many prescribers are turning to experimental drugs. This review aims to assess the risk of drug–drug interactions in the severely ill COVID-19 patient. Experimental therapies were identified by searching ClinicalTrials.gov for ‘COVID-19’, ‘2019-nCoV’, ‘2019 novel coronavirus’ and ‘SARS-CoV-2’. The last search was performed on 30 June 2020. Herbal medicines, blood-derived products and in vitro studies were excluded. We identified comorbidities by searching PubMed for the MeSH terms ‘COVID-19’, ‘Comorbidity’ and ‘Epidemiological Factors’. Potential drug–drug interactions were evaluated according to known pharmacokinetics, overlapping toxicities and QT risk. Drug–drug interactions were graded GREEN and YELLOW: no clinically significant interaction; AMBER: caution; RED: serious risk. A total of 2378 records were retrieved from ClinicalTrials.gov, which yielded 249 drugs that met inclusion criteria. Thirteen primary compounds were screened against 512 comedications. A full database of these interactions is available at www.covid19-druginteractions.org. Experimental therapies for COVID-19 present a risk of drug–drug interactions, with lopinavir/ritonavir (10% RED, 41% AMBER; mainly a perpetrator of pharmacokinetic interactions but also risk of QT prolongation particularly when given with concomitant drugs that can prolong QT), chloroquine and hydroxychloroquine (both 7% RED and 27% AMBER, victims of some interactions due to metabolic profile but also perpetrators of QT prolongation) posing the greatest risk. With management, these risks can be mitigated. We have published a drug–drug interaction resource to facilitate medication review for the critically ill patient.

Download Full-text