11 Medications That May Interact With Grapefruit Juice

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If you're a grapefruit lover, you may be disappointed to learn that grapefruit and grapefruit juice can interact with many medications. Some of the most commonly prescribed medications in the U.S., like statin medications for high cholesterol, are among those that interact with grapefruit.

Grapefruit can affect how well certain medications work or may increase your risk of medication side effects. Below, we'll detail 11 medications that can interact with grapefruit juice and how you might manage these drug interactions.

1. Some statins

Statins are first-choice options for treating high cholesterol. But grapefruit and grapefruit juice can increase the levels of certain statin medications. This can lead to an increased risk of statin side effects, like muscle pain and possible muscle breakdown (rhabdomyolysis). Luckily, not all statins are affected.

The statins most affected by grapefruit are:

• Atorvastatin (Lipitor)

• Lovastatin

• Simvastatin (Zocor)

Statins that aren't known to interact with grapefruit include:

• Rosuvastatin (Crestor)

• Pravastatin

• Fluvastatin (Lescol XL)

• Pitavastatin (Livalo)

But it's not clear how risky the interaction between grapefruit and statins is. Some experts think you should avoid grapefruit juice entirely with atorvastatin, lovastatin, and simvastatin. Others recommend simply limiting grapefruit intake, or lowering the statin dose. And still, some believe there's no need to avoid moderate intake of grapefruit products.

Talk to your prescriber if you take a statin and love grapefruit products. They may recommend a statin that doesn't interact with grapefruit, or offer other management tips.

2. Calcium channel blockers

Grapefruit products can increase levels of certain heart medications called calcium channel blockers (CCBs). These medications are commonly used to treat high blood pressure and other heart conditions. When taken with grapefruit, CCBs could cause your blood pressure to drop too low.

The CCBs that are most likely to interact with grapefruit include:

• Nicardipine (Procardia)

• Felodipine

• Nimodipine (Nymalize)

Other CCBs, like verapamil and nifedipine (Procardia) may also be affected. But these interactions may not be as serious as the interaction with the CCBs listed above.

So if you have high blood pressure, what medications can you take with grapefruit juice? If your prescriber recommends a CCB, amlodipine (Norvasc) may be a good choice. There's also other blood pressure medications that aren't known to interact with grapefruit juice. This includes:

• Angiotensin-converting enzyme (ACE) inhibitors like lisinopril (Zestril)

• Some angiotensin-receptor blockers (ARBs) like valsartan(Cozaar)

• Thiazide diuretics like hydrochlorothiazide (Microzide)

• Some beta blockers like metoprolol (Lopressor)

3. Amiodarone

Medications that treat arrhythmias (irregular heartbeats) are called antiarrhythmics. Grapefruit products may increase the levels of an antiarrhythmic called amiodarone (Pacerone). This could lead to high levels of amiodarone in your body, which could worsen arrhythmias. Other serious side effects could include lung or liver damage.

We don't have much research on this interaction, but the FDA has warned about it. To be safe, talk to your prescriber about this interaction if you're concerned. They'll help you weigh the risks and benefits.

4. Estrogen-containing medications

Grapefruit may interact with medications that contain estrogen. This is because grapefruit on its own can increase estrogen levels in the body. When combined with estrogen-containing medications, levels can rise even higher and cause estrogen-related side effects such as nausea, headache, and weight gain. High estrogen levels also lead to an increased risk of blood clots. Examples of estrogen-containing medications include:

• Many birth control pills like Yasmin and Ocella (which contain drospirenone / ethinyl estradiol)

• Estradiol (Estrace)

• Premarin (conjugated estrogens)

High blood levels of estrogen, or taking estrogen for a long time, may also have long-term effects, like an increased risk of breast cancer. So researchers have studied whether grapefruit can increase the risk of breast cancer by increasing estrogen levels. But studies on postmenopausal women taking estrogen-containing hormone therapy show mixed results. If you're concerned about the long-term risks of high estrogen levels, talk to your healthcare team.

5. Plavix

Plavix (clopidogrel) is an antiplatelet medication that prevents blood clots in people at risk of stroke or heart attack. Small studies have shown that grapefruit juice may lower Plavix levels in the body. This could make Plavix less effective and make blood clots more likely.

We need more research before we can say how serious this interaction is. Talk to your prescriber about taking clopidogrel if you drink grapefruit juice. Because clopidogrel is such an important medication, they may think it's safest to avoid grapefruit products altogether.

6. Viagra

Grapefruit juice may increase blood levels of Viagra (sildenafil), a medication used to treat erectile dysfunction. This could make Viagra side effects (like low blood pressure and headaches) more likely. But it's unclear how serious this interaction is. Talk to your prescriber if you're concerned about this interaction. They may just want you to monitor for side effects.

7. Buspirone

Some medications used to treat anxiety may be affected by grapefruit. This includes buspirone. An older study on buspirone showed that large amounts of grapefruit juice can increase absorption of buspirone.

Taking buspirone with grapefruit juice, especially in large quantities, may make it more likely to cause side effects. This includes drowsiness or dizziness.

8. Some opioids

Opioids are medications that treat pain. Grapefruit may increase levels of these medications. This includes oxycodone (Roxicodone, OxyContin) and methadone. In severe cases, high opioid levels could lead to slowed breathing and opioid overdose.

Oxycodone and methadone aren't the only opiods that may interact with grapefruit juice. Since high levels of opioids can be dangerous, your healthcare team may recommend avoiding grapefruit completely while taking certain opioid medications.

9. Allegra

Allegra(fexofenadine) is an over-the-counter allergy medication. Grapefruit may decrease blood levels of Allegra. This could cause Allegra to be less effective. If you're taking it for allergies, this might mean you won't feel as much relief. So if you love grapefruit, talk to your healthcare team about whether another allergy medication is a better option for you, such as Zyrtec (cetirizine) or Claritin (loratadine).

10. Some steroids

Grapefruit juice may increase levels of some oral corticosteroids like budesonide (Entocort EC). It may also increase levels of oral methylprednisolone (Medrol) when taken in large amounts. This can make steroid side effects more likely, including high blood pressure and swelling.

Your prescriber may want you to avoid grapefruit juice if you take certain steroids. But not all steroids interact with grapefruit. For example, prednisone (Rayos) likely doesn't interact with grapefruit.

11. Immunosuppressants

Medications that dampen your immune system response are called immunosuppressants. They're used to prevent your body from rejecting an organ transplant. Some immunosuppressants also used to treat various autoimmune conditions.

Some immunosuppressants may interact with grapefruit. This interaction is potentially dangerous - it can increase medication levels in your body. High levels of immunosuppressants can have many negative effects, including a higher risk of infections, kidney problems, and high blood pressure. Examples of immunosuppressants that interact with grapefruit include:

• Cyclosporine (Sandimmune)

• Tacrolimus (Prograf, Envarsus XR, Astagraf XL)

• Sirolimus (Rapamune)

Your prescriber may ask you to avoid consuming grapefruit while taking any of these medications.

Why does grapefruit interact with these medications?

With most grapefruit-drug interactions, grapefruit blocks the metabolism (breakdown) of the interacting medication

Certain liver enzymes (proteins) are responsible for metabolizing many medications in the body. Grapefruit can block some of these enzymes. This prevents them from working as they normally would. And in turn, you can experience high levels of a medication in your blood that would have normally been metabolized by these enzymes.

Grapefruit may also affect how some oral medications are absorbed and enter the blood. In many cases, grapefruit increases blood levels of the interacting medication. More rarely, grapefruit can decrease levels of the interacting medications, making it less effective.

How much grapefruit does it take to interfere with medication?

There's no exact amount. It varies among individuals and medications. However, some research shows that even just one cup of grapefruit juice can interact with certain medications. So check with your healthcare team about whether there is an amount of grapefruit you can safely consume.

Well, what's the verdict? Can you drink grapefruit juice with your medications?

This is where it gets complicated. Grapefruit juice may affect you differently than it affects someone else. There are so many factors involved, including:

• Which medications you're taking

• How much grapefruit you consume

• The type of grapefruit product you consume

• Your individual metabolism

The best way to handle grapefruit-drug interactions is to talk with your healthcare team if you plan to enjoy grapefruit regularly. Give them an updated list of all the medications you take. They can let you know whether it's safe to have grapefruit.

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