At present, it is the season when grapefruit is listed in large quantities, it is moderately sweet and sour, rich in nutrition, the pulp contains vitamin C is high, the medicinal value is high, it has the effect of eliminating food and detoxification, it is one of the fruits that people like to eat, and it is also recognized by the medical community as a fruit with therapeutic effects.
But can you imagine that eating grapefruit would be dangerous?
Mr. Liu, 58 years old in Wuhan, usually loves to eat grapefruit, and every day after work for the past 1 week, he will carry a grapefruit home, basically he eats a whole by himself.
2 days ago, Mr. Liu suddenly felt sore limbs, weak hands and feet, and then the symptoms continued to worsen, and he couldn't even walk, so his family rushed him to the hospital. The doctor got the blood test results and found that the creatine kinase index in Mr. Liu's body was more than 5 times higher than the normal value, and the doctor diagnosed that this was "rhabdomyolysis", and the "accomplice" was actually "grapefruit".
Eating grapefruit can cause muscle dissolution? What's going on here?
It turned out that 3 months ago, Mr. Liu was diagnosed with hyperlipidemia and took atorvastatin for lipid-lowering treatment on the advice of the doctor. The most obvious side effect of statins is the cause of rhabdomyolysis.
Rhabdomyolysis syndrome refers to the destruction and dissolution of rhabdomyocytes due to various reasons such as squeezing, exercise, high fever, inflammation, drugs, etc., and a large number of myoglobin, creatine kinase and other components are released into the bloodstream, causing disturbances in the human environment. Typical symptoms are muscle pain, muscle weakness, black or strong brown urine, body weakness, dizziness, dizziness, etc., which can lead to acute kidney injury, acute heart failure, etc. when severe, and can cause death if not treated in time.
The reason why Yuzu is an "accomplice" is because Mr. Liu had eaten yuzu for a week before he had symptoms. The specific ingredients in grapefruit inhibit the breakdown and metabolism of many drugs (including statins) in the body, so that the drug maintains a high concentration in the blood, and some of the toxic side effects that originally have will be amplified.
The grapefruit in the above incident is not our grapefruit in the broad sense of the word, but grapefruit, that is, grapefruit.
How does grapefruit interfere with the drug?
Mainly because grapefruit contains furan bean vanillin. Furandouin can inhibit the enzyme CYP3A4 that breaks down drugs in the human body. Some drugs are metabolized through CYP3A4 in the small intestine, and taking grapefruit at the same time will affect the metabolism and excretion of these drugs, and more drugs will not be metabolized, enter the bloodstream, and stay in the body for a longer time.
The final result is that the normal dose of the drug was originally eaten, but due to the action of grapefruit, the drug contained in the patient's body exceeded, resulting in a change in the efficacy of the drug, and sometimes even caused the drug originally used for treatment to become "poison".
What drugs can't be taken with grapefruit?
Canadian researchers published a paper in the Journal of the Canadian Medical Association that as many as 85 drugs were found to have adverse reactions when taken with grapefruit juice, of which 45 drugs had serious side effects, most of which were commonly used drugs.
(1) Antitumor drugs: crizotinib, seritinib, nilotinib, everolimus, sunitinib, lapatinib, imatinib, dasatinib, erlotinib, pazotinib, van der thani.
(2) Anti-infective drugs: erythromycin.
(3) Lipid-lowering drugs: simvastatin, atorvastatin, lovastatin.
(4) Other cardiovascular drugs: nimodipine, felodipine, nifedipine, amiodarone, ivabradine, verapamil, amlodipine, nisodipine, dronedarone, cilostazole, rivaroxaban, apixaban, eplerenone, ticagrelor, quinidine.
(5) Central nervous system medication: carbamazepine, pimozide, diazepam, buspirone, sertraline, midazolam, oxycodone, dextromethorphan, fentanyl, afentanil.
(6) Gastrointestinal medication: cisapride, domperidone.
(7) Immunosuppressants: cyclosporine, everolimus, sirolimus, tacrolimus.
(8) Medication for the urinary system: tamsulosin.
How long should I take my medication and eat grapefruit?
Some people may ask, grapefruit, grapefruit and other fruits can not be eaten with some fruits, then I can always eat it at intervals. The question is, how long should the interval be?
One study showed that after eating grapefruit, the possibility of interaction with the drug lasted up to 72 hours. Therefore, patients should stop eating grapefruit 72 hours before taking drugs that may interact.
The U.S. Food and Drug Administration believes that eating grapefruit only a few hours before or after taking medication may still pose a great danger. Therefore, when taking these medications, it is best to avoid or minimize the intake of grapefruit juice or fresh grapefruit altogether. For safety reasons, it is recommended that you should avoid eating grapefruit or drinking grapefruit juice for 3 days before taking the drug and 6 hours after taking the drug.
In addition, in recent years, we often hear a sentence is "talk about toxicity without dose, that is, play hooligans", so is it possible to eat less grapefruit, this interaction will not happen? Unfortunately, this is difficult to determine, because the amount of CYP3A4 enzyme in the intestines of different people varies greatly, and the effect of grapefruit on different people is also very different. Studies have shown that drinking about 230 ml of grapefruit juice can reduce the concentration of CYP3A4 enzyme in the intestine by 47%, and this effect lasts for 24 to 72 hours.
Do other fruits have this effect?
Tomatoes, oranges and citrus and other rue plants of the fruit, peel parts contain hesperidin or naringin, which will affect the metabolic enzymes in the human body, thereby affecting the metabolism and excretion of drugs, so when taking drugs in daily life, we must pay attention to the interaction with these fruits.
Write at the end
Xiaobian would like to remind everyone that when taking medicine, remember to read the instructions. The "taboos" and "precautions" of the manual must be carefully read!
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