Talk:Grapefruit–drug interactions

message: ===Most items on the list have no citation===
Shouldn't we remove items without citation?  The list has become... Explosive. It mentioned modafnil but then the modafnil article mentioned completely different enzymes. 99.104.126.16 (talk) 19:50, 1 February 2012 (UTC)
replies: text: I think "List of affected drugs" is a useful article (bias: I initially created this page). I agree that this page and grapefruit juice overlap a lot, however. I think the article about CYP3A4 should discuss the enzyme and its function, and leave its interactions to this page. I will admit that this page isn't very useful if so incomplete. njaard 03:44, 20 January 2007 (UTC)
thread_title: Inclusion of drugs on list

message: Shouldn't we remove items without citation?  The list has become... Explosive. It mentioned modafnil but then the modafnil article mentioned completely different enzymes. 99.104.126.16 (talk) 19:50, 1 February 2012 (UTC)
thread_title: Most items on the list have no citation

message: It seems like we have three articles on the same fundamental point - grapefruit juice acts on certain CYP enzymes.
I propose that we eliminate "grapefruit juice" and "list of drugs affected by grapefruit" entirely (redirect to grapefruit), since they revolve entirely around the CYP inhibition effect.  Instead of those pages, we can have a brief note in the main grapefruit article about the CYP interactions.  That way a reader can follow the link to CYP3A4 or whatever if they want specific information about that.
This way, people who want to know about grapefruits can get relevant information in the article.  The article is about grapefruits, not about enzyme/drug interactions - a mere note that it will occur, a brief warning for consumers, and a link to the appropriate articles should suffice.  CYP3A4 adequately covers the information expressed in grapefruit juice/list of drugs affected, and does so under a more appropriate title.
Any thoughts, suggestions?  My primary concern is that we have multiple articles with the same information, and that we could condense this information and put it into more appropriate articles. 129.170.202.243 07:04, 17 January 2007 (UTC)
replies: text: I think "List of affected drugs" is a useful article (bias: I initially created this page). I agree that this page and grapefruit juice overlap a lot, however. I think the article about CYP3A4 should discuss the enzyme and its function, and leave its interactions to this page. I will admit that this page isn't very useful if so incomplete. njaard 03:44, 20 January 2007 (UTC)
thread_title:  Solution to Grapefruit/Grapefruit juice/List of drugs affected by grapefruit 

message: According to Micromedex, Wellbutrin package insert, and Lexi-comp, bupropion is metabolized mainly by CYP2B6. Lexi-comp mentions that CYP3A4 only plays a minor role in bupropion metabolism. Grapefruit juice is an inhibitor of CYP3A4. Therefore I think bupropion does NOT interact with grapefruit juice.
Reference [1] concluded that multiple doses of bupropion does NOT induce CYP2B6, CYP3A4, and CYP2E1 in human. It doesn't support a major interaction with grapefruit juice.
My suggestion would be removing buproprion from the list.  —Preceding unsigned comment added by Jellen (talk • contribs) 05:56, 18 October 2007 (UTC)
thread_title:  Bupropion interacts with grapefruit juice??? 

message: You are missing alot of substances here, specifically most of the opiates.  Tramadol, Oxycodone, Hydrocodone, etc.  Plus Codeine interacts with grapefruit juice, but in this case it is weakened by grapefruit juice's CYP3A4 inhibition. —Preceding unsigned comment added by 68.8.17.27 (talk • contribs) 
Thank you for your suggestion. When you feel an article needs improvement, please feel free to make those changes.  Wikipedia is a wiki, so anyone can edit almost any article by simply following the  link at the top. The Wikipedia community encourages you to be bold in updating pages. Don't worry too much about making honest mistakes — they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills.  New contributors are always welcome. You don't even need to log in (although there are many reasons why you might want to). WLU 17:18, 15 June 2007 (UTC)
thread_title:  Missing alot 

message: The Grapefruit-drug interaction article lists Levothyroxine as one of the drugs whose absorption is affected by grapefruit, but the only readily available research online, which is the one cited, (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884777/), concluded that "Grapefruit juice may slightly delay the absorption of levothyroxine, but it seems to have only a minor effect on its bioavailability. Accordingly, the clinical relevance of the grapefruit juice-levothyroxine interaction is likely to be small."
Currently, the wiki Levothyroxine article (https://en.wikipedia.org/wiki/Levothyroxine) states that "Grapefruit juice may delay the absorption of levothyroxine, but it is not believed to have a significant effect on bioavailability;" it cites the same source.
Thus we have two different articles citing the same source but implying different things.  The Grapefruit-drug interaction article implies that the grapefruit effect is significant (by omitting to say otherwise -why else would it be listed?), while the Levothyroxine article states that is is probably not.
Lastly, the research itself is based on a sample of only ten healthy (and young) subjects. Eight were male.  Thyroid problems are much more common among the elderly than the young.  (I just checked google - apparently it's also more common among women than men, so the age and gender selected for the study is the opposite of the most commonly affected portion of the population!)  Can we know from a sample of 8 young men and 2 young women, aged 20-30, whether or not grapefruit juice will affect the absorption of levothyroxine in elderly women?  I think not.  (Could there be variations among ethnic groups?  Certainly won't know from a study of 10 people.)
Surely both articles would be improved by saying something to the effect that a study of 10 healthy 20-30 year olds (8 male, 2 female) showed that "[g]rapefruit juice  may slightly delay the absorption of levothyroxine, but it seems to have only a minor effect on its bioavailability. Accordingly, the clinical relevance of the grapefruit juice-levothyroxine interaction is likely to be small," at least on young men. That informs readers that the study is based on a tiny sample and may not be applicable to them.
I am a new user and I'm not inclined to change the article myself - bringing these problems to the attention of any interested parties.
A Michener (talk) 17:22, 7 December 2013 (UTC)
thread_title:  Levothyroxine 

message: Are those who take Prozac and other SSRIs affected by grapefruit? 71.161.252.201 (talk) 05:07, 8 January 2016 (UTC)
thread_title:  Fluoxetine (Prozac) 

message: listed which specifically DO NOT interact with grapefruit - pravastatin PRAVACHOL.  According to the recent FDA information published (link - www.fda.gov/.../UCM292839.pdf‎ ), sorry cannot edit.
Actinic2020 (talk) 17:35, 4 May 2014 (UTC)
thread_title:  Correction needs to be made to statins... 

message: Levoamphetamine is the l isomer of amphetamine and a completely different drug than Propylhexedrine, the active ingredient in Benzedrex. Maybe the author confused Benzedrine, a similar drug composed of levoamphetamine and dextroamphetamine. Not sure how this should be changed though because there is no currently approved medication with levoamphetamine as the only active ingredient.  — Preceding unsigned comment added by 70.112.155.33 (talk) 05:19, 26 January 2015 (UTC)
thread_title:  Benzedrex is not Levoamphetamine 

message: https://www.health.harvard.edu/staying-healthy/grapefruit-and-medication-a-cautionary-note
Numerous medications listed in the Harvard article as non-reactive alternatives are shown in this Wikipedia page as reactive.  For example this wikipedia page shows Clonazepam (Klonopin), with citations from 1999 and 2019, as reacting with Grapefruit.  The Hardvard article list Clonazepam as a non-reactive anti-anxiety medication alternative.  I would make this change myself, but I do not feel qualified to make a judgement about which is actually correct, and belive that are probably people much more qualified than me who can make an appropriate judgement.  — Preceding unsigned comment added by 2600:1700:AB18:D82F:D5BB:DC7:FE:494A (talk) 04:44, 27 January 2023 (UTC)
thread_title:  Contradictions with Harvard Medical School article dated March 2021 

message: === Codeine Metabolism ===
The citation on the line about codeine and tramadol is ONLY a citation for codeine being metabolized by CYP3A4 (which is consistent with the section title).  The sentence, however, includes the much more complex and important point "It reduces the amount of codeine converted by CYP3A4 into norcodeine thus increasing the amount metabolised into morphine.", but there is no citation for that.  In a quick search of PubMed, I found no support for this claim (zero results for a search on 'grapefruit codeine' as well as searching on 'bergamottin' and 'naringin' plus codeine).  Though this statement could be true, I'm not able to confirm it or find primary support for it.
As a first, minor step, I moved the reference citation.  I'm continuing to look into this, hopefully find something else to link to.
One thing that is inaccurate on this list is the claim that quetiapine and carbamazepine are only affected in a minor way by grapefruit juice. This is not true; the interactions are major, and the consequences for bipolar or epileptic patients taking these drugs can be devastating. Quetiapine is extensively metabolized by the CYP3A4 enzyme (Bakken et al, 2008). This is, of course the same enzyme process that is inhibited by grapefruit juice, but what a lot of people don't realize is that pomegranate juice has an even more dramatic effect on drugs metabolized this way (Hidaka et al, 2005). Take a look at that Hidaka article and see what a number pomegranate juice does on Tegretol (carbamazepine) absorption. In fact, evidence suggests that both pomegranate and starfruit have a much larger effect on this metabolization process than does grapefruit (Fujita et al, 2004). These facts need to be much better and more widely known than they are. This is particularly true because pomegranate juice is such a widespread product now. Let's get the word out about just how dangerous these drug interactions are. 
Bakken, G., et al. (2008). Metabolism of quetiapine by CTP3A4 and CYP3A5 in presence or absence of cytochrome b5. Drug Metabolism and Disposition, Nov. 20 (Epub ahead of print). 
Fujita, K., et al. (2004). Potent inhibition by star fruit of human cytochrome P450 3A activity. Drug Metabolism and Disposition, 32, 581-583. 
Hidaka, M., et al. (2005). Effects of pomegranate juice on human cytochrome P450 3A and carbamazepine pharmacokinetics in rats. Drug Metabolism and Disposition, 33, 644-648.  —Preceding unsigned comment added by 67.90.153.194 (talk) 18:50, 24 November 2008 (UTC)
thread_title: Mechanism

message: The citation on the line about codeine and tramadol is ONLY a citation for codeine being metabolized by CYP3A4 (which is consistent with the section title).  The sentence, however, includes the much more complex and important point "It reduces the amount of codeine converted by CYP3A4 into norcodeine thus increasing the amount metabolised into morphine.", but there is no citation for that.  In a quick search of PubMed, I found no support for this claim (zero results for a search on 'grapefruit codeine' as well as searching on 'bergamottin' and 'naringin' plus codeine).  Though this statement could be true, I'm not able to confirm it or find primary support for it.
As a first, minor step, I moved the reference citation.  I'm continuing to look into this, hopefully find something else to link to.
One thing that is inaccurate on this list is the claim that quetiapine and carbamazepine are only affected in a minor way by grapefruit juice. This is not true; the interactions are major, and the consequences for bipolar or epileptic patients taking these drugs can be devastating. Quetiapine is extensively metabolized by the CYP3A4 enzyme (Bakken et al, 2008). This is, of course the same enzyme process that is inhibited by grapefruit juice, but what a lot of people don't realize is that pomegranate juice has an even more dramatic effect on drugs metabolized this way (Hidaka et al, 2005). Take a look at that Hidaka article and see what a number pomegranate juice does on Tegretol (carbamazepine) absorption. In fact, evidence suggests that both pomegranate and starfruit have a much larger effect on this metabolization process than does grapefruit (Fujita et al, 2004). These facts need to be much better and more widely known than they are. This is particularly true because pomegranate juice is such a widespread product now. Let's get the word out about just how dangerous these drug interactions are. 
Bakken, G., et al. (2008). Metabolism of quetiapine by CTP3A4 and CYP3A5 in presence or absence of cytochrome b5. Drug Metabolism and Disposition, Nov. 20 (Epub ahead of print). 
Fujita, K., et al. (2004). Potent inhibition by star fruit of human cytochrome P450 3A activity. Drug Metabolism and Disposition, 32, 581-583. 
Hidaka, M., et al. (2005). Effects of pomegranate juice on human cytochrome P450 3A and carbamazepine pharmacokinetics in rats. Drug Metabolism and Disposition, 33, 644-648.  —Preceding unsigned comment added by 67.90.153.194 (talk) 18:50, 24 November 2008 (UTC)
thread_title:  Codeine Metabolism 

message: Why is there no mention of Grapefruit's effect on inhibition of CYP1A2? For example: It "decreased the oral clearance of caffeine by 23% (95% CI: 7%-30%) and prolonged its half-life by 31%." That was according to this study http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1381556/ There are many sources Online about the drug interaction of this enzyme, for example https://www.wikigenes.org/e/gene/e/1544.html
2605:E000:EFC0:3B:3C5D:8C0C:A4D3:ABF3 (talk) 18:10, 4 June 2015 (UTC)
thread_title:  CYP1A2 

message: === Rename ===
This page is more than just a list, it should probably be moved to Grapefruit-medication interaction or something similar.  WLU 17:49, 16 August 2007 (UTC)
replies: text: I agree, move Grapefruit juice to List of drugs affected by grapefruit. JKW 23:08, 2 January 2007 (UTC)
replies: text:  It would be overwhelming to the juice article, as it involves many other non-grapefruit sources, and should merely be referenced there and any other article about a food source with bergamottin.  99.104.126.16 (talk) 19:50, 1 February 2012 (UTC)
thread_title: Change the name of article

message: This page is more than just a list, it should probably be moved to Grapefruit-medication interaction or something similar.  WLU 17:49, 16 August 2007 (UTC)
thread_title:  Rename 

message: Grapefruit juice article really is all about drugs and their interaction with grapefruit juice, not anything else about the juice. Gzuckier 21:05, 22 November 2006 (UTC)
replies: text: I agree, move Grapefruit juice to List of drugs affected by grapefruit. JKW 23:08, 2 January 2007 (UTC)
replies: text:  It would be overwhelming to the juice article, as it involves many other non-grapefruit sources, and should merely be referenced there and any other article about a food source with bergamottin.  99.104.126.16 (talk) 19:50, 1 February 2012 (UTC)
thread_title: merge with [[Grapefruit juice]]

message: An anonymous user, operating from two different IP addresses, has recently repeatedly posted claims that the "grapefruit effect" is also caused by other citrus flavourings. This claim has been questioned. Wikipedia policy is that, if any statement in an article is challenged or questioned, the onus is on the person wishing to keep the information there to provide a reliable source to support it. It may be that what the anonymous editor says is true, but we cannot assume that it is true just because some anonymous person chooses to edit Wikipedia and say so, because unfortunately many people edit Wikipedia and make false claims. JamesBWatson (talk) 21:29, 2 February 2012 (UTC)
replies: text: The BBC article I mention below also has the claim of other citrus fruits causing the same problems.MidlandLinda (talk) 21:38, 26 November 2012 (UTC)
thread_title:  Other fruits 

message: === Inappropriate link ===
the following should be a reference, it's almost useless as a link and totally inappropriate.  WLU (talk) 22:18, 2 January 2008 (UTC)
thread_title: External links

message: the following should be a reference, it's almost useless as a link and totally inappropriate.  WLU (talk) 22:18, 2 January 2008 (UTC)
thread_title:  Inappropriate link 

message: Hello fellow Wikipedians,
I have just added archive links to  on Grapefruit–drug interactions. Please take a moment to review my edit. If necessary, add  after the link to keep me from modifying it. Alternatively, you can add  to keep me off the page altogether. I made the following changes:
*Added archive http://web.archive.org/web/20110123231957/http://www.gistsupport.org:80/treatments-for-gist/gleevec/novartis-answers-about-gleevec.php to http://www.gistsupport.org/treatments-for-gist/gleevec/novartis-answers-about-gleevec.php
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Cheers.—cyberbot IITalk to my owner:Online 09:21, 21 March 2016 (UTC)
thread_title:  External links modified 

message: === This article is hard to read ===
I'm a reasonably smart guy, albeit with little background in anatomical science, but I'm having a lot of trouble understanding either the symptons or the significance of the grapefruit-juice effect.  The article seems to be filled with scientific jargon, which, while it may be a good medical description of the phenomenon--and, if it is, certainly should remain in the article--tells me very little about why I should care about this.  I take an anti-anxiety medication under a drug class that's mentioned on the list, without its very common brand name being listed (let's set aside how this requires information synthesis that I, but not all readers, happened to be aware of, when trying to read a reference guide on a potentially-dangerous pharmaceutical problem), but after reading this article, I have no idea what to make of this interaction.  All I understand is that it may increase blood concentration, but is not, somehow, absorbed through the intestine.  Anyone care to explain more plainly what this means in the article, and what its associated dangers are?  I'd try to be more specific, or even edit myself, but as I'm complaining about my lack of understanding, that seems paradoxical.  Thanks!65.117.234.99 (talk) 14:30, 11 November 2009 (UTC)
replies: text: I agree with the above. Too dense. 71.127.3.139 (talk) 13:07, 3 March 2010 (UTC)
replies: text: also should maybe the parts that aren't amphetamines have a header/index listing so they don't fall under amphetamines?  — Preceding unsigned comment added by 2605:A000:A7C1:5A00:85CA:9936:E69A:7B17 (talk) 16:14, 25 October 2014 (UTC)
replies: text: I completely agree with this. Too technical. I don't understand what interactions increase the effect of the drug and what decreases the effectiveness. --2605:E000:1525:16C:DCBA:C1C7:8B6F:5721 (talk) 06:13, 30 May 2015 (UTC)
replies: text: I just tried re-writing the lead. See my comment below.  Blue Rasberry (talk) 18:44, 4 May 2016 (UTC)

text: This is still a poorly-written article. I don't think the editors have yet grasped why. I'm not asking them to revise the intro to clarify just what people can expect, symptomatically, from some of the interactions along the lines of "...patients could bleed like a stuck pig..." but I'd be willing to split the difference. JohndanR (talk) 17:45, 16 October 2021 (UTC)

text: It has been 3 years but I re-wrote the intro. See my comment below for details. I hope you got over your infection three years ago.  Blue Rasberry (talk) 18:45, 4 May 2016 (UTC)
thread_title: Simplify the language

message: I'm a reasonably smart guy, albeit with little background in anatomical science, but I'm having a lot of trouble understanding either the symptons or the significance of the grapefruit-juice effect.  The article seems to be filled with scientific jargon, which, while it may be a good medical description of the phenomenon--and, if it is, certainly should remain in the article--tells me very little about why I should care about this.  I take an anti-anxiety medication under a drug class that's mentioned on the list, without its very common brand name being listed (let's set aside how this requires information synthesis that I, but not all readers, happened to be aware of, when trying to read a reference guide on a potentially-dangerous pharmaceutical problem), but after reading this article, I have no idea what to make of this interaction.  All I understand is that it may increase blood concentration, but is not, somehow, absorbed through the intestine.  Anyone care to explain more plainly what this means in the article, and what its associated dangers are?  I'd try to be more specific, or even edit myself, but as I'm complaining about my lack of understanding, that seems paradoxical.  Thanks!65.117.234.99 (talk) 14:30, 11 November 2009 (UTC)
replies: text: I agree with the above. Too dense. 71.127.3.139 (talk) 13:07, 3 March 2010 (UTC)
replies: text: also should maybe the parts that aren't amphetamines have a header/index listing so they don't fall under amphetamines?  — Preceding unsigned comment added by 2605:A000:A7C1:5A00:85CA:9936:E69A:7B17 (talk) 16:14, 25 October 2014 (UTC)
replies: text: I completely agree with this. Too technical. I don't understand what interactions increase the effect of the drug and what decreases the effectiveness. --2605:E000:1525:16C:DCBA:C1C7:8B6F:5721 (talk) 06:13, 30 May 2015 (UTC)
replies: text: I just tried re-writing the lead. See my comment below.  Blue Rasberry (talk) 18:44, 4 May 2016 (UTC)

text: This is still a poorly-written article. I don't think the editors have yet grasped why. I'm not asking them to revise the intro to clarify just what people can expect, symptomatically, from some of the interactions along the lines of "...patients could bleed like a stuck pig..." but I'd be willing to split the difference. JohndanR (talk) 17:45, 16 October 2021 (UTC)
thread_title:  This article is hard to read 

message: As is all too common in Wiki articles, the Intro is full of scientific jargon (mostly names of chemical compounds) that are surely very off-putting for the average reader. While I myself have sufficient background in chemistry and biology to understand what I was reading, I seriously doubt that the typical reader would have a clue what any of it means. Generally speaking, that kind of info should not be in the Intro, which should serve as, well, an introduction to the subject for the layperson. What a concept! I'm hoping one of the regular editors will take this to heart and respond accordingly. (I'm taking antiobiotics right now, which is why I was looking at the article -- so I'm not really up to doing the job myself at present.) Cgingold (talk) 00:03, 4 August 2013 (UTC)
replies: text: It has been 3 years but I re-wrote the intro. See my comment below for details. I hope you got over your infection three years ago.  Blue Rasberry (talk) 18:45, 4 May 2016 (UTC)
thread_title:  Intro needs to be rewritten 

message: Guys
Should we have a companion page "List of products containing grapefruit"?
This would be useful to many readers of "List of drugs affected by grapefruit", specifically, those using the drugs. 
Stevechelt (talk) 19:12, 27 May 2010 (UTC)
thread_title:  "List of products containing grapefruit"? 

message: The BBC has this news item http://www.bbc.co.uk/news/health-20497086 which is in layman's English and one of it's links is this http://www.nhs.uk/chq/Pages/2474.aspx?CategoryID=73&SubCategoryID=103 from NHS Direct and therefore official advice.  They look as if they could be usefully included in this page, but I think it would need a rewrite to insert them neatly and I do not feel competent to do this. MidlandLinda (talk) 21:34, 26 November 2012 (UTC)
replies: text: Also http://abcnews.go.com/blogs/health/2012/11/26/grapefruit-medicine-interaction-warning-expanded (list of drugs has been expanded). 220.255.2.77 (talk) 21:11, 27 November 2012 (UTC)
thread_title:  Two new articles for inclusion. 

message: Would a popular culture section be worthwhile or relevant for this page? For example, Hunter S Thompson's love of grapefruit could relate to this effect (increasing drug potency).  — Preceding unsigned comment added by 86.184.200.220 (talk) 01:00, 18 December 2013 (UTC)
thread_title:  Insert pop culture section? 

message: I rearranged all of the comments on this talk page and put them into sections per WP:REFACTOR. The discussions were not orderly and I hope that this makes it easier to see what is left to do.  Blue Rasberry (talk) 18:42, 4 May 2016 (UTC)
thread_title:  Refactored comments 

message: The content in this article existed in three different places -
*Grapefruit–drug interactions (here)
*Grapefruit
*Grapefruit juice
I merged the content from grapefruit and grapefruit juice here. I deleted content which seemed redundant, then I copyedited what remained.
Here is how it was before. Here is how it is now.
I wrote original text for most of the lead based on an article by my employer, Consumer Reports. The most complicated words I put in the lead are "enzyme" and "metabolizes". Previously the lead talked about "enzyme cytochrome P450 isoform CYP3A4" and that was too much. Most readers want practical layman information. Anyone who wants more can scroll down a bit.  Blue Rasberry (talk) 18:41, 4 May 2016 (UTC)
thread_title:  Merged content, copyedited article 

message: Prompted by the comments from the move review, I've updated the scope of the article. It may perhaps now need a new name, but I'm not sure what it should be. HLHJ (talk) 00:18, 20 August 2017 (UTC)
thread_title:  Updating scope of article 

message: There is a new review article, which is also accessible in full text, which could surely be used to update this article, in case someone is willing to give it an in-depth look: . --Chris Howard (talk) 14:51, 9 June 2019 (UTC)
thread_title:  Review article of 2017 

message: @Zefr: Please explain why you have deleted the name of David Bailey as leading discoverer of these interactions. Your edit of June 20 contains only the unhelpful comment WP:MEDMOS. On reading MEDMOS I see no requirement that the (leading) discoverer of a medical phenomenon be left unidentified. There are many Wikipedia articles which do identify such discoverers. As one of many examples, the article on polio vaccine identifies both Salk and Sabin. Do you want to remove their names?? If not, why is this article different? Dirac66 (talk) 19:13, 24 June 2023 (UTC)
replies: text: The work of Bailey and colleagues is acknowledged in 12 references (there are duplicates to be fixed), giving sufficient recognition to this research group. As there is an article for David Bailey (pharmacologist), indicating notability (WP:NOTABLE), I will revise the article. Zefr (talk) 19:49, 24 June 2023 (UTC)
replies: text: OK, the history paragraph is OK now that you have reinserted Bailey's name. And I agree that merging duplicate references is a good idea, although I had not noticed that it needed doing here. Thank you. Dirac66 (talk) 01:30, 25 June 2023 (UTC)
thread_title:  Unexplained deletion of discoverer's name