14 Medications to Avoid Mixing With Grapefruit

Grapefruit, a type of citrus fruit, can be consumed as food, juice, or a dietary supplement. However, it can interact with many types of medications.These interactions usually occur due to grapefruit’s effects on naturally occurring proteins in your body.

This may lead to inappropriate medication levels in the body.If there is too much of an active substance, you may experience side effects. If there is too little of an active substance, the drug cannot do its job.This is whygrapefruitcan be dangerous and should be avoided for some medications.

1. Certain Statins

Certainstatins and grapefruitdo not mix well together.For example, consuming grapefruit while taking Lipitor (atorvastatin) can result in high atorvastatin levels in your bloodstream.Too much atorvastatin may increase your risk ofrhabdomyolysis(muscle breakdown).

This interaction is more likely when you drink or eat grapefruit at more than 1.2 liters daily.

The following is a list of statins that interact with grapefruit:

However, there are alternative statins with a lower risk of interacting with grapefruit. These statins include:

2. Calcium Channel Blockers

Grapefruit may interact with some blood pressure medications—specifically thecalcium channel blockerdrug class.

For example, grapefruit can raise levels of Procardia (nifedipine), a calcium channel blocker, in your bloodstream.This increases your risk for side effects, such as low blood pressure (hypotension) and swelling.

Some alternatives to calcium channel blockers with little to no interaction with grapefruit include:

3. Estrogen-Containing Medications

Grapefruit can increase estrogen levels in estrogen-containing medications, such as hormonalcontraceptive pillsor estradiol tablets.High estrogen levelsmay lead to more side effects.

In general, high doses of estrogen are linked to a risk of heart-related conditions, such as heart attack and blood clots. Overdose with estrogen may also cause nausea, vomiting, and vaginal bleeding.

4. Certain Immunosuppressants

Grapefruit interacts with certain immunosuppressants—drugs that decrease the intensity of the immune response when the immune system is overactive and doing damage. It raises the levels of someimmunosuppressive drugs, which can increase the risk of problems such as kidney toxicity.

The following is a list of example immunosuppressants that interact with grapefruit:

You’ll likely need to avoid or limit grapefruit while taking any of the above medications.

5. Buspirone

High levels of buspirone may increase your risk of side effects, such as:

If you are taking buspirone, it’s recommended to avoid drinking grapefruit juice in large amounts.

6. Corticosteroids

Grapefruit can raise the levels of certain oralcorticosteroids (steroids)in the body. This includes budesonide, a steroid used in treating the inflammatory bowel disease Crohn’s disease, and Medrol (methylprednisolone), which treats several inflammatory conditions.

7. Anti-Arrythmic Medications

Grapefruit can interact with some anti-arrhythmic medications, such as Multaq (dronedarone) and Pacerone (amiodarone).Grapefruit raises the drug levels in your body.This may increase the risk of side effects, including severe heart rhythm problems.

8. A Few Diabetes Medications

Common side effects of saxagliptin include:

If taken with something that strongly blocks the CYP3A4 liver protein—like grapefruit—the saxagliptin dosage should be low at 2.5 milligrams (mg) daily.

Alternatives may include a similar but different class of diabetes medication calledglucagon-like peptide 1 (GLP-1) agonists. Examples include Victoza (liraglutide) and Ozempic (semaglutide).

9. Allegra (Fexofenadine)

Allegra (fexofenadine) is an example of an OTCantihistaminethat interacts with grapefruit. Grapefruit can limit how much fexofenadine enters the bloodstream. This decreases the drug’s effectiveness.

An alternative antihistamine that is likely safe against grapefruit is Claritin (loratadine).

10. Blood Thinners (Anticoagulants)

Examples of blood thinners that can interact with grapefruit are:

11. Some Cancer Medications

Grapefruit can interact with some cancer medications, such as dasatinib and nilotinib used forchronic myeloid leukemia(CML). Grapefruit can raise the amount of these medications in your body.This can increase the risk of side effects, such as severe heart rhythm problems and toxicity.

Some dosage adjustments are possible with dasatinib.

12. Certain Drugs Used to Treat Infections

Grapefruit can interact with certain drugs used to treat infections, such as:

In general, high drug levels might be linked to more side effects, such as a severe heart rhythm problem with erythromycin and rilpivirine or dangerously low blood pressure with maraviroc.

As for Paxlovid, bictegravir, and doravirine, some of the common side effects are related to the digestive system.

13. Certain Opioids

Grapefruit can interact with some pain medications, including opioids like oral oxycodone, fentanyl, and methadone. Grapefruit might raise levels of these medications in the blood.In some cases, this can increase the risk of a dangerously slow breathing rate, which is a side effect of an opioid overdose.

14. Erectile Dysfunction and Urinary Tract Drugs

Grapefruit juice may interact with the following medications:

Summary

Grapefruit is a citrus fruit that is a source of various nutrients. However, grapefruit can also be dangerous due to numerous drug interactions. Therefore, grapefruit should be avoided with certain medications.

While this article provided several examples of grapefruit medication interactions, it is not a complete list. Before including grapefruit as part of your routine or making any medication changes, reach out to a healthcare provider.

35 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Grapefruit.Food and Drug Administration.Grapefruit juice and some drugs don’t mix.DailyMed.Label: atorvastatin calcium tablet, film coated.Bailey DG, Dresser G, Arnold JMO.Grapefruit-medication interactions: forbidden fruit or avoidable consequences?CMAJ. 2013;185(4):309-316. doi:10.1503/cmaj.120951DailyMed.Label: nifedipine tablet, extended release.Kane GC, Lipsky JJ.Drug-grapefruit juice interactions.Mayo Clinic Proceedings. 2000;75(9):933-942. doi:10.4065/75.9.933Monroe KR, Stanczyk FZ, Besinque KH, Pike MC.The effect of grapefruit intake on endogenous serum estrogen levels in postmenopausal women.Nutr Cancer. 2013;65(5):644-652. doi:10.1080/01635581.2013.795982DailyMed.Label: estradiol tablet.DailyMed.Label: tacrolimus capsule.Auten AA, Beauchamp LN, Joshua Taylor, Hardinger KL.Hidden sources of grapefruit in beverages: potential interactions with immunosuppressant medications.Hosp Pharm. 2013;48(6):489-493. doi:10.1310/hpj4806-489PDR.BuSpar.DailyMed.Label: buspirone hydrochloride tablet.MedlinePlus.Cushing syndrome.DailyMed.Label: amiodarone hydrochloride tablet.DailyMed.Label: Multaq- dronedarone tablet, film coated.Food and Drug Administration.Onglyza label.Food and Drug Administration.Ozempic label.Food and Drug Administration.Victoza label.Poison Control.Loratadine (Claritin): side effects and interactions.PDR.Eliquis.PDR.Xarelto.Holmberg MT, Tornio A, Neuvonen M, et al.Grapefruit juice inhibits the metabolic activation of clopidogrel.Clin Pharmacol Ther. 2014;95(3):307-313. doi:10.1038/clpt.2013.192PDR.Dasatinib.PDR.Tasigna.Bordes C, Leguelinel-Blache G, Lavigne JP, et al.Interactions between antiretroviral therapy and complementary and alternative medicine: a narrative review.Clin Microbiol Infect. 2020;26(9):1161-1170. doi:10.1016/j.cmi.2020.04.019DailyMed.Label: Paxlovid - nirmatrelvir and ritonavir kit.DailyMed.Label: Paxlovid- nirmatrelvir and ritonavir kit.DailyMed.Label: Biktarvy- bictegravir sodium, emtricitabine, and tenofovir alafenamide fumarate tablet.DailyMed.Label: Pifeltro- doravirine tablet, film coated.Feng XQ, Zhu LL, Zhou Q.Opioid analgesics-related pharmacokinetic drug interactions: from the perspectives of evidence based on randomized controlled trials and clinical risk management.J Pain Res. 2017;10:1225-1239. doi:10.2147/JPR.S138698PDR.OxyContin.PDR.Flomax.PDR.Rapaflo.PDR.Uroxatral.PDR.Viagra.

35 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Grapefruit.Food and Drug Administration.Grapefruit juice and some drugs don’t mix.DailyMed.Label: atorvastatin calcium tablet, film coated.Bailey DG, Dresser G, Arnold JMO.Grapefruit-medication interactions: forbidden fruit or avoidable consequences?CMAJ. 2013;185(4):309-316. doi:10.1503/cmaj.120951DailyMed.Label: nifedipine tablet, extended release.Kane GC, Lipsky JJ.Drug-grapefruit juice interactions.Mayo Clinic Proceedings. 2000;75(9):933-942. doi:10.4065/75.9.933Monroe KR, Stanczyk FZ, Besinque KH, Pike MC.The effect of grapefruit intake on endogenous serum estrogen levels in postmenopausal women.Nutr Cancer. 2013;65(5):644-652. doi:10.1080/01635581.2013.795982DailyMed.Label: estradiol tablet.DailyMed.Label: tacrolimus capsule.Auten AA, Beauchamp LN, Joshua Taylor, Hardinger KL.Hidden sources of grapefruit in beverages: potential interactions with immunosuppressant medications.Hosp Pharm. 2013;48(6):489-493. doi:10.1310/hpj4806-489PDR.BuSpar.DailyMed.Label: buspirone hydrochloride tablet.MedlinePlus.Cushing syndrome.DailyMed.Label: amiodarone hydrochloride tablet.DailyMed.Label: Multaq- dronedarone tablet, film coated.Food and Drug Administration.Onglyza label.Food and Drug Administration.Ozempic label.Food and Drug Administration.Victoza label.Poison Control.Loratadine (Claritin): side effects and interactions.PDR.Eliquis.PDR.Xarelto.Holmberg MT, Tornio A, Neuvonen M, et al.Grapefruit juice inhibits the metabolic activation of clopidogrel.Clin Pharmacol Ther. 2014;95(3):307-313. doi:10.1038/clpt.2013.192PDR.Dasatinib.PDR.Tasigna.Bordes C, Leguelinel-Blache G, Lavigne JP, et al.Interactions between antiretroviral therapy and complementary and alternative medicine: a narrative review.Clin Microbiol Infect. 2020;26(9):1161-1170. doi:10.1016/j.cmi.2020.04.019DailyMed.Label: Paxlovid - nirmatrelvir and ritonavir kit.DailyMed.Label: Paxlovid- nirmatrelvir and ritonavir kit.DailyMed.Label: Biktarvy- bictegravir sodium, emtricitabine, and tenofovir alafenamide fumarate tablet.DailyMed.Label: Pifeltro- doravirine tablet, film coated.Feng XQ, Zhu LL, Zhou Q.Opioid analgesics-related pharmacokinetic drug interactions: from the perspectives of evidence based on randomized controlled trials and clinical risk management.J Pain Res. 2017;10:1225-1239. doi:10.2147/JPR.S138698PDR.OxyContin.PDR.Flomax.PDR.Rapaflo.PDR.Uroxatral.PDR.Viagra.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

MedlinePlus.Grapefruit.Food and Drug Administration.Grapefruit juice and some drugs don’t mix.DailyMed.Label: atorvastatin calcium tablet, film coated.Bailey DG, Dresser G, Arnold JMO.Grapefruit-medication interactions: forbidden fruit or avoidable consequences?CMAJ. 2013;185(4):309-316. doi:10.1503/cmaj.120951DailyMed.Label: nifedipine tablet, extended release.Kane GC, Lipsky JJ.Drug-grapefruit juice interactions.Mayo Clinic Proceedings. 2000;75(9):933-942. doi:10.4065/75.9.933Monroe KR, Stanczyk FZ, Besinque KH, Pike MC.The effect of grapefruit intake on endogenous serum estrogen levels in postmenopausal women.Nutr Cancer. 2013;65(5):644-652. doi:10.1080/01635581.2013.795982DailyMed.Label: estradiol tablet.DailyMed.Label: tacrolimus capsule.Auten AA, Beauchamp LN, Joshua Taylor, Hardinger KL.Hidden sources of grapefruit in beverages: potential interactions with immunosuppressant medications.Hosp Pharm. 2013;48(6):489-493. doi:10.1310/hpj4806-489PDR.BuSpar.DailyMed.Label: buspirone hydrochloride tablet.MedlinePlus.Cushing syndrome.DailyMed.Label: amiodarone hydrochloride tablet.DailyMed.Label: Multaq- dronedarone tablet, film coated.Food and Drug Administration.Onglyza label.Food and Drug Administration.Ozempic label.Food and Drug Administration.Victoza label.Poison Control.Loratadine (Claritin): side effects and interactions.PDR.Eliquis.PDR.Xarelto.Holmberg MT, Tornio A, Neuvonen M, et al.Grapefruit juice inhibits the metabolic activation of clopidogrel.Clin Pharmacol Ther. 2014;95(3):307-313. doi:10.1038/clpt.2013.192PDR.Dasatinib.PDR.Tasigna.Bordes C, Leguelinel-Blache G, Lavigne JP, et al.Interactions between antiretroviral therapy and complementary and alternative medicine: a narrative review.Clin Microbiol Infect. 2020;26(9):1161-1170. doi:10.1016/j.cmi.2020.04.019DailyMed.Label: Paxlovid - nirmatrelvir and ritonavir kit.DailyMed.Label: Paxlovid- nirmatrelvir and ritonavir kit.DailyMed.Label: Biktarvy- bictegravir sodium, emtricitabine, and tenofovir alafenamide fumarate tablet.DailyMed.Label: Pifeltro- doravirine tablet, film coated.Feng XQ, Zhu LL, Zhou Q.Opioid analgesics-related pharmacokinetic drug interactions: from the perspectives of evidence based on randomized controlled trials and clinical risk management.J Pain Res. 2017;10:1225-1239. doi:10.2147/JPR.S138698PDR.OxyContin.PDR.Flomax.PDR.Rapaflo.PDR.Uroxatral.PDR.Viagra.

MedlinePlus.Grapefruit.

Food and Drug Administration.Grapefruit juice and some drugs don’t mix.

DailyMed.Label: atorvastatin calcium tablet, film coated.

Bailey DG, Dresser G, Arnold JMO.Grapefruit-medication interactions: forbidden fruit or avoidable consequences?CMAJ. 2013;185(4):309-316. doi:10.1503/cmaj.120951

DailyMed.Label: nifedipine tablet, extended release.

Kane GC, Lipsky JJ.Drug-grapefruit juice interactions.Mayo Clinic Proceedings. 2000;75(9):933-942. doi:10.4065/75.9.933

Monroe KR, Stanczyk FZ, Besinque KH, Pike MC.The effect of grapefruit intake on endogenous serum estrogen levels in postmenopausal women.Nutr Cancer. 2013;65(5):644-652. doi:10.1080/01635581.2013.795982

DailyMed.Label: estradiol tablet.

DailyMed.Label: tacrolimus capsule.

Auten AA, Beauchamp LN, Joshua Taylor, Hardinger KL.Hidden sources of grapefruit in beverages: potential interactions with immunosuppressant medications.Hosp Pharm. 2013;48(6):489-493. doi:10.1310/hpj4806-489

PDR.BuSpar.

DailyMed.Label: buspirone hydrochloride tablet.

MedlinePlus.Cushing syndrome.

DailyMed.Label: amiodarone hydrochloride tablet.

DailyMed.Label: Multaq- dronedarone tablet, film coated.

Food and Drug Administration.Onglyza label.

Food and Drug Administration.Ozempic label.

Food and Drug Administration.Victoza label.

Poison Control.Loratadine (Claritin): side effects and interactions.

PDR.Eliquis.

PDR.Xarelto.

Holmberg MT, Tornio A, Neuvonen M, et al.Grapefruit juice inhibits the metabolic activation of clopidogrel.Clin Pharmacol Ther. 2014;95(3):307-313. doi:10.1038/clpt.2013.192

PDR.Dasatinib.

PDR.Tasigna.

Bordes C, Leguelinel-Blache G, Lavigne JP, et al.Interactions between antiretroviral therapy and complementary and alternative medicine: a narrative review.Clin Microbiol Infect. 2020;26(9):1161-1170. doi:10.1016/j.cmi.2020.04.019

DailyMed.Label: Paxlovid - nirmatrelvir and ritonavir kit.

DailyMed.Label: Paxlovid- nirmatrelvir and ritonavir kit.

DailyMed.Label: Biktarvy- bictegravir sodium, emtricitabine, and tenofovir alafenamide fumarate tablet.

DailyMed.Label: Pifeltro- doravirine tablet, film coated.

Feng XQ, Zhu LL, Zhou Q.Opioid analgesics-related pharmacokinetic drug interactions: from the perspectives of evidence based on randomized controlled trials and clinical risk management.J Pain Res. 2017;10:1225-1239. doi:10.2147/JPR.S138698

PDR.OxyContin.

PDR.Flomax.

PDR.Rapaflo.

PDR.Uroxatral.

PDR.Viagra.

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