Grapefruit Interactions With Bipolar Drugs

Grapefruit Interactions With Bipolar Drugs Bipolar Disorder Treatment Medications Print Grapefruit Interactions With Bipolar Drugs By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial policy Marcia Purse Medically reviewed by Medically reviewed by Steven Gans, MD on February 08, 2020 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on February 20, 2020 Bipolar Disorder Overview Symptoms & Diagnosis Causes Treatment Living With In Children Your Rights Westend61  / Getty Images Grapefruit juice may seem like the ideal drink for a good, old-fashioned American breakfast, but when it comes to washing down your bipolar medications, think again. Unlike some types of citrus fruit, grapefruit can  interfere with the metabolization of certain drugs, inadvertently increasing their concentration to potentially toxic levels. Bipolar drugs are not the only ones affected. Also on the no-fly list are medications used to treat everything from  high cholesterol and arrhythmia to allergies and HIV. Even Viagra is complicated by the otherwise healthy effects of grapefruit. Which Medications Interact With Grapefruit Juice? How Grapefruit Interferes With Drug Concentration A number of psychotropic drugs, including those used treat anxiety, depression, and psychosis, are among the 80 agents grapefruit juice is known to interfere with. Forty-three of those drugs had serious adverse effects.?? This is because grapefruit contains furanocoumarins, an organic compound which blocks an enzyme that normally breaks down certain medications. While other citrus fruits like pomelos, limes, and Seville oranges also contain furanocoumarins, they havent been studied as closely.?? When this enzyme is blocked, the drug concentration levels in the  blood will be higher than expected. In some cases, the intended effect and/or side effects of the drug will be strongerâ€"even dangerous. Degrees and Persistence of Effect The degree by which grapefruit can affect certain drugs can vary. For some medications, one small glass of juice can result in what would be equivalent to a double or triple dose. For example, as much as 99 percent of BuSpar (buspirone) is normally metabolized before the drug enters the bloodstream. When taken with grapefruit juice, the concentration can increase by as much as 400 percent. Or, as demonstrated in this research, four-fold.?? At the same time, the effects of grapefruit can be long-lasting, interacting with certain drugs anywhere from several hours to a few days after ingestion. Alternately, you can avoid grapefruit altogether and substitute with (non-Seville) orange juice.   Any drug that will interact with grapefruit with have all of these defining elements: it will be taken orally, it will have very low to intermediate absolute bioavailability, and also it will be metabolized by the cytochrome P450 3A4 enzyme (CYP3A4). Grapefruit and some of the related citrus can irreversibly inhibit that enzyme. Such drugs should not be eaten with grapefruit or any of the related citrus, or alternative medications should be prescribed. Although it is probably purely speculative to suggest who the most vulnerable patient would likely be, people over 45 years old are the prime purchasers of grapefruit and receive the most prescriptions for drugs.?? List of Psychotropic Medications Affected by Grapefruit All told, there are over a dozen drugs commonly used to treat symptoms of bipolar disorder that are known to be affected, in differing degrees, by grapefruit. Anafranil (clomipramine)BuSpar (buspirone)Elavil (amitriptyline)Halcion (triazolam)Luvox (fluvoxamine)Prozac (fluoxetine)Seroquel (quetiapine)Serzone (nefazodone)Tegretol (carbamazepine)Trazodone (desyrel)Valium (diazepam)Versed (midazolam)Zoloft (sertraline) Always read the packet insert in its entirety to understand which interactions can occur. Typically, you can find this in or around the fifth paragraph where it would read: Talk with your doctor before including grapefruit or grapefruit juice in your diet while you are taking this medicine.   A Word From Verywell Each year, an increasing number of drugs?? are identified as having a possible interaction with grapefruit. In the end, you can usually still enjoy the grapefruit if taken wisely and enjoy the benefits of its combination of vitamin  C,  fiber, potassium, lycopene, and choline. Speak with your doctor if in doubt.