Fruit juices can hinder drug absorption

Grapefruit, orange and apple juices can harm the body's ability to absorb certain medications and make the drugs less effective.

The research showed that these juices can decrease the effectiveness of certain drugs used to treat heart disease, cancer, organ-transplant rejection and infection, "potentially wiping out their beneficial effects," it said.

David Bailey, a professor of clinical pharmacology with the University of Western Ontario and leader of the study, was the first researcher to identify grapefruit juice's potential to increase the absorption of certain drugs two decades ago, possibly turning some doses toxic. The new findings came as part of his continuing research on the subject.

"Recently, we discovered that grapefruit and these other fruit juices substantially decrease the oral absorption of certain drugs undergoing intestinal uptake transport," said Bailey.

"The concern is loss of benefit of medications essential for the treatment of serious medical conditions."

Healthy volunteers took fexofenadine, an antihistamine used to fight allergies, along with either a glass of grapefruit juice, a glass of water with naringin (which gives the bitter taste to grapefruit juice), or plain water.

Those who drank the grapefruit juice absorbed only half the amount of fexofenadine, compared to those who drank plain water.

Researchers said the water with naringin served to block "a key drug uptake transporter, called OATP1A2, involved in shuttling drugs from the small intestine to the bloodstream."

"Blocking this transporter reduces drug absorption and neutralizes their potential benefits," the study said.

"By contrast, drugs whose levels are boosted in the presence of grapefruit juice appear to block an important drug metabolizing enzyme, called CYP3A4, that normally breaks down drugs."

Among the drugs affected by consumption of grapefruit, orange and apple juices are: etoposide, an anticancer agent; beta blockers (atenolol, celiprolol, talinolol) used to treat high blood pressure and prevent heart attacks; and certain antibiotics (ciprofloxacin, levofloxacin, itraconazole).

Bailey said patients should consult with a doctor about taking medications with juice, and stick to plain water when taking most medications.

"This is just the tip of the iceberg," Bailey said. "I'm sure we'll find more and more drugs that are affected this way."