Pamplemousse : interactions médicamenteuses

Concomitant intake of large quantities, more than 1.2 liters daily, of grapefruit juice is not recommended in patients taking amlodipine and atorvastatin tablets [see Drug Interactions (7.3) ]. (notice Amlodipine et atorvastatine, Mises en garde et précautions)

Concomitant intake of large quantities, more than 1.2 liters daily, of grapefruit juice is not recommended in patients taking LIPITOR [see Drug Interactions (7.1) ] . (notice Atorvastatine, Mises en garde et précautions)

Grapefruit or grapefruit juice may also increase axitinib plasma concentrations and should be avoided. (notice Axitinib, Interactions médicamenteuses)

Patients receiving buspirone should be advised to avoid drinking such large amounts of grapefruit juice. (notice Buspirone, Interactions médicamenteuses)

Avoid ingestion of foods (e.g., grapefruit, grapefruit juice) or nutritional supplements that are known to inhibit cytochrome P450 while taking COMETRIQ. (notice Cabozantinib, Interactions médicamenteuses)

Grapefruit Juice Grapefruit and grapefruit juice affect metabolism, increasing blood concentrations of cyclosporine, thus should be avoided. (notice Ciclosporine, Interactions médicamenteuses)

CYP3A4 The concomitant use of colchicine capsules and CYP3A4 inhibitors (e.g., clarithromycin, ketoconazole, grapefruit juice, erythromycin, verapamil, etc.) should be avoided due to the potential for serious and life-threatening toxicity [see Warnings and Precautions (5.3) and Clinical Pharmacology (12) ] . (notice Colchicine, Interactions médicamenteuses)

• Grapefruit juice: Avoid concomitant use. (notice Dronédarone, Interactions médicamenteuses)

Avoid food or drink containing grapefruit. (notice Élexacaftor, tézacaftor et ivacaftor, Interactions médicamenteuses)

Avoid co-administering erlotinib with strong CYP3A4 inhibitors (e.g., boceprevir, clarithromycin, conivaptan, indinavir, itraconazole, ketoconazole, lopinavir/ritonavir, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telithromycin, voriconazole, grapefruit or grapefruit juice) or a combined CYP3A4 and CYP1A2 inhibitor (e.g., ciprofloxacin). (notice Erlotinib, Interactions médicamenteuses)

Intervention: Avoid grapefruit juice when taking VYTORIN. (notice Ézétimibe et simvastatine, Interactions médicamenteuses)

Grapefruit juice may also increase plasma concentrations of imatinib; avoid grapefruit juice [see Clinical Pharmacology (12.3)] . (notice Imatinib, Interactions médicamenteuses)

Avoid food or drink containing grapefruit. (notice Ivacaftor, Interactions médicamenteuses)

Avoid coadministration of VITRAKVI with strong CYP3A4 inhibitors, including grapefruit or grapefruit juice. (notice Larotrectinib, Interactions médicamenteuses)

Patients must avoid grapefruit juice ( 4 , 5.6 , 7.1 ). (notice Lomitapide, Interactions médicamenteuses)

…products Gemfibrozil Avoid with lovastatin Cyclosporine Danazol Do not exceed 20 mg lovastatin daily Diltiazem Dronedarone Verapamil Amiodarone Do not exceed 40 mg lovastatin daily Grapefruit juice Avoid grapefruit juice Immune-Mediated Necrotizing Myopathy There have been rare reports of immune-mediated necrotizing myopathy (IMNM), an autoimmune myopathy, associated… (notice Lovastatine, Mises en garde)

•Avoid consumption of grapefruit or grapefruit juice during treatment with MOVANTIK [see Dosage and Administration (2.1) ] . (notice Naloxégol, Interactions médicamenteuses)

Grapefruit juice should be avoided by patients on nifedipine. (notice Nifédipine, Précautions)

Avoid grapefruit juice. (notice Nimodipine, Interactions médicamenteuses)

Avoid grapefruit or grapefruit juice during IBRANCE treatment. (notice Palbociclib, Interactions médicamenteuses)

Interaction with Food Patients should avoid grapefruit juice because it may inhibit the metabolism of pimozide by CYP 3A4. (notice Pimozide, Interactions médicamenteuses)

Although the clinical significance of this interaction is unknown, grapefruit juice should be avoided. (notice Quinidine, Interactions médicamenteuses)

Intervention: Avoid grapefruit juice when taking ZOCOR. (notice Simvastatine, Interactions médicamenteuses)

Grapefruit Juice Because grapefruit juice inhibits the CYP3A4-mediated metabolism of sirolimus, it must not be taken with sirolimus [ see Clinical Pharmacology (12.3) ]. (notice Sirolimus, Interactions médicamenteuses)

Avoid food or drink containing grapefruit. (notice Suzétrigine, Interactions médicamenteuses)

Avoid grapefruit or grapefruit juice. (notice Tacrolimus, Interactions médicamenteuses)

Patients should avoid grapefruit juice beverages while taking SAMSCA [see Clinical Pharmacology (12.3) ] . (notice Tolvaptan, Interactions médicamenteuses)

Grapefruit juice may also increase plasma concentrations of toremifene and should be avoided. (notice Torémifène, Interactions médicamenteuses)

Food or drink containing grapefruit should be avoided during treatment with RINVOQ/RINVOQ LQ. (notice Upadacitinib, Interactions médicamenteuses)

CYP450 Inhibitors Grapefruit juice, certain fluoroquinolone and macrolide antibiotics, azole antifungals, cimetidine Increased exposure of amiodarone. (notice Amiodarone, Interactions médicamenteuses)

Le jus de pamplemousse peut augmenter les taux sanguins de certains inhibiteurs calciques utilisés contre l'hypertension, ce qui peut provoquer une baisse excessive de la pression artérielle. (FDA, Grapefruit Juice and Some Drugs Don't Mix)

Although specific interactions have not been studied, other CYP3A4 inhibitors, including grapefruit juice are likely to increase avanafil exposure. (notice Avanafil, Interactions médicamenteuses)

Examples: Macrolide antibiotics (e.g., erythromycin), azole-antifungal agents (e.g., ketoconazole), protease inhibitors (e.g., ritonavir), grapefruit juice CYP3A4 Inducers Clinical Impact: The concomitant use of Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate Capsules and CYP3A4 inducers can result in lower codeine levels, greater norcodeine levels,… (notice Butalbital, paracétamol, caféine et codéine, Interactions médicamenteuses)

Inhibitors of CYP3A4 or CYP2C19 Inhibitors of CYP3A4 Coadministration of strong (e.g., ketoconazole) and moderate (e.g., erythromycin, diltiazem and grapefruit juice) CYP3A4 inhibitors can increase exposure to cilostazol. (notice Cilostazol, Interactions médicamenteuses)

Therefore, give one third the recommended dosage of EMFLAZA when moderate or strong CYP3A4 inhibitors (e.g., clarithromycin, fluconazole, diltiazem, verapamil, grapefruit juice) are used concomitantly with EMFLAZA [see Dosage and Administration ( 2.5 ) and Clinical Pharmacology ( 12.3 )] . (notice Déflazacort, Interactions médicamenteuses)

CYP3A4 inhibitors such as itraconazole, voriconazole, fluconazole, grapefruit juice, or ketoconazole may increase plasma hormone concentrations. (notice Désogestrel et éthinylestradiol, Interactions médicamenteuses)

Inhibitors of this isoenzyme (e.g., macrolide antibiotics, azole antifungal agents, protease inhibitors, serotonin reuptake inhibitors, amiodarone, cannabinoids, diltiazem, grapefruit juice, nefazadone, norfloxacin, quinine, zafirlukast) should be cautiously co-administered with dofetilide as they can potentially increase dofetilide levels. (notice Dofétilide, Interactions médicamenteuses)

Monitor for increased dronabinol-related adverse reactions when dronabinol oral solution is co-administered with inhibitors of CYP2C9 (e.g., amiodarone, fluconazole) and inhibitors of CYP3A4 enzymes (e.g., ketoconazole, itraconazole, clarithromycin, ritonavir, erythromycin, grapefruit juice). (notice Dronabinol, Interactions médicamenteuses)

Concomitant administration of moderate or strong CYP3A4 inhibitors such as azole antifungals (e.g., ketoconazole, itraconazole, voriconazole, fluconazole), verapamil, macrolides (e.g., clarithromycin, erythromycin), diltiazem, and grapefruit juice can increase the plasma concentrations of the estrogen or the progestin or both. (notice Drospirénone et éthinylestradiol, Interactions médicamenteuses)

Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (notice Estradiol, Interactions médicamenteuses)

…Systemic Exposure of COCs (enzyme inhibitors): Concomitant administration of moderate or strong CYP3A4 inhibitors like azole antifungals (for example, ketoconazole, itraconazole, voriconazole, fluconazole), verapamil, macrolides (for example, clarithromycin, erythromycin), diltiazem, and grapefruit increase the serum concentrations of both estradiol and dienogest. (notice Estradiol et diénogest, Interactions médicamenteuses)

Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and result in adverse reactions. (notice Estradiol et noréthistérone, Interactions médicamenteuses)

Concomitant administration of strong or moderate CYP3A4 inhibitors such as itraconazole, voriconazole, fluconazole, grapefruit juice, or ketoconazole may increase plasma estrogen and/or progestin concentrations. (notice Étonogestrel et éthinylestradiol, Interactions médicamenteuses)

Le jus de pamplemousse augmente les taux sanguins des médicaments antirejet utilisés après une greffe. (FDA, Grapefruit Juice and Some Drugs Don't Mix)

Coadministration of CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, erythromycin, grapefruit juice, cimetidine) with felodipine may lead to several-fold increases in the plasma levels of felodipine, either due to an increase in bioavailability or due to a decrease in metabolism. (notice Félodipine, Interactions médicamenteuses)

No dosing adjustments are recommended in the presence of moderate CYP3A4 inhibitors (e.g., erythromycin, fluconazole, diltiazem, verapamil and grapefruit juice). (notice Fésotérodine, Interactions médicamenteuses)

Le jus de pamplemousse modifie la quantité de ces médicaments qui atteint la circulation sanguine (il l'augmente pour la plupart, mais la diminue pour la fexofénadine). (FDA, Grapefruit Juice and Some Drugs Don't Mix)

…telaprevir, telithromycin and conivaptan Examples of moderate CYP3A4 inhibitors Amprenavir, atazanavir, ciprofloxacin, diltiazem, erythromycin, fluconazole, fosamprenavir, verapamil, and grapefruit juice Clinical Implications The concomitant use of ADDYI with moderate or strong CYP3A4 inhibitors increases flibanserin exposure compared to the use of ADDYI alone. (notice Flibansérine, Interactions médicamenteuses)

Le jus de pamplemousse peut augmenter les taux sanguins de certains inhibiteurs calciques utilisés contre l'hypertension, ce qui peut provoquer une baisse excessive de la pression artérielle. (FDA, Grapefruit Juice and Some Drugs Don't Mix)

Examples of moderate CYP3A4 inhibitors include diltiazem, verapamil, and grapefruit juice [ s ee Warnings and Precautions ( 5.3 ) and Clinical Pharmacology ( 12.3 )] . (notice Ivabradine, Interactions médicamenteuses)

CYP3A inhibitors such as itraconazole, voriconazole, fluconazole, grapefruit juice The effect of grapefruit juice on CYP3A4 enzymes (e.g., strong vs. moderate inhibition) depends on its brand, concentration, and preparation. , or ketoconazole may increase systemic exposure of the estrogen and/or progestin component of CHCs. (notice Lévonorgestrel et éthinylestradiol, Interactions médicamenteuses)

Le jus de pamplemousse peut augmenter les taux sanguins de certains inhibiteurs calciques utilisés contre l'hypertension, ce qui peut provoquer une baisse excessive de la pression artérielle. (FDA, Grapefruit Juice and Some Drugs Don't Mix)

Le jus de pamplemousse peut augmenter les taux sanguins de certains inhibiteurs calciques utilisés contre l'hypertension, ce qui peut provoquer une baisse excessive de la pression artérielle. (FDA, Grapefruit Juice and Some Drugs Don't Mix)

CYP3A4 inhibitors such as itraconazole, voriconazole, fluconazole, grapefruit juice, or ketoconazole may increase plasma hormone concentrations. (notice Norelgestromine et éthinylestradiol, Interactions médicamenteuses)

Substances increasing the systemic concentrations of HCs: Co-administration of certain HCs and strong or moderate CYP3A4 inhibitors such as itraconazole, voriconazole, fluconazole, grapefruit juice, or ketoconazole may increase the systemic concentrations of progestins, including norethindrone. (notice Noréthistérone, Interactions médicamenteuses)

CYP3A4 inhibitors such as itraconazole, voriconazole, fluconazole, grapefruit juice, or ketoconazole may increase plasma hormone concentrations. (notice Norgestimate et éthinylestradiol, Interactions médicamenteuses)

Concomitant administration of CYP3A4 inhibitors such as itraconazole, fluconazole, grapefruit juice or ketoconazole may increase plasma hormone concentrations. (notice Norgestrel et éthinylestradiol, Interactions médicamenteuses)

Examples Clarithromycin, conivaptan, grapefruit juice, indinavir, itraconazole, ketoconazole, lopinavir/ritonavir, mibefradil, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, and voriconazole Intervention If a patient initiates or discontinues therapy with a strong CYP3A4 inhibitor, dose adjustment of Paricalcitol Injection may be necessary. (notice Paricalcitol, Interactions médicamenteuses)

In addition, grapefruit juice was also reported to produce a 1.6-fold increase in the C max and a 1.9-fold increase in the AUC of praziquantel. (notice Praziquantel, Interactions médicamenteuses)

Drugs that inhibit these CYP pathways (such as desipramine, paroxetine, ritonavir, sertraline for CYP2D6; ketoconazole, erythromycin, saquinavir, and grapefruit juice for CYP3A4; and amiodarone and tobacco smoke for CYP1A2) can be expected to cause increased plasma levels of propafenone. (notice Propafénone, Mises en garde et précautions)

Moderate CYP3A Inhibitors Limit the dose of ASPRUZYO Sprinkle to 500 mg twice daily in patients on moderate CYP3A inhibitors, including diltiazem, verapamil, erythromycin, fluconazole, and grapefruit juice or grapefruit-containing products [see Dosage and Administration (2.2), Clinical Pharmacology (12.3)]. (notice Ranolazine, Interactions médicamenteuses)

The recommended dose of BELSOMRA is 5 mg in subjects receiving moderate CYP3A inhibitors (e.g., amprenavir, aprepitant, atazanavir, ciprofloxacin, diltiazem, erythromycin, fluconazole, fosamprenavir, grapefruit juice, imatinib, verapamil). (notice Suvorexant, Interactions médicamenteuses)

Although specific interactions have not been studied, other CYP3A4 inhibitors, such as erythromycin, itraconazole, and grapefruit juice, would likely increase tadalafil exposure. (notice Tadalafil, Interactions médicamenteuses)

Dose adjustment is recommended with concomitant use of UBRELVY and moderate CYP3A4 inhibitors (e.g., cyclosporine, ciprofloxacin, fluconazole, fluvoxamine, grapefruit juice) [see Dosage and Administration ( 2.2 )] . (notice Ubrogépant, Interactions médicamenteuses)

…recommended not to exceed a single 5 mg dose of vardenafil hydrochloride tablets in a 24-hour period when used in combination with erythromycin. [See Dosage and Administration (2.4) and Warnings and Precautions (5) .] Although specific interactions have not been studied, other CYP3A4 inhibitors, including grapefruit juice would likely increase vardenafil exposure. (notice Vardénafil, Interactions médicamenteuses)

Grapefruit juice may significantly increase verapamil levels ( 7.3 ) (notice Vérapamil, Interactions médicamenteuses)

…itraconazole, fluconazole, voriconazole ) , cimetidine, ciprofloxacin, clarithromycin, dalfopristin, danazol, dantrolene, delavirdine, diltiazem, erythromycin, fluoxetine, fluvoxamine, grapefruit juice, ibuprofen, isoniazid, loratadine, nefazodone, niacinamide, nicotinamide, olanzapine, omeprazole, oxybutynin, quinine, quinupristin, ticlopidine, troleandomycin, valproate,… (notice Carbamazépine, Interactions médicamenteuses)

Strong and moderate CYP3A inhibitors include, but are not limited to, atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, amprenavir, aprepitant, diltiazem, erythromycin, fluconazole, fosamprenavir, grapefruit juice, and verapamil. (notice Dextrométhorphane et quinidine, Mises en garde et précautions)

Less potent inhibitors include saquinavir, nefazodone, fluconazole, grapefruit juice, fluoxetine, fluvoxamine, zileuton, and clotrimazole. (notice Dihydroergotamine, Mises en garde)

Examples of less potent CYP 3A4 inhibitors include: saquinavir, nefazodone, fluconazole, fluoxetine, grapefruit juice, fluvoxamine, zileuton, metronidazole, and clotrimazole. (notice Ergotamine et caféine, Mises en garde)

Examples: Macrolide antibiotics (e.g., erythromycin), azole-antifungal agents (e.g., ketoconazole), protease inhibitors (e.g., ritonavir), grapefruit juice. (notice Fentanyl, Interactions médicamenteuses)

Examples: Anti-fungals: itraconazole, posaconazole, voriconazole Antibiotics: erythromycin and clarithromycin Antiretrovirals: ritonavir Grapefruit juice CYP3A4 Inducers Clinical Impact: Hydrocortisone is metabolized by cytochrome P450 3A4 (CYP3A4). (notice Hydrocortisone, Interactions médicamenteuses)

Examples of some of the strong CYP 3A4 inhibitors include saquinavir, grapefruit juice, nefazodone, macrolide antibiotics (e.g., troleandomycin, clarithromycin), HIV protease or reverse transcriptase inhibitors (e.g., ritonavir, indinavir, nelfinavir) or azole antifungals (e.g., ketoconazole, itraconazole, voriconazole). (notice Méthylergométrine, Interactions médicamenteuses)

Quinine sulfate may be taken with grapefruit juice. (notice Quinine, Interactions médicamenteuses)

Some botanicals and foods can interact with warfarin sodium through CYP450 interactions (e.g., echinacea, grapefruit juice, ginkgo, goldenseal, St. (notice Warfarine, Interactions médicamenteuses)

The following have no clinically relevant effects on the pharmacokinetics of amlodipine: cimetidine, grapefruit juice, magnesium and aluminum hydroxide antacid, sildenafil. (notice Telmisartan et amlodipine, Interactions médicamenteuses)