Grapefruit interactions

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) ] . (Atorvastatin label, Warnings and precautions)

Patients receiving buspirone should be advised to avoid drinking such large amounts of grapefruit juice. (Buspirone label, Drug interactions)

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) ] . (Colchicine label, Drug interactions)

Grapefruit Juice Grapefruit and grapefruit juice affect metabolism, increasing blood concentrations of cyclosporine, thus should be avoided. (Cyclosporine label, Drug interactions)

• Grapefruit juice: Avoid concomitant use. (Dronedarone label, Drug interactions)

Avoid food or drink containing grapefruit. (Elexacaftor, tezacaftor, and ivacaftor label, Drug interactions)

Interaction With Grapefruit Juice Grapefruit and grapefruit juice inhibit cytochrome P450 3A4 and P-gp activity and should therefore be avoided with concomitant use of Zortress and cyclosporine or tacrolimus. (Everolimus label, Warnings and precautions)

Intervention: Avoid grapefruit juice when taking VYTORIN. (Ezetimibe and simvastatin label, Drug interactions)

Grapefruit juice may also increase plasma concentrations of imatinib; avoid grapefruit juice [see Clinical Pharmacology (12.3)] . (Imatinib label, Drug interactions)

Avoid food or drink containing grapefruit. (Ivacaftor label, Drug interactions)

…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… (Lovastatin label, Warnings)

Avoid ingestion of grapefruit and grapefruit juice should be avoided while taking nifedipine. (Nifedipine label, Drug interactions)

Avoid grapefruit or grapefruit juice during IBRANCE treatment. (Palbociclib label, Drug interactions)

Intervention: Avoid grapefruit juice when taking ZOCOR. (Simvastatin label, Drug interactions)

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

Avoid grapefruit or grapefruit juice. (Tacrolimus label, Drug interactions)

Food or drink containing grapefruit should be avoided during treatment with RINVOQ/RINVOQ LQ. (Upadacitinib label, Drug interactions)

CYP450 Inhibitors Grapefruit juice, certain fluoroquinolone and macrolide antibiotics, azole antifungals, cimetidine Increased exposure of amiodarone. (Amiodarone label, Drug interactions)

Grapefruit juice can raise blood levels of some calcium channel blockers used for blood pressure, which may cause excessive lowering of blood pressure. (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. (Avanafil label, Drug interactions)

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. (Cilostazol label, Drug interactions)

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. (Dofetilide label, Drug interactions)

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). (Dronabinol label, Drug interactions)

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. (Drospirenone and ethinyl estradiol label, Drug interactions)

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. (Estradiol label, Drug interactions)

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. (Felodipine label, Drug interactions)

No dosing adjustments are recommended in the presence of moderate CYP3A4 inhibitors (e.g., erythromycin, fluconazole, diltiazem, verapamil and grapefruit juice). (Fesoterodine label, Drug interactions)

Grapefruit juice changes the amount of these drugs that reaches the bloodstream (raising most, but lowering fexofenadine). (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. (Flibanserin label, Drug interactions)

Grapefruit juice can raise blood levels of some calcium channel blockers used for blood pressure, which may cause excessive lowering of blood pressure. (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 )] . (Ivabradine label, Drug interactions)

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. (Levonorgestrel and ethinyl estradiol label, Drug interactions)

Grapefruit juice can raise blood levels of some calcium channel blockers used for blood pressure, which may cause excessive lowering of blood pressure. (FDA, Grapefruit Juice and Some Drugs Don't Mix)

Grapefruit juice can raise blood levels of some calcium channel blockers used for blood pressure, which may cause excessive lowering of blood pressure. (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. (Norgestimate and ethinyl estradiol label, Drug interactions)

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. (Propafenone label, Warnings and precautions)

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)]. (Ranolazine label, Drug interactions)

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). (Suvorexant label, Drug interactions)

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

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 )] . (Ubrogepant label, Drug interactions)

…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. (Vardenafil label, Drug interactions)

Grapefruit juice may significantly increase verapamil levels ( 7.3 ) (Verapamil label, Drug interactions)

…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,… (Carbamazepine label, Drug interactions)

Less potent inhibitors include saquinavir, nefazodone, fluconazole, grapefruit juice, fluoxetine, fluvoxamine, zileuton, and clotrimazole. (Dihydroergotamine label, Warnings)

Examples: Macrolide antibiotics (e.g., erythromycin), azole-antifungal agents (e.g., ketoconazole), protease inhibitors (e.g., ritonavir), grapefruit juice. (Fentanyl label, Drug interactions)

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). (Hydrocortisone label, Drug interactions)

Some botanicals and foods can interact with warfarin sodium through CYP450 interactions (e.g., echinacea, grapefruit juice, ginkgo, goldenseal, St. (Warfarin label, Drug interactions)