Grapefruit Interacts with Many Medications

Grapefruit is a delicious citrus fruit with many health benefits. However, it can interact with some common medications, altering their effects on your body. 

If you’re curious about the grapefruit warning on many medicines, this article will help you understand why it’s there and what your options are. 

Here’s a closer look at 32 common drugs that may have dangerous interactions with grapefruit, as well as some alternatives. 

Note: This article contains general information — not specific medical advice. Talk to your physician before changing your use of any medication.

How Does It Interact With Medications?

Medications are processed in your liver and small intestine by a specialized group of proteins called cytochrome P450 (CYPs).

CYPs break down medications, reducing the blood levels of many of them. 

Grapefruit and a few of its close relatives, such as Seville oranges, tangelos, pomelos and Minneolas, contain a class of chemicals called furanocoumarins.

Furanocoumarins disrupt the normal function of CYPs. In fact, studies show that they increase the blood levels of over 85 medications (1). 

By slowing down the way in which CYPs normally break down medications in your gut and liver, grapefruit can increase the side effects of these drugs (1). 

There are three things to know in order to understand if and how you can safely consume grapefruit with these medications.

1. It doesn’t take much: One whole grapefruit or one glass of grapefruit juice is enough to alter how these medications affect you.
2. It lasts several days: Grapefruit’s ability to affect medication lasts for 1–3 days. Taking your medication a few hours apart from consuming it isn’t long enough.
3. It’s significant: For a small number of drugs, grapefruit’s effects can be serious.

With that in mind, here is detailed information about 32 common medications that may interact with grapefruit, categorized by use.

1–3: Some Cholesterol Medications

Some cholesterol medications called statins are affected by grapefruit. 

Statins work by limiting the natural production of cholesterol. This improves the profile of lipoproteins in the blood and decreases deaths from heart disease in patients at risk of it (2).

Statins can cause rhabdomyolysis, or the breakdown of muscle tissue. This leads to muscle weakness, pain and occasionally kidney damage (3).

Grapefruit increases the blood levels of three common statins substantially, increasing the risk of rhabdomyolysis (4): 

1. Atorvastatin (Lipitor)
2. Lovastatin (Mevacor)
3. Simvastatin (Zocor)

One study showed that drinking a glass of grapefruit juice with simvastatin or lovastatin increased blood levels of these statins by 260% (5). 

Alternatives: Pravastatin (Pravachol), rosuvastatin (Crestor) and fluvastatin (Lescol) do not interact with grapefruit (1).

Summary: Grapefruit can increase the side effects of some statin cholesterol medications, causing muscle damage.

4–7: Certain Blood Pressure Medications

Most types of blood pressure medicine are not affected by grapefruit. 

However, the following four blood pressure medications should be used cautiously: 

4. Felodipine
5. Nifedipine (Procardia)
6. Losartan (Cozaar)
7. Eplerenone (Inspra)

The first two medications in this list are known as calcium channel blockers. They work by changing the way your blood vessels use calcium, relaxing the vessels and relieving blood pressure. 

The last two medications in this list work by decreasing the activity of a hormone called angiotensin 2, which naturally increases blood pressure. 

One study found blood levels of nifedipine increased dramatically when taken with about 2 cups (500 ml) of grapefruit juice, compared to no juice. This resulted in a rapid drop in blood pressure, which could be dangerous if unsupervised (6).

Losartan is unusual in that its effects decrease — instead of increase — with grapefruit. This may limit its ability to control blood pressure (7). 

Eplerenone works similarly to losartan, but its levels increase when taken with grapefruit. Excessive eplerenone levels can cause too much potassium in the blood, which can interfere with heart rhythm (1). 

Alternatives: Spironolactone (Aldactone), a similar drug to losartan and eplerenone, does not interact with grapefruit. Amlodipine (Norvasc) is a calcium channel blocker like felodipine and nifedipine, which also does not interact with grapefruit (6, 8). 

Summary: Though grapefruit does not interfere with most blood pressure medications, it can cause a few medications to over-correct blood pressure.

8–9: A Few Heart Rhythm Medications

Grapefruit influences a few medications that treat abnormal heart rhythms. 

These interactions can be particularly dangerous, and include: 

8. Amiodarone
9. Dronedarone (Multaq)

A study gave a glass of grapefruit juice (about 300 ml) to 11 men taking amiodarone. Drug levels increased by up to 84%, compared to those not drinking the juice (9). 

These two medications play a critical role in managing the health of patients with heart rhythm disorders. Grapefruit-related changes in levels of these drugs have occasionally caused dangerous heart rhythm changes (10).

Summary: Although only a few heart rhythm medications interact with grapefruit, the side effects can be dangerous.

10–13: Some Anti-Infection Medications

Collectively called antimicrobials, these anti-infection medications vary widely in their actions and breakdown in the body. 

Although antimicrobials are one of the most diverse categories of medications, there are only a few medications with known important grapefruit interactions:

10. Erythromycin
11. Rilpivirine and related HIV drugs
12. Primaquine and related antimalarial drugs
13. Albendazole

Erythromycin is used to treat several types of bacterial infections. A study comparing grapefruit juice to water in patients taking erythromycin showed that the juice increased the drug’s blood levels by 84% (11).

Excess levels of this medication can disrupt heart rhythm (11).

Levels of the HIV medications rilpivirine and maraviroc, in addition to primaquine-related antimalarial drugs, are also increased by grapefruit. This may affect heart rhythm or function (1). 

Because antimicrobials are generally taken for a limited time, perhaps it’s easiest to simply avoid grapefruit while taking these medications. 

Alternatives: Clarithromycin is a medication in the same class as erythromycin that does not interact with grapefruit. Doxycycline is both an antibiotic and antimalarial drug that also does not interact with it (1). 

Summary: Some anti-infection medications should not be used with grapefruit, as they can lead to disrupted heart rhythm or function.

14–21: Several Mood Medications

Most antidepressants and anti-anxiety drugs are safe to use with grapefruit. 

However, several mood medications do interact with it, including:

14. Bupropion (Wellbutrin)
15. Quetiapine (Seroquel)
16. Lurasidone (Latuda)
17. Ziprasidone (Geodon)
18. Buspirone (Buspar)
19. Diazepam (Valium)
20. Midazolam (Versed)
21. Triazolam (Halcion)

In addition to being an antidepressant, bupropion is prescribed to help people quit smoking. Its blood levels increase with grapefruit, which can increase dizziness and sleepiness (1).

Drugs like quetiapine and lurasidone are used to treat mood and behavioral disorders. Increased levels of these drugs can cause heart rhythm changes or sleepiness (1).

Furthermore, diazepam, midazolam and triazolam are sedatives that are sometimes used for panic attacks or other forms of anxiety. 

One study compared some of these drugs in nine patients with and without grapefruit. It showed that grapefruit can increase these drugs’ effects, resulting in excessive drowsiness (12).

Summary: Eating grapefruit while taking the mood-related medications above can result in heart rhythm changes, excessive sleepiness and other drug-specific effects.

22–25: Certain Blood Thinners

Blood thinners are used to treat or prevent blood clots. Some of them are affected by grapefruit, including:

22. Apixaban (Eliquis)
23. Rivaroxaban (Xarelto)
24. Clopidogrel (Plavix)
25. Ticagrelor (Brilinta)

Clopidogrel depends on CYPs — the proteins that grapefruit limits — to work. Thus, it becomes less active when mixed with grapefruit. 

A study of seven patients taking clopidogrel with 200 ml of either grapefruit juice or water showed lower activation of the drug with the juice. However, its ability to treat blood clots was not affected (13).

Contrarily, grapefruit increases the blood levels of other medications on this list, which can result in bleeding (14).

Alternatives: Warfarin (Coumadin) is used for similar purposes as apixaban and rivaroxaban. While warfarin is sensitive to foods containing vitamin K, its activation is not affected by grapefruit (15).

Summary: Several blood thinners are affected by grapefruit. This can lead to bleeding or less effective prevention of blood clots.

26–28: Several Pain Medications

Multiple pain medications are affected by grapefruit:

26. Fentanyl
27. Oxycodone
28. Colchicine

Fentanyl and oxycodone are narcotic pain relievers. Although their blood levels are only slightly affected by small amounts of grapefruit, it may change the length of time they remain in the body (16, 17).

Colchicine is an older medication used to treat gout. It is processed by CYPs and could potentially interact with grapefruit. Nevertheless, a 2012 study showed that drinking 240 ml of grapefruit juice only had a minimal effect on its levels (18). 

Alternatives: Morphine and dilaudid are narcotic pain relievers that are not affected by grapefruit (1). 

Summary: Some narcotic pain relievers persist longer in the blood when taken with grapefruit.

29–32: A Few Erectile Dysfunction and Prostate Medications

A few erectile dysfunction and prostate medications deserve attention regarding grapefruit interactions:

29. Sildenafil (Viagra)
30. Tadalafil (Cialis)
31. Tamsulosin (Flomax)
32. Silodosin (Rapaflo)

Erectile dysfunction medications like sildenafil and tadalafil work by relaxing blood vessels, which increases blood flow to an erection. 

Because other blood vessels relax with these medications as well, increased blood levels of these drugs caused by grapefruit can decrease blood pressure (8). 

Moreover, prostate enlargement medications such as tamsulosin can also cause increased dizziness and low blood pressure when taken with grapefruit (19).

Alternatives: Another class of prostate enlargement medications, which includes finasteride and dutasteride, is not significantly affected by grapefruit (19). 

Summary: Grapefruit should not be consumed with erectile dysfunction medications or certain prostate enlargement medications.

Should You Give Up Grapefruit?

While this article lists 32 common medications that interact with grapefruit, it is not a complete list. 

Drugs.com offers a drug interaction checker that you can use to check your medications for interactions. 

Additionally, Rxlist.com lists some less common medications that also interact with grapefruit. 

It’s important to remember that just one whole grapefruit or about one large glass of juice is enough to change the blood levels of many drugs. And some of these medications may have serious side effects when they interact with grapefruit. 

If you are currently taking medications with grapefruit interactions, switch to an alternative drug or stop consuming grapefruit.

If in doubt, reach out to your doctor or pharmacist for personalized advice. 

Summary: Even small amounts of grapefruit can interact with some medications and cause serious side effects.

The Bottom Line

Grapefruit interferes with proteins in the small intestine and liver that normally break down many medications. 

Eating grapefruit or drinking grapefruit juice while taking these medications can lead to higher levels in your blood — and more side effects. 

With some drugs, with even small amounts of grapefruit can cause severe side effects. Therefore, the combination should be avoided. 

These drugs may be marked with a grapefruit interaction warning by your pharmacy. 

Make sure your doctor and pharmacist know if you regularly consume grapefruit. They can help you decide whether it’s safe to consume while on certain medications. 

~Thanks to Dr. Matthew Thorpe, MD, PhD

10 Essential Oils to Stock Up On!

This is the mecca list: the recommend top 10 oils to start out with, based on a number of factors: affordability, efficacy, potency, and range of applications.

All 10 can be purchased for $15 or less, and each one packs a real punch and can be used in a variety of ways. They don’t just smell good - they have the ability to make you feel really good, too, offering a wide variety of health benefits. .

You could actually just pick any one of these and start to incorporate it into your life in multiple ways. That’s the amazing thing about essential oils: each one is like getting eight medicines in one. So, start wherever you want, but I guarantee that once you do, you’ll want more.

1. Lemon oil

Lemon oil is commonly used in commercially available products you encounter every day. If you walk down the aisles of any grocery store, you’ll find everything from household cleaner to hand soap to flavored sparkling water with the essence of lemon. As is the case with many citrus oils, the scent closely mimics that of the fruit from which it’s derived: bright, light, zesty, and clean.

These days, of course, a lot of those flavors and smells are made artificially, but still, there’s a reason that lemon has become so universally identified with freshness and cleanliness: its oil is a powerful antibacterial, astringent, and antiseptic agent.

Diluted lemon oil can be wonderfully effective when it comes to skin care because of its high concentration of D-limonene, a compound that assists in diminishing the appearance of wrinkles, promoting circulation, and toning the skin. In fact, recent research showed that D-limonene has skin-repairing and anti-inflammatory properties.

The scent of lemon oil has also been shown to have a powerful effect on mood. One study’s findings suggest that lemon oil vapor has antidepressant qualities. Another compelling study found that the scent of lemon oil boosted participants’ moods, a finding confirmed through self-reported data as well as empirical data (elevated levels of the anti-stress hormone norepinephrine were measured in the blood of participants).

2. Cinnamon oil

If lemon oil is bright, cool, and invigorating, cinnamon oil is its opposite: sweet and spicy, musky and warm. It conjures up a distinct mixture of sexy exoticness and cozy familiarity because it’s both a Far East import and a spice drawer mainstay.

Derived from both the bark and leaf of the Cinnamomum verum tree, it’s actually one of history’s oldest essential oils, with the Egyptians recording their extensive use of it in Ebers Papyrus, a medical text dating to approximately 1550 BC.

At that time, cinnamon was a hot commodity. It was expensive and hard to get because Arab traders controlled most of the supply coming from Sri Lanka and India and—they kept the true source of their supply a secret. Cinnamon oil was affordable only for the very wealthy—emperors, royals, and, later on, Europe’s elite. Fortunately for us, price and access to this super-useful oil are no obstacle today.

In aromatherapy, cinnamon essential oil can be used to help clear up chest colds. Applied topically, it can soothe muscle aches and pains, thanks to its antispasmodic and analgesic properties. It’s also an antiseptic and makes a powerful natural preservative. It is both antibacterial and antimicrobial, as well as being anti-inflammatory, and pain-relieving. Some studies have shown that cinnamon oil contains powerful antioxidants and could potentially be useful in fighting neurological disorders and heart disease.

3. Lemongrass oil

Lemongrass is a fast-growing, tropical grass native to Sri Lanka and south India and is now cultivated in warm climates in Africa and Asia. The entire plant is utilized in everything from tea to cleaning products, and it has been used for years in Indian healing traditions to treat maladies like gastrointestinal issues and fever (it earned the nickname “fever grass”).

Lemongrass essential oil is derived from the steam distillation of the plant and, true to its name, it possesses a mild, sweet, lemony-yet-herbal aroma. Its cheerful, energetic scent alone is convincing, but there is also plenty of evidence that it possesses powerful medicinal and pharmacological properties, including the potential to slow the growth of cancerous cells and tumors.

Research also shows that lemongrass essential oil is antibacterial and anti-fungal, antimicrobial, anti-inflammatory, and can be a potent insect repellent. Its antifungal properties are especially helpful in combating the nasty yeast associated with dandruff. One study noted that participants who used a dandruff tonic with a 10 percent concentration of lemongrass oil saw a significant reduction in dandruff in as little as a week.

Personally, I love to add some lemongrass oil to my bath when I’m feeling sick.

4. Clary sage

Clary sage possesses myriad beneficial properties for the skin: It’s antibacterial, astringent, antiseptic, and can help improve circulation. The uniquely sweet herbal aroma of clary sage helps to cut through some of the more pungent ingredients used in natural skin care, too.

Clary sage is a perennial plant that is native to the northern Mediterranean region and North Africa; its essential oil is derived via the steam distillation of the plant’s flowering tops and leaves. Although the ancient Egyptians used it in medicinal practices, it wasn’t until medieval times that clary sage really took off. During this time, doctors and herbalists used clary sage seeds to help treat vision problems; “clary” is derived from the Latin word for clear, “clarus.” And it was also used to flavor wine (and referred to as “muscatel sage” because of its similarity to German muscat wine). Someone, somewhere, got clever—maybe while drunk off clary sage wine?—and mashed up the two nicknames. Hence: clary sage.

Clary sage has been lauded for its reputed ability to regulate hormones, and its scent is thought to have antidepressant effects. A 2014 study of twenty-two postmenopausal women in their 50s—some of whom were depressed—showed that breathing diffused clary sage helped to alleviate participants’ depression by lowering cortisol levels and improving thyroid hormone levels. And a 2012 study revealed that clary sage—along with lavender and marjoram—makes an effective massage treatment for alleviating menstrual pain and cramping.

5. Lavender oil

First of all, what we call lavender is actually Lavandula angustifolia, one type of lavender among 39 total species. Different species have different properties, but all types contain large proportions of linalool, linalyl acetate, eucalyptol, and camphor. That’s a lot of components to have in high quantities, and it’s the reason it’s such a powerhouse essential oil. Lavender is: sedative, antispasmodic, anti-anxiety, anti-inflammatory, antimicrobial, antioxidant, antibacterial, anesthetic,  immune-boosting, and antiviral.

It’s super safe, but it does have a high content of linalool, which can be sensitizing for some people. As with all essential oils, and ingredients in general, be sure to try a small amount on your skin, diluted at about six drops in one tablespoon of carrier oil, and watch for a reaction.

If your skin loves lavender, you can use up to a 50-50 mix of half lavender oil, half carrier oil in your DIY products. I use lavender in many different ways, all day, every day.

6. Tea tree oil

Tea tree oil (also called melaleuca oil) is definitely enjoying a moment in the natural-beauty-world sun right now, and deservedly so. It’s pretty awesome stuff.

The only place that tea trees grow naturally is in Australia, but they grow super abundantly there. Traditionally, native Australian cultures used tea tree leaves to treat coughs and colds, heal wounds, and alleviate sore throats and skin ailments.

Tea tree oil is antiviral, anti-inflammatory, and exhibits anticancer activity. It kills oral bacteria for up to two weeks, can be used for gingivitis, heals mild to moderate dandruff, kills the influenza virus, and has been shown to slow the growth of tumors in mice. This Australian wonder also works like benzoyl peroxide to treat acne. It takes longer, but causes fewer side effects, while being less drying than the common drugstore ingredient.

I put tea tree oil in virtually all of my DIY products; I recommend diluting to a 5 percent concentration, which is about 14 drops per tablespoon of carrier oil. One of my favorite ways to use it is to add a couple of drops to my store-bought mouthwash.

7. Eucalyptus

Eucalyptus essential oil is definitely not for the weak. Even if you’ve never smelled it directly, you’ve probably smelled something that contains it—like Vicks VapoRub, maybe? The scent is similar to camphor (another ingredient in VapoRub, and also in Tiger Balm ointment) and slightly minty. It will clear your airways super quick and can take your breath away.

Here’s what else it’s been shown to do: It works as a pesticide and has the ability to kill fungus, bacteria, insects, mites, and weeds—and it has been believed to kill the drug-resistant parasite that causes malaria. (It’s possible this is why eucalyptus trees were first planted in California in the 1850s. They were an invasive species from Australia but the government was worried about the spread of malaria. The trees helped!) It can also help boost your immune system and is anti-inflammatory.

I like to diffuse eucalyptus oil at home. The scent is a little strong, but it really freshens up a room and makes the air feel clean. It also makes a great pantry and closet moth and bug repellent.

8. Rosemary oil

The scent of this oil is a lot like the herb you put in your food. It’s commonly found in skin care, especially natural products, because it not only has topical benefits but also will extend the shelf life of a product exponentially.

Rosemary oil is a stimulant. When inhaled, the aroma of rosemary has been shown to increase heart rate, blood pressure, and respiratory rate and boost your immune system. It has also been shown to increase brain wave activity and aid the part of your nervous system that controls organ function. But while it stimulates many bodily systems, it also decreases levels of the stress hormone cortisol. And it does all of this while airborne, so you can simply diffuse it and gain these health benefits. If you like the scent of eucalyptus, you can combine it with rosemary to make your space smell like a forest.

9. Sweet orange oil

In my opinion, sweet orange is the best-smelling essential oil, period. It makes me happy and energized from one whiff, and in a weird way I believe that just smelling it can sometimes satisfy my sweet cravings (which are severe and constant!). So having orange oil around solves all of these problems for me in one inexpensive, convenient swoop.

In studies, it reduced anxiety when it was inhaled, and when applied topically, it slowed down participants’ pulse rates and breathing rates, while they also reported feeling more cheerful and vigorous.

It can be a little tricky to incorporate orange oil into your life because it doesn’t diffuse well, and, like lemon oil, it can make your skin photosensitive when applied topically, so I recommend using it in products you plan on rinsing off in the shower, and not going higher than 12 drops of essential oil per ounce of carrier oil. I find the smell of sweet orange oil to be so fragrant that you need only a very small amount when DIYing.

One important note: Make sure you purchase sweet orange oil and not bitter orange, since bitter orange oil is very phototoxic.

10. Peppermint oil

You know what peppermint smells like. It’s already in your medicine cabinet, mixed into your toothpaste or mouthwash or shampoo. Or it might be in the chewing gum in your back pocket. But what you probably don’t know is why peppermint is in all of these products.

Peppermint oil is made up mostly of menthol and menthone. It is a stimulant, antispasmodic, antiviral, antimicrobial, antifungal, and antioxidant. It is an effective treatment for headaches: participants in one study reported a significant reduction in the pain of their tension headaches within 15 minutes, and the pain continued to drop for the following hour. It helps soothe nausea, improves concentration and memory, and is an analgesic, which means it numbs and kills pain on the skin.

I think peppermint oil is best when it’s in a lip product. It’s incredibly invigorating, and having it literally right under your nose makes you feel refreshed all day.

Essential oils are excellent bath add-ons as well!

~ Excerpted from her latest book, Just the Essentials by Adina Grigore, 2017

Always in a Rush? Consider This.....

Being in a rush feels like the natural solution anytime you 're running late, but in truth all any anxious state really does is help hide a lower level of self that's incapable of considering the best use of your time, let alone what its unconscious "choices" are doing to you!

Anxiety is a negative state produced by a divided mind as it rushes to close the gap between these two (self-created) opposing thoughts: where I am right now, and "where" I want to get to, which is the same as what I want "to become," i.e., at peace, content, safe, etc.

This imagined pleasure of "arriving there," or in "getting it" done is the secret opposite of the pain born in not wanting to experience what is at hand. Understood properly, what these facts mean is that the only "answer" there is to an anxious state is to not answer it at all...but to see the state for what it is: an illusion.

Do what you are doing; be where you are. Give your full attention to the duty of the moment, and the feeling that "there isn't enough time" will disappear. The prison and the pain of psychological time dissolves as you withdraw your attention from the divided mind that creates its demands.

~Thanks to Guy Finley