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142526 tn?1397090672

NO grapefruit!

For anyone who is doing the DAA's or is about to start tx, do not eat or drink grapefruit juice.  It causes the effectiveness of these meds to decrease and that's not what we want.  You'd want the best chance at attaining SVR and want to keep steady consistent med levels in the blood stream to have the best chance at clearing ALL of the virons once and for all...
I hope everyone's tx doc or trial PA or NP has advised to this and to imported oranges, not sure what my NP called these oranges. I just made a mental note to cut out my orange intake as well for the 12 weeks of tx, and 24 wks would not have been that long either to stop the grapefruit and oranges as long as it's helping achieve the best outcome possible. :-)
Best Answer
Avatar universal
Yup...can give up grapefruit for a few months to give my slaying dragon a chance....... Never heard about Seville oranges....will check that out.  I am a fruit and veggie freak...which is funny because when I was a kid I would only eat peaches or corn...LOL.  ..Really got into vegetables when I traveled Asia and India and things were still moving on the plate or the protein palate was completely different than in US.  .  Nope...give me a carrot please.  Just got a new dehydrator I am looking forward to dehydrating fruit, tomatoes, veggies this summer.    Good luck everyone.  Alaska....I watch every show on TV about Alaska.
Good luck to everyone else too.  
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Avatar universal
Amen and Amen!!!  : -)
Helpful - 0
683231 tn?1467323017
Yeah bottom line we want to be cured and if that means doing things to be extra careful like changing out tooth brushes every day, week or month. Not taking antacids of any type or avoiding grapefruit mango or whatever.

Heck lighting candles every day and burning incense as long as we are cured!

Best to all
Lynn
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Avatar universal
Lynn:  Thank you for those link addresses.  The one on wikipedia,
       http://en.wikipedia.org/wiki/Grapefruit%E2%80%93drug_interactions
said that Grapefruit juice affects ritnour, which is a protease inhibitor.  

Why wouldn't it affect other protease inhibitors?    

I am so ignorant on these chemical interactions! Anyway, I have not yet found where I read it was contraindicated.  I do remember it also mentioned mango, but I cannot remember what it said.  I am still searching.  God, I hate not having a memory!  

Pat
Helpful - 0
317787 tn?1473358451
Sorry I did a search for sovaldi and grapefruit juice.
I remembered hearing this before so thought it might help someone

This drug is so new they don't know everything that can affect it yet.
I would not take a chance myself.

The same thing happened with Incivek, they were learning as we were treating

Randy you are right about the 450 thing, the grapefruit  competes with the drug.
Helpful - 0
683231 tn?1467323017
I do agree about anything questionable when treating with these expensive meds with in some cases our lives on the line that when in doubt just don't do or take or eat whatever it is.
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Avatar universal

Hi Lynn,

I posted all about grapefruit above. I couldn't find info with Sovaldi either & Dee's post(yours) is excellent as well. I'm thinking that grapefruit is just a fairly large no no warning with many medications in general because of above info( increasing/ decreasing concentrations of meds, & to me it just makes sense not to eat it ( more than a wee bit) with any meds. Just my opinion, :-)
Best best AG
Ran
Helpful - 0
683231 tn?1467323017
It looks like more of a problem with Olysio but not Sovaldi as far as I can find.

My doctors office has said nothing in regards to grapefruit or citrus in any form only to avoid antacids especially Prilosec/ Nexium.

Always best to follow our doctors personal advice of course

Best to all
Helpful - 0
683231 tn?1467323017
Humm I didnt find it with the link alll I got was

"Sorry, the page you were looking for in this blog does not exist. "

I was able to search for it and did find it that way

Grapefruit juice: Dangerous medication interactions

http://hepatitiscnewdrugs.blogspot.com/2011/01/grapefruit-juice-dangerous-medication.html

But I don't see anything about Sovaldi.

Grapefruit juice: Dangerous medication interactions

Researchers have known for twenty years that taking medications with grapefruit juice can increase the absorption of certain drugs — with the potential for turning normal doses into toxic overdoses.

However, a few years ago a study found that consuming grape, apple or even orange juice can affect the absorption of other drugs, potentially wiping out their beneficial effects and in some cases causing toxic side effects.

The juice from these fruits often interferes with the way the body metabolises some medications. Usually enzymes lining the small intestines destroy a certain portion of the medication taken, causing only a limited amount from making its way to your blood stream.
.
However, grapefruit juice wields the power to prevent your intestinal lining from working appropriately. Grapefruit is metabolised in the liver by an enzyme that also metabolises close to half the drugs consumed by people today. What happens is when the grapefruit keeps the enzyme busy, it is unable to break down the drugs, causing the drug to accumulate in the bloodstream. Depending on the drug , an individual will have a variety of side effects due to the “overdose”.

The first controlled human studies on this potentially dangerous interaction took place in 2008 by University of Western Ontario, headed up by David G. Bailey, Ph.D., a professor of clinical pharmacology.

According to the study grapefruit, orange and apple juice have been shown to lower the absorption of etoposide, an anticancer agent; also certain beta blockers (atenolol, celiprolol, talinolol) used to treat high blood pressure and prevent heart attacks; cyclosporine, a drug taken to prevent rejection of transplanted organs; and certain antibiotics (ciprofloxacin, levofloxacin, itraconazole). Medications taken for depression, seizures and abnormal heart rhythms were also listed as likely candidates.

A Few Examples of grapefruit-medication interactions

Anti-anxiety; Buspirone (BuSpar)
Anti-arrhythmia; Amiodarone (Cordarone)
Antidepressant; Sertraline (Zoloft)
Antihistamine; Fexofenadine (Allegra)
Anti-retroviral Saquinavir; (Invirase), indinavir (Crixivan)
Anti-seizure Carbamazepine; (Carbatrol, Tegretol)
Calcium channel blocker; Nifedipine (Procardia), nimodipine (Nimotop), nisoldipine (Sular)
Immunosuppressant; Cyclosporine (Neoral, Sandimmune), tacrolimus (Prograf), sirolimus (Rapamune)
Statin; Simvastatin (Zocor), lovastatin (Mevacor), atorvastatin (Lipitor)
.
"List of drugs affected by grapefruit"
.
Covered in the December 2010 online issue of "Today's Dietitian" is a comprehensive article on food and medication interactions, entitled; "When Foods and Drugs Collide — Studies Expose Interactions Between Certain Foods and Medications."written by Denise Webb, PhD, RD .

The article references a wikipedia link

http://en.wikipedia.org/wiki/Grapefruit%E2%80%93drug_interactions

Grapefruit–drug interactions

But I still do not see sovaldi or sofosbuvir for that matter

Lynn


Helpful - 0
7469840 tn?1409845836
I think I also read something about the new Kara Kara Oranges, something about them having been crossed with red grapefruit. The seville oranges are in orange marmalade too.
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Avatar universal

Great article Dee!!! AND I didn't know of it's interaction with calcium channel blockers as well...... Thank you!!

Hugs,
Ran
Helpful - 0
Avatar universal
Thanks Dee! I can't find thread all grapefruit talk was on..... Duh.... so thx for bumping this up, I'll post here.... That old P450 cytochrome again lolThe CYP3A4 isoform of cytochrome P450 is located in both the liver and the enterocytes. Many oral drugs undergo first-pass (presystemic) metabolism by the enzyme. Several organic compounds found in grapefruit and specifically in grapefruit juice exert inhibitory action on drug metabolism by the enzyme. It has been established that a group of compounds called furanocoumarins are responsible for this interaction, and not flavonoids as was previously reported.[31] The list of active furanocoumarins found in grapefruit juice includes: bergamottin, bergapten, bergaptol and 6',7'-dihydroxybergamottin.

This interaction is particularly dangerous when the drug in question has a low therapeutic index, so that a small increase in blood concentration can be the difference between therapeutic effect and toxicity. Grapefruit juice inhibits the enzyme only within the intestines if consumed in low amounts. Intestinal enzyme inhibition will only affect the potency of orally administrated drugs. When larger amounts of grapefruit are consumed it may also inhibit the enzyme in the liver. The hepatic enzyme inhibition may cause an additional increase in potency and a prolonged metabolic half-life (prolonged metabolic half-life for all ways of drug administration).[32] The degree of the effect varies widely between individuals and between samples of juice, and therefore cannot be accounted for a priori.

Another mechanism of interaction is possibly through the P-glycoprotein (Pgp) that is localized in the apical brush border of the enterocytes. Pgp transports lipophilic molecules out of the enterocyte back into the intestinal lumen. Drugs that possess lipophilic properties are either metabolised by CYP3A4 or removed into the intestine by the Pgp transporter. Both the Pgp and CYP3A4 may act synergistically as a barrier to many orally administered drugs. Therefore, their inhibition (both or alone) can markedly increase the bioavailability of a drug.

The interaction caused by grapefruit compounds lasts for up to 72 hours, and its effect is the greatest when the juice is ingested with the drug or up to 4 hours before the drug.[33][34][35]
Helpful - 0
317787 tn?1473358451
Here is an article on grapefruits, bumping this up for others.

http://hepatitiscnewdrugs.blogspot.com/2011/01/grapefruit-juice-dangerous-medication.html
Helpful - 0
Avatar universal
this is an old post, but I am glad I found it. I have been drinking grapefruit juice. No one told me not to drink it. Thanks!
Helpful - 0
142526 tn?1397090672
I'm in a phase 3 trial in with 400 participants and tx'ing for 12 weeks, as a relapser. Taking 3 DAA's without RIBA, for non cirrhotic patients. I've been undetected since week 2 and symptom free, not even a headache, and I wake up every morning feeling very refreshed and can't wait to start my day. Hoping these aren't just the meds making me feel like I got the best nights rest ever, and really hope this continues after EOT.
The info we all get is likely to be coming straight from the pharma companies that sponsor these trials about no grapefruit, and (got the exact name)  Seville oranges.  I'm not too terribly surprised that the tx'ing docs not involved in trials with the new meds are not aware or the ones that are aware simply forget to tell patients about the grapefruit and Seville oranges, I'm not real sure though. They definitely stressed it to us at orientation and even remind us at the routine visits on occasion.. Oh and the Seville orange is mostly grown outside of the US, but it is used in some of our orange marmalades, so be weary of using orange marmalades for now. NP said domestic oranges are fine.


Heart, I think there will be a war inside for sure, these meds will kick and stomp and the virus will be toast, very quickly too. :-) lots of luck to you dragon slayer friend! That's nice to hear the meds are getting tracked so closely, and that way they won't be sitting around somewhere in the heat later on either, you'll know when they are delivered.
Lynn, I didn't come up with anything else after searching. Just have to go by what what we are told. Better to be safe than sorry is the approach anyone should take, it's for just 12 or 24 weeks. In some trials it's only 8 short weeks. Good luck to you too, wishing you SVR :-)
Loves, good luck to you and wishing you SVR! You're welcome and thanks for stopping by, wow Alaska !
Linda, glad you tuned in to see the post, yeah exactly what good forums are for. You're very welcome and no worries on having the gf juice just on one day, or one time, you're on your way to SVR :-)))
Again, good luck to everyone tx'ing or about to start,  these meds are a dream come true! Let's all kick some dragon... Lol
Mag
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Avatar universal
Just talked to the nurse for the 24 hour hot line for sovaldi and she said it would probably be good to avoid grapefruit or grapefruit juice but the other citrus fruits like oranges, lemons, limes, kiwi's, etc were fine to eat or drink.

She is going to run the supplementals past the pharmacists who review all the meds you are taking.  She said while on protocol not to take over the counter drugs without clearing it with them and your doctor.  I usually take children's Benadryl to keep my allergies in check in the spring and she said she is running that past the pharmacist too,  

My drugs were delivered this a.m. and within 15 minutes the nurse was calling from sovaldi stating that they were just informed that I had received my drugs and had I had a chance to go through the paperwork that come with them?  So there must be some solid interaction going on between the fedex and drug company when they deliver.  She gave me a number and said that any one receiving the drugs are also contacted and given the same into that I was getting.  So everyone must have some sort of literature and a number to call for assistance or questions.  They were very nice and helpful.  

I am taking 1 sovaldi and 6 riba a day...wish we luck gang....going to have a war of the world game going on inside of me...LOL
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Avatar universal
Wow!  Thanks for the info, I'm on Sovaldi/Olysio and no one warned me. There are no classes either where I live in Alaska. Thank you so much, I had NO idea!
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Avatar universal
Just did a class last week and start on sovaldi and riba Wednesday....they said nothing about citrus fruits like oranges, lemons, etc.  Someone did ask about grapefruit juice and they were told there was no problem.  If you can't find out 100% for the next 12 weeks just give up grapefruit juice...small price to pay to rid yourself of HCV.  But we were told at class there were no dietary restrictions.

Once I receive my meds I will call the 24 hour nurse line and ask about the grapefruit juices and the supplements from another post.
Helpful - 0
683231 tn?1467323017
Well what ever work for you and your Dr advises.

I am not seeing anything else and the link I sent was almost the only thing I could find on Grapefruit and nothing about orange juice of any type except the suggestion to avoid acid drinks (grapefruit juice, orange juice etc.) if you are feeling nauseous.

I even checked the Olysio prescribing information and did not see anything about grapefruit so probably why they didn't say anything at my doctors office.

Kinda interested to see what you turn up.

Best of luck with your treatment and hope you acheive SVR!
Lynn
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Avatar universal
Wow...thanks for your post...I had not heard about grapefruit juice until I posted that I drank it for potassium...Now that I know,thanks to you guys...that will stop...I called the Janssen company(makers of Olysio) and was told that there was none...but on further research found concerns...only did it once....won't do it again....cannot afford to risk my SVR...Thanks....this if exactly what forums are for.So glad I joined...will pass it on....Linda
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142526 tn?1397090672
Thanks, I'm looking for something as a reference to what my hep doc and NP warned my trial group about and will post a link as well. I see it says above to replace drinking grapefruit with OJ, and that's not what we were told especially of no one knows what kind of orange is in the OJ. I'll get the name of the orange we are suppose to stay clear of and post here later after I talk with the NP.
Helpful - 0
683231 tn?1467323017
Hi Mag
I had not heard or seen that info. I am taking Sovaldi Olysio so I had to see what I could turn up.Thanks fo rthe info!

I found this on web MD

"WebMD Home  Drugs & Medications A-ZSaveDrugs & Medications - Olysio oral
Olysio oral
Back to Drug Overview
Simeprevir/Grapefruit Juice

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug, changing your diet or commencing any course of treatment.

Medical warning:

Very important. A change in your diet, medicine, or dosage may be necessary. Promptly consult your doctor or pharmacist.

How the interaction occurs:

Grapefruit juice may increase the amount of simeprevir in your blood.

What might happen:

When simeprevir is taken with grapefruit juice, the grapefruit juice may cause the simeprevir to build up in your body. This increased amount of simeprevir can have a greater effect of both desired and undesired effects.

What you should do about this interaction:

While you are taking this medicine, you should avoid eating grapefruit or drinking grapefruit juice. You may choose an alternative citrus beverage (such as orange juice). In the event that you are instructed by a healthcare professional (e.g., doctor, pharmacist, or dietitian) to eat grapefruit or drink grapefruit juice you should discuss with your doctor the effects of grapefruit on the blood levels of this medicine. These effects can occur even if grapefruit is not consumed at the same time as the simprevir dose. This interaction may occur at any time in your treatment with simeprevir if grapefruit or grapefruit juice is consumed.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.Reference:1.Olysio (simeprevir) US prescribing information. Janssen Products, LP November, 2013."

LINK:
http://www.webmd.com/drugs/drug-165474-Olysio+oral.aspx?drugid=165474&drugname=Olysio+oral&dmid=129&dmtitle=More%20significant&intrtype=FOOD&pagenumber=9
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142526 tn?1397090672
As long as the ingredients list on the other juices doesn't have any grapefruit or orange added then it's okay. We were all warned against grapefruit and the imported oranges which are not to be used on tx, that's all...
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Avatar universal
What about welchs grape juice and apple juice?
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