Doctor's fruit warning to people on sertraline and midazolam

Doctor's fruit warning to people on sertraline and midazolam It may cause serious side effects – always consult your healthcare provider if concerned Millions of people taking common medications such as sertraline and midazolam and have been given a warning by a doctor. Such people are being warned that consuming grapefruit — a popular ingredient in summer drinks and snacks — can carry serious risks. "Grapefruit is a pleasant snack for most but it is important to disclose large amounts of grapefruit use to your doctor because it can interact with an array of medications," says Dr Nicole James, a resident doctor who used to work in the UK but is now based in Illinois. "Grapefruit contains natural compounds - primarily furanocoumarins and flavonoids, These inhibit an important enzyme called cytochrome P450 3A4," explains Dr James, who previously worked for the NHS in London. This enzyme, known as CYP3A4, plays a key role in breaking down oral medications so the body can process them correctly. "When you ingest grapefruit it blocks this enzyme," says the doctor, who also serves as a clinical research fellow in the Department of Dermatology at Stanford University. "This causes drugs that would normally be broken down in the gut wall to instead pass through intact, leading to significantly higher-than-intended blood levels of the medication," Dr James warns. Having abnormally high concentrations of medication in the bloodstream can trigger serious and potentially dangerous side effects. "Patients taking statins could experience higher levels than normal which can cause muscle break down and cramps," Dr James says. Patients taking certain blood pressure medications such as amlodipine "may experience dizziness and low blood pressure." Sedatives can also carry a risk, with drugs like midazolam being affected by grapefruit and causing "extreme drowsiness and even slowed breathing." Antidepressants such as sertraline also carry an advisory warning to steer clear of the fruit. You might assume it would take a considerable amount of grapefruit to make a difference, but Dr James warns this is far from the truth. "As little as one grapefruit or 200 mL of juice can cause a clinically relevant increase in medication concentrations, and the effect can last up to 72 hours because grapefruit irreversibly inactivates CYP3A4 enzyme," she says. For this reason, she urges people to keep a close eye on mixed fruit juices, smoothies and cocktails this summer, as grapefruit juice is frequently used as an ingredient. "If a patient ingests a large amount of grapefruit while on these medications they should monitor for any symptoms and avoid ingesting any more grapefruit," Dr James says, advising anyone with concerns to seek medical attention without delay. The doctor also warns of the following ingredients patients should be aware of: - Vitamin K containing ingredients such as leafy green vegetables or cranberry juice if taking warfarin - commonly prescribed for reducing risk of heart attack and stroke. - Dairy containing products can reduce the effectiveness of certain antibiotics such as ciprofloxacin and bisphosphanates (like alendronate often taken for osteoporosis prevention). - Herbal remedies that can inhibit or increase activity of the CYP3A4 enzyme like St Johns Wort and Goldenseal. The NHS website tells sertraline users: "Do not drink grapefruit juice while taking sertraline." A full list of medications that grapefruit interferes with can be found here: https://bnf.nice.org.uk/interactions/grapefruit/.