Editing Grapefruit (section)

== Drug interactions ==

{{main|Grapefruit–drug interactions}}

[[File:Bergamottin-3D-balls.png|thumb |Grapefruit juice contains [[bergamottin]], one of the [[furanocoumarin]]s which inhibit the metabolism of many drugs, causing multiple side-effects.<ref name="BaileyDresser2012"/> ]]

Grapefruit and [[grapefruit juice]] [[drug interaction|interact]] with many drugs, resulting in numerous [[adverse effect]]s including [[bone marrow suppression]]<!--myelotoxicity-->, [[nephrotoxicity]], [[Arrhythmia|abnormal heart rhythm]]<!--torsade de pointes-->, [[rhabdomyolysis]], [[hypotension]], [[gastrointestinal bleeding]], [[dizziness]], and [[Hypoventilation|respiratory depression]], according to the drug involved.<ref name="BaileyDresser2012"/>

One interaction occurs from grapefruit [[furanocoumarin]]s, such as [[bergamottin]] and [[6',7'-dihydroxybergamottin]], which occur in both flesh and peel. Furanocoumarins inhibit the [[CYP3A4]] [[enzyme]] (among others from the [[cytochrome P450]] enzyme family responsible for metabolizing 90% of drugs).<ref>{{cite journal |last1=Kakar |first1=S.M. |last2=Paine |first2=M.F. |last3=Stewart |first3=P.W. |last4=Watkins |first4=P.B. |title=6',7'-Dihydroxybergamottin contributes to the grapefruit juice effect |journal=Clinical Pharmacology and Therapeutics |pmid=15179411 |year=2004 |volume=75 |issue=6 |pages=569–579 |doi=10.1016/j.clpt.2004.02.007 |hdl=2027.42/109773 |hdl-access=free}}</ref> The action of the CYP3A4 enzyme itself is to metabolize many medications.<ref name="refseq">{{NCBI RefSeq |title=CYP3A4 cytochrome P450 family 3 subfamily A member 4 [Homo sapiens (human)] |url=https://www.ncbi.nlm.nih.gov/gene/1576}}</ref> If a drug's breakdown for removal is lessened, then the level of that drug in the blood may become and remain high, leading to adverse effects.<ref name="BaileyDresser2012"/> On the other hand, some drugs must be metabolized to become active, and inhibiting CYP3A4 may lead to reduced drug effects.<ref name="BaileyDresser2012"/>

Another effect is that grapefruit compounds may inhibit the absorption of drugs in the intestine. If a drug is not absorbed, then not enough of it is in the blood to have a therapeutic effect. Each affected drug has either a specific increase of effect or decrease.<ref>{{Cite web |date=2022-09-29 |title=How the "Don't take this medication with grapefruit juice" warning originated {{!}} Science-Based Medicine |url=https://sciencebasedmedicine.org/how-the-dont-take-this-medication-with-grapefruit-juice-warning-originated/ |access-date=2022-11-04 |website=sciencebasedmedicine.org |archive-date=2022-11-04 |archive-url=https://web.archive.org/web/20221104121805/https://sciencebasedmedicine.org/how-the-dont-take-this-medication-with-grapefruit-juice-warning-originated/ |url-status=live }}</ref><!--independent source, non-profit, sceptical attitude, shd be fine for this modest (non-MEDRS) claim-->

One whole grapefruit or a glass of {{convert |200 |ml |usoz |sigfig=1 |abbr=on}} of grapefruit juice is enough to cause drug overdose toxicity.<ref name="BaileyDresser2012">{{cite journal |last1=Bailey |first1=D. G. |last2=Dresser |first2=G. |last3=Arnold |first3=J. M. O. |title=Grapefruit-medication interactions: Forbidden fruit or avoidable consequences? |journal=Canadian Medical Association Journal |volume=185 |issue=4 |year=2012 |pages=309–316 |doi=10.1503/cmaj.120951 |pmid=23184849 |pmc=3589309}}</ref> Typically, drugs that are incompatible with grapefruit are marked as such on the container or [[Medication package insert|package insert]].<ref name="BaileyDresser2012"/>
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{| class="wikitable" style="float:right; width:12em; text-align:center;"
|+ Grapefruit production <br>{{small|2023, millions of tonnes}}
|-
|{{CHN}} ||5.20
|-
|{{VIE}} ||1.20
|-
|{{MEX}} ||0.49
|-
|{{SAF}} ||0.41
|-
|{{USA}} ||0.30
|-
|'''World''' ||9.93
|-
|colspan=2|{{small|Source: [[FAOSTAT]] of the [[United Nations]]}}<ref name="faostat">{{cite web|url=http://www.fao.org/faostat/en/#data/QCL|title=Grapefruit production in 2023, Crops/Regions/World list/Production Quantity/Year (pick lists)|date=2025|publisher=UN Food and Agriculture Organization, Corporate Statistical Database (FAOSTAT)|access-date=8 May 2025}}</ref>
|}