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Tuesday, November 27, 2012

Tuesday Morning News: Stop Consuming Grapefruit While Taking Drugs, for One

Posted by on Tue, Nov 27, 2012 at 8:07 AM

Democrats Elected on More Liberal Platforms: Will they block Obama's centrism on Medicare and Social Security in deficit talks?

Robbers in South Seattle: Targeting Vietnamese-owned businesses?

Poverty in Latin America: Lowest level in three decades.

Egyptian Protesters: "The Muslim Brotherhood stole the revolution."

They Tell Me My Confidence Is Higher Than It's Been for 4 1/2 Years: As a consumer.

Home Prices: Biggest rise in two years.

Drugs and Grapefruit Are a Deadly Mix?: No joke. "It’s hard to avoid putting a drug out on the market that is not affected by grapefruit juice.” There's a whole list of drugs to avoid mixing with the dangerous (???) citrus fruit.

Seattle People Like to Name Their Chow Chow "Bear": And other facts about dog-naming in Seattle in 2012.

Students Are Falling from Buildings: At WSU. The fourth this year.

Washington Ranks 32nd in High School Graduation Rate Among States: This is the first time the US Dept of Ed has measured this way. Now I'd like to know how our racial graduation-rate gap compares to other states.

Chinese Communist Newspaper: Falls for Onion joke that Kim Jong Un is the sexiest man alive. OR ARE THEY SATIRISTS THEMSELVES? HMM?

Man Choked to Death on Roach Parts: It was an eating contest.

I Haven't Watched It But: This is a video called "World's Biggest Pile of Leaves."

The Ladies on TV News: Ten years ago, they had to wear dark boring suits, "but now a little anchor leg is fine." FREEDOM IS JUST SO FREEING.

The Arafat Exhumation: Test results on whether he was poisoned could still be months away.

France Will Back Palestine: In its non-member bid at the UN.

Personality Disorders: How do you diagnose and treat a problem based on who a person is?

This is so cool. Cheetahs captured running at full speeds as never before, thanks to new camera technology. Metafilter, I love you (except for that time when you sent me to that "parent rap," because that was terrible, Metafilter).

Cheetahs on the Edge—Director's Cut from Gregory Wilson on Vimeo.


Comments (25) RSS

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Pile of leaves was a huge disappointment. "Good for them"
Posted by cliche on November 27, 2012 at 8:23 AM · Report this
care bear 2
I hate grapefruit juice. This is further proof that it's evil.
Posted by care bear on November 27, 2012 at 8:40 AM · Report this
Interesting about the drugs that interact with grapefruit juice. I am taking two of them.

For those who don't know, tadalafil which is on the list, is available under the brand name Cialis. At 62 taking a boner pill may not be critically necessary but it greatly improves the quality of my sex life.
Posted by Dr.Duck on November 27, 2012 at 8:40 AM · Report this
mikethehammer 4
Cheetah was pretty badass. Though I can't be the only one who was hoping it would culminate in her catching up to whoever the cruel bastard was pulling the string and maul them.
Posted by mikethehammer on November 27, 2012 at 8:41 AM · Report this
Pope Peabrain 5
Can't the Democrats in the senate pass a bill extending middle class tax cuts and passing it on to the house without Republicans? Then the ball is in the Republican house. If they refuse to pass it, the "fiscal cliff" is on them. They lost the election. If they want to make things worse for themselves, let them.
Posted by Pope Peabrain on November 27, 2012 at 8:42 AM · Report this
Delishuss 6
That's interesting. Every time I've taken a multivitamin after eating half a grapefruit with my breakfast, I've puked it up. #themoreyouknow
Posted by Delishuss on November 27, 2012 at 8:54 AM · Report this
They banned my favorite antihistamine after some idiot failed to read the "DO NOT TAKE WITH GRAPEFRUIT JUICE" warning on the box, and died. No other antihistamine works as well as that one did. I wish they'd banned grapefruit juice instead of my beloved terfenadine.
Posted by originalcinner on November 27, 2012 at 9:01 AM · Report this
long-time reader 8
Further evidence for my hypothesis that grapefruit is poison.
Posted by long-time reader on November 27, 2012 at 9:41 AM · Report this
rob! 9
@7, good news! Terfenadine itself was not the magical chemical that ...antihistaminized you. That drug is almost entirely converted by the body in short order to fexofenadine before it hits the circulation (unless inhibitors of that reaction, like grapefruit chemicals, are present, in which case terfenadine in the blood causes cardiotoxic effects).

Hmmm, fexofenadine—that would be Allegra, legally clearing airways since 1996.

Happy breathing!
Posted by rob! on November 27, 2012 at 9:42 AM · Report this
I see grapefruit is not the only suspect juice.

"The problem is caused by an active ingredient in some citrus fruits, including grapefruit, limes and pomelos. Even the Seville oranges used in marmalades can trigger it. The fruits produce organic chemical compounds called furanocoumarins, which interfere with a human digestive enzyme."

I don't buy grapefruit nor grapefruit juice. But I was served some a short while back. I attended a party where a punch made of grapefruit juice, ice cream, and sparkling water was served.
Posted by Dr.Duck on November 27, 2012 at 9:58 AM · Report this
spaceapple 11
I like how we see grapefruit as the danger, and not the prescription drugs.
Posted by spaceapple on November 27, 2012 at 10:05 AM · Report this
It's not just grapefruit. Seville oranges have the same stuff in them.

For the record, what actually happens with the interaction is that the grapefruit (seville orange, etc.) competes for a metabolic pathway in the liver that the drug needs to use to be metabolized. This increases the half-life of the drug in the body, often significantly. If you consume grapefruit (or the drug) only infrequently, it's not as much of a problem as if you have it every day. What happens with frequent consumption of grapefruit is that the pathway remains blocked and the drug can quickly build up in the bloodstream to toxic levels if you're taking periodic doses of it.

This only happens with drugs that use that one particular enzymatic pathway (Cytochrome P450/CYP3A4) in the liver. Unfortunately, there are quite a few that do.

Unless you read the professional package insert for each drug you're prescribed to make sure it's not using that pathway to be metabolized, yeah, avoid grapefruit. (And Seville oranges, and pomelos.)
Posted by Brooklyn Reader on November 27, 2012 at 11:18 AM · Report this
Will in Seattle 13
Drug interactions, along with side effects from other dietary supplements, regulated or unregulated, is really hard to program for.

I remember when we were designing the Group Health software. Most medical insurance pharmacies only went out to two or three interactions, extending it as far as we did was a major pain.

Here's a hint: If it says "take on an empty stomach" that means nothing in it, other than water.
Posted by Will in Seattle on November 27, 2012 at 11:23 AM · Report this
MacCrocodile 14
@11 - Drugs are awesome. Grapefruit is the devil's own gallbladder.
Posted by MacCrocodile on November 27, 2012 at 11:38 AM · Report this
More, I Say! 15
Is the grapefruit thing why people always say that drinking OJ or grapefruit-J will enhance your LDS/mushroom experience?
Posted by More, I Say! on November 27, 2012 at 11:57 AM · Report this
enhance your LDS/mushroom experience

Mormons do magic mushrooms? Who knew?

(Yes, I understand that it was a typo.)
Posted by N in Seattle on November 27, 2012 at 12:08 PM · Report this
Sandiai 17
I only take my Mormons with mushrooms.
Posted by Sandiai on November 27, 2012 at 1:34 PM · Report this
Sandiai 18
Sorry. Psilocybin is metabolized by 2D6. Like meth and ecstacy.
Posted by Sandiai on November 27, 2012 at 1:41 PM · Report this
Some Old Nobodaddy Logged In 19
@14 No, they're not. Not the crap produced by the pharma industry. This is just nature's way of telling us that we shouldn't poison our bodies w/ expensive & damaging chemicals.

Posted by Some Old Nobodaddy Logged In on November 27, 2012 at 1:46 PM · Report this
MacCrocodile 20
@19 - Oh, for a second there, I thought you were going to defend grapefruit, the devil's own gallbladder (from now on, to be referred to in full). Yeah, I can agree with you to a certain extent, but I warn you, my listening things and thinking stuff shuts down when I hear "pharma industry" and "chemicals".
Posted by MacCrocodile on November 27, 2012 at 2:01 PM · Report this
Sandiai 21
That cockroach thing was very disturbing. I guess, 'thank God' the camera was off when (a few minutes later??) he died. New word for me, signs of anaphylaxis on the skin are called "stigmata." Sad story. Gross. And sad.
Posted by Sandiai on November 27, 2012 at 11:08 PM · Report this
Goddammit. I love grapefruit juice. Once I read somewhere on the Internet that it slows down metabolism of caffeine so drinking it alongside a morning cup of joe would make the effects of caffeine last longer. My husband remembered it the other way around. We got into an argument about it at a party in front of a research chemist who set us straight, but now I can't remember which of us he said was right. I thought my husband was vindicated, but this report leads me to believe I was on to something.
Posted by katallred on November 27, 2012 at 11:11 PM · Report this
Sandiai 23
@22 It sounds like you were right, since it just seems to go one way with grapefruit: make the drugs last longer and even build up in concentration.
Posted by Sandiai on November 27, 2012 at 11:17 PM · Report this
pharmswede 24
Cancer Causes Control. 2009 Aug;20(6):803-9.

Prospective study of the association between grapefruit intake and risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC).

TLDR: No connection between grapefruit, birth control, and breast cancer found.

Grapefruit inhibits cytochrome P450 3A4 and may affect estrogen metabolism. In the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined the relationships of grapefruit intake with risk of breast cancer and with serum sex hormone levels. 114,504 women with information on dietary intake of grapefruit and on reproductive and lifestyle risk factors were followed for a median 9.5 years and 3,747 incident breast cancers were identified. Fifty-nine percent of women reported eating grapefruit, 4% ate > or = 60 g/day. Cox proportional hazard models were used to estimate the hazard ratio (HR) for breast cancer according to grapefruit intake, adjusting for study centre, reproductive factors, body mass index, energy intake, and alcohol intake. Grapefruit intake was not related to the risk of breast cancer: compared with women who ate no grapefruit, women with the highest intake of > or =60 g/day had a HR of 0.93 (95% CI 0.77-1.13), p for linear trend = 0.5. There was no relationship between grapefruit intake and breast cancer risk among premenopausal women, all postmenopausal women, or postmenopausal women categorized by hormone replacement therapy use (all p>0.05). There was no association between grapefruit intake and estradiol or estrone among postmenopausal women. In this study, we found no evidence of an association between grapefruit intake and risk of breast cancer.
Posted by pharmswede on November 28, 2012 at 12:28 PM · Report this
More, I Say! 25
Gosh darn it. No more dropping hits of Mormon for me. Sigh.
Posted by More, I Say! on November 28, 2012 at 4:46 PM · Report this

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