Is grapefruit a risky citrus?
Q: I have gotten conflicting information from my doctor, a couple of pharmacists and patient-information inserts about how to avoid interactions between statins and grapefruit:
• Don’t take the medication with grapefruit juice.
• Don’t have grapefruit products at the same time of day as a statin.
• It’s OK to have grapefruit products after, but not before, a statin.
• Don’t have more than 1 quart (though one said 8 ounces) of grapefruit products a day.
• Don’t have any grapefruit products at all while taking statins.
I hope you can clarify this. I have been avoiding grapefruit completely, and would like to be able to eat it again if it is safe to do so.
A: Certain cholesterol-lowering drugs such as atorvastatin (Lipitor), lovastatin (Mevacor) and simvastatin (Zocor) interact with compounds in grapefruit and its juice. These natural chemicals can slow the rate at which the drugs are processed by the body. This may result in a higher blood level of the drug and consequently a greater risk of side effects.
Only grapefruit and bitter orange (not regular oranges) contain the active compounds. The enzymes that are affected may show changed activity for more than 24 hours after a person drinks a glass of juice, so the idea that one could have grapefruit for breakfast and take a pill before bedtime is mistaken.
Some people are far more susceptible to this effect than others.
Q: I have a lot of swelling and pain in my joints. A cousin with arthritis recommended a compounded cream called ketoprofen gel. What can you tell me about this medicine, its side effects and its interactions with other drugs?
A: Ketoprofen, like ibuprofen, is a nonsteroidal anti-inflammatory drug. You won’t find this on the shelf in a chain store, but some pharmacists can compound this topical treatment without a prescription.
Q: While in Africa, I started drinking rooibos tea every day. Now that I am back home, my usual fall allergies have not appeared. Have you heard of this before?
A: We have heard of rooibos tea (”red bush” tea) from South Africa. It has been used traditionally against pollen allergies, but there is not a lot of clinical research to support its effectiveness. One study did suggest that there is an effect on the immune system that might help relieve allergic symptoms (Bioscience, Biotechnology and Biochemistry, October 2001).
In their column, Joe and Teresa Graedon answer letters from readers. Write to them c/o King Features Syndicate, 888 Seventh Ave., New York, NY 10019, or via their Web site: www.peoplespharmacy.org