| Drug | How To take It | Comments | Grapefruit Effect | Management |
|---|---|---|---|---|
| Alendronate | Before Meals Do Not Crush or Chew | Take in the morning with a glass of plain water only and at least 30 min before any food, beverage or other medication | ||
| Atovaquone/Proguanil | With or After Meals | Daily dose should be taken with food or milk; absorption reduced when fasting; may be crushed and mixed with condensed milk just prior to administration | ||
| Budesonide (ODT) | Do Not Crush or Chew | Orodispersible; place on tip of tongue and gently press against top of mouth to dissolve. Take after a meal; allow at least 30 min before eating or drinking or performing oral hygiene | ||
| Abemaciclib | Manufacturer states that grapefruit, grapefruit juice and products containing grapefruit extract should be avoided. Abemaciclib is primarily eliminated by CYP3A4 metabolism and has a mean absolute oral bioavailability of 45%. Co-administration of a CYP3A inhibitor (clarithromycin) resulted in a 3.4-fold increase in the plasma exposure of abemaciclib | Grapefruit contraindicated. Seville orange, lime and pomelo may also cause the interaction. If grapefruit consumed during drug therapy, caution and clinical monitoring required, especially for venous thromboembolism, neutropenia, hepatotoxicity, diarrhea | ||
| Atorvastatin | Studies in healthy subjects; markedly increased atorvastatin AUC and Cmax. Case reports of rhabdomyolysis with consumption of normal amounts of grapefruit. Manufacturer states that consumption of excessive grapefruit juice with atorvastatin is not recommended. Atorvastatin is likely less affected than lovastatin and simvastatin. Administration of the moderate CYP3A4 inhibitors clarithromycin or erythromycin in patients taking atorvastatin, lovastatin or simvastatin has been found to be associated with higher risk of hospitalization due to rhabdomyolysis or acute kidney injury and all-cause mortality in older adults | Grapefruit contraindicated. Seville orange, lime and pomelo may also cause the interaction. If grapefruit consumed during drug therapy, caution and clinical monitoring required, especially for myopathy, rhabdomyolysis, acute renal failure Potential alternative drugs (depending on indication, patient factors): known not to interact—pravastatin; predicted not to interact—fluvastatin, rosuvastatin |
