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Grapefruit juice is the fruit juice from grapefruits. It is rich with Vitamin C and ranges from sweet-tart to very sour. Variations include white grapefruit, pink grapefruit and ruby red grapefruit juice.[1][2] Grapefruit juice, and grapefruit in general, is a potent inhibitor of the intestinal cytochrome P450 enzyme CYP3A4, which can impact the metabolism of a variety of drugs, increasing their bioavailability when administered orally. [3][4][5][6][7] In some cases, this can lead to a fatal interaction with drugs like astemizole or terfenadine.[4] The effect of grapefruit juice with regard to drug absorption was originally discovered in 1989. However, the effect became well-publicized after being responsible for a number of deaths due to overdosing on medication.[8] Recently some researchers have shown that furanocoumarins rather than flavonoids are the ingredients causing the various drug interactions. http://www.hon.ch/News/HSN/532584.html [9] An easy way to tell if a medication may be affected by grapefruit juice is by researching whether another known CYP3A4 inhibitor drug is already contraindicated with the active drug of the medication in question. Examples of such known CYP3A4 inhibitors include cisapride (Propulsid), erythromycin, itraconazole (Sporanox), ketoconazole (Nizoral), and mibefradil (Posicor)[citation needed].
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