17 replies to this topic

[Marnie]

Mmmmm. . .grapefruit!!!  Haven't had one in almost 2 years.  It was delicious.  Two more days to enjoy them.  

[Trey]

http://cmlhope.com/2...ous-leukemia-2/

[GerryL]

Does grapefruit affect all TKIs?

[jenn]

omg the forbidden fruit !!!! Hahahaha,the one thing I first read about not to eat !!!!

[GerryL]

I knew there was a connection between Gleevec and Grapefruit -

CYP3A4 inhibitors

Drugs that inhibit CYP3A4 activity may decrease imatinib metabolism, increase blood concentrations, and increase the risk of side effects. Strong CYP3A4 inhibitors include the following:

• antifungals (e.g., ketoconazole (Nizoral), itraconazole (Sporanox), and voriconazole(Vfend))
  
• antibiotics(e.g., erythromycin, clarithromycin (Biaxin), telithromycin(Ketek))
  
• antiretrovirals (e.g., nelfinavir (Viracept), ritonavir (Norvir), saquinavir(Fortovase))
  
• nefazodone (Serzone)
  
• Some components of grapefruit and grapefruit juice
  

Just Googled grapefruit and the other two TKIs - it really is the forbidden fruit - luckily I've never particularly liked it.

[Trey]

Grapefruit does not decrease TKI drug effectiveness, but rather enhances it by keeping the TKI drug in the body longer, which essentially is like taking increased dosage.  If someone is not on max dosage, is that such a bad thing?

[hannibellemo]

I really miss pink grapefruit in the winter! I have to use tequila and lime juice to ward off scurvy now!

So, I know Trey partakes - who still tastes the forbidden fruit?

Pat

[Marnie]

I stick with the tequila and lime juice.  But I AM going to the store to pick up a couple more grapefruit today.  I can eat them until Sunday night.

[Trey]

I'm working my way through a bag of Texas Ruby Reds right now.  Telling a Texan to stay away from grapefruit is like telling a Brit to stop eating mashie peas with their fish and chips....

http://www.flickr.co...hor/1894069045/

[AliceJane]

Really? You don't abstain from grapefruit?  I love grapefruit, expecially Ruby Red, my fav.  Choice between orange, apple and grapefruit I pick grapefruit any day.  I miss them, a lot.  And next to Margaritta my fav. drink is a Salty Dog.  Does this mean I can indulge some?

[ROM1212]

OK, folks, so we CAN eat grapefruit?

I am grateful to be PCRU and haven't eaten one grapefruit since I began the G.  So is it correct to say G+G won't have any effect on my current counts?  Maybe some affect on side effects?

If this is true, I'm gonna eat a 1/2 tonight, yahoo!

[PhilB]

Put me down in the partakers camp.  On the one hand they may make your side effects worse, on the other they may actually improve your response.

For anyone suffering from severe problems like low counts, pleural effusion, etc. it probably makes a lot of sense to avoid them completely.  For the rest it's a trade off between the risk of worse side effects versus how nice they taste.  My compromise is to largely avoid them around dinner time when I take my G, but to make free with the juice at breakfast.

[mck_001]

I'm a rule follower for the most part, so don't eat grapefruit.  Dr. Cortes also told me no alcohol or tylenol or motrin (while on sprycel...I think he told me tylenol was ok with Gleevec...maybe it was motrin...can't remember?)

Anyway, so since I'm not a big drinker or grapefruit drinker and since they gave me another rX for headaches and common things I'd pop a motrin for, I'm sticking to the rules. 

[GerryL]

I've also read that lime juice and red wine are potential inhibitors - though red wine reverses itself out fairly quickly. I still have a glass of red wine every now and again.

[VickiW]

ok, watched a video conference with Dr, Druker's NP, and she said (I'm pretty sure this was in relation to Sprycel) the no-no's were; Tylenol, black raspberry, pomagranite and grapefruit juice.  No comment on consuming the fruits themselves, just the juice.  Alchohol occasionally (1 to 2) but never with Tylenol as they both stress the liver.

[gunner]

I have a bottle of grapefruit juice in the refrigerator door. Not my favorite, but I take it intentionally as an alternative to taking a higher dosage of Gleevec.

I see folks on this board who are getting their meds changed and dosages adjusted frequently for what appears to be no justifable reason. If a jug of grapefruit juice makes the Gleevec work better, I don't see a problem.

Besides- my onc was always confusing grapefruit juice and grape juice when I first started taking Gleevec, so I can always claim ignorance!

The oncs will never 'approve' of your consumming grapefruit product, because there is the note on the interactions list. I was going through my list of high blood pressure meds last night, trying to determine which one I should drop. My BP has been well controlled for years, yet my primary doctor has never suggested cutting back on any of the medication. So I am going to propose which one I want to drop the next time I see him. My wife was looking through the interactions info, and found that one of the drugs would also interact with grapefruit juice. That was the first I had heard of it! There is also the issue of the severity of the interaction. If the interaction was to cause internal bleeding, brain hemorhaging, anal leakage, coughs, colds, sore holes, fits, farts, or freckles, then I would consider avoiding it.

[mck_001]

But, isn't "more" not necessarily better?  TKI's aren't vitamins that if you take too much, you're body will excrete the leftovers and they have impacts on our organs and the rest of our body.  So, if you're increasing the power of it, aren't you increasing the potential harm that it can do to other parts of your body?

Just curious what thoughts are on that....

[CallMeLucky]

It appears the logic is that if you are on 400mg of Gleevec and the drug has been safely prescribed at 800mg, then it is okay to have a little grapefruit juice at 400mg, because while it will have the effect of increasing the dosage, it certainly wont increase it by double the amount you are taking (i.e. it shouldn't hurt you and may make the drug more potent).

On the other hand, I'm like you, I'm not looking to take that chance, I'm tired enough and my legs hurt enough, the drug seems to be working, so I'm not going to mess with the protocol.  I suppose it helps that I was never a big fan of grapefruit juice in the first place.  It's a little ironic that I would never have considered eating one before CML but now listening to everyone rave about them and being told I can't have them makes me crave it a bit.  I guess that's human nature for you.  I'm more frustrated about my workout supplements that I can't take anymore.