Drug interactions with grapefruit juice: Extent, probable mechanism and clinical relevance

Drug Safety

Volumn 18, Issue 4, 1998, Pages 251-272

  Fuhr, Uwe ^a  

^a UNIVERSITY OF COLOGNE   (Germany)

Author keywords

[No Author keywords available]

Indexed keywords

CYCLOSPORIN; CYTOCHROME P450; FELODIPINE; MIDAZOLAM; NARINGENIN; NIFEDIPINE; NIMODIPINE; NISOLDIPINE; NITRENDIPINE; PSORALEN DERIVATIVE; SAQUINAVIR; TERFENADINE; TRIAZOLAM; VERAPAMIL;

AREA UNDER THE CURVE; ARTICLE; BIOAVAILABILITY; CITRUS FRUIT; DRUG BLOOD LEVEL; DRUG INTERACTION; ENZYME INHIBITION; FIRST PASS EFFECT; FRUIT JUICE; GRAPEFRUIT; PRIORITY JOURNAL; SIDE EFFECT; SMALL INTESTINE;

AGE FACTORS; ANIMALS; BEVERAGES; CALCIUM CHANNEL BLOCKERS; CITRUS; COUMARINS; CYTOCHROME P-450 ENZYME SYSTEM; FEMALE; FLAVONOIDS; FOOD-DRUG INTERACTIONS; HERB-DRUG INTERACTIONS; HUMANS; INTESTINE, SMALL; MALE; MIXED FUNCTION OXYGENASES; PSORALENS; RISK ASSESSMENT; SEX FACTORS;

EID: 0031966729     PISSN: 01145916     EISSN: None     Source Type: Journal    
DOI: 10.2165/00002018-199818040-00002     Document Type: Article

References (113)

1. Bailey DG, Spence JD, Edgar B, et al. Ethanol enhances the hemodynamic effects of felodipine. Clin Invest Med 1989 Dec; 12 (6): 357-62
2. Bailey DG, Arnold JM, Spence JD. Grapefruit juice and drugs. How significant is the interaction? Clin Pharmacokinet 1994 Feb; 26 (2): 91-8
3. Fuhr U, Klittich K, Staib AH. Inhibitory effect of grapefruit juice and its bitter principal, naringenin, on CYP1A2 dependent metabolism of caffeine in man. Br J Clin Pharmacol 1993 Apr; 35 (4): 431-6
4. Edgar B, Bailey D, Bergstrand R, et al. Acute effects of drinking grapefruit juice on the pharmacokinetics and dynamics of felodipine - and its potential clinical relevance. Eur J Clin Pharmacol 1992; 42 (3): 313-7
5. Bailey DG, Arnold JM, Munoz C, et al. Grapefruit juice - felodipine interaction: mechanism, predictability, and effect of naringin. Clin Pharmacol Ther 1993 Jun; 53 (6): 637-42
6. Lundahl J, Regardh CG, Edgar B, et al. Relationship between time of intake of grapefruit juice and its effect on pharmacokinetics and pharmacodynamics of felodipine in healthy subjects. Eur J Clin Pharmacol 1995; 49 (1-2): 61-7
7. Lown KS, Bailey DG, Fontana RJ, et al. Grapefruit juice increases felodipine oral availability in humans by decreasing intestinal CYP3A protein expression. J Clin Invest 1997 May 15; 99 (10): 2545-53
8. Bailey DG, Bend JR, Arnold JM, et al. Erythromycin-felodipine interaction: magnitude, mechanism, and comparison with grapefruit juice. Clin Pharmacol Ther 1996 Jul; 60 (1): 25-33
9. Bailey DG, Arnold JM, Bend JR, et al. Grapefruit juice-felodipine interaction: reproducibility and characterization with the extended release drug formulation. Br J Clin Pharmacol 1995 Aug; 40 (2): 135-40
10. Bailey DG, Spence JD, Munoz C, et al. Interaction of citrus juices with felodipine and nifedipine. Lancet 1991 Feb 2; 337 (8736): 268-9
11. Josefsson M, Zackrisson AL, Ahlner J. Effect of grapefruit juice on the pharmacokinetics of amlodipine in healthy volunteers. Eur J Clin Pharmacol 1996; 51 (2): 189-93
12. Sigusch H, Henschel L, Kraul H, et al. Lack of effect of grapefruit juice on diltiazem bioavailability in normal subjects. Pharmazie 1994 Sep; 49 (9): 675-9
13. Rashid TJ, Martin U, Clarke H, et al. Factors affecting the absolute bioavailability of nifedipine. Br J Clin Pharmacol 1995 Jul; 40 (1): 51-8
14. Sigusch H, Hippius M, Henschel L, et al. Influence of grapefruit juice on the pharmacokinetics of a slow release nifedipine formulation. Pharmazie 1994 Jul; 49 (7): 522-4
15. Fuhr U, Maier A, Blume H, et al. Grapefruit juice increases oral nimodipine bioavailability [abstract]. Eur J Clin Pharmacol 1994 Aug; 47 (1): A100
16. Bailey DG, Arnold JM, Strong HA, et al. Effect of grapefruit juice and naringin on nisoldipine pharmacokinetics. Clin Pharmacol Ther 1993 Dec; 54 (6): 589-94
17. Bailey DG, Munoz C, Arnold JM, et al. Grapefruit juice and naringin interaction with nitrendipine Clin Pharmacol Ther 1992 Feb; 51 (2): 156
18. Soons PA, Vogels BA, Roosemalen MC, et al. Grapefruit juice and cimetidine inhibit stereoselective metabolism of nitrendipine in humans. Clin Pharmacol Ther 1991 Oct; 50 (4): 394-403
19. Fuhr U, Harder S, Lopez-Rojas P, et al. Increase of verapamil concentrations in steady stale by coadministration of grapefruit juice [abstract]. Naunyn Schmiedeberg's Arch Pharmacol 1994 Mar; 349 Suppl: R134
20. Herlitz H, Edgar B, Hedner T, et al. Grapefruit juice: a possible source of variability in blood concentration of cyclosporin A [letter]. Nephrol Dial Transplant 1993; 8 (4): 375
21. Min DI, Ku YM, Perry PJ, et al. Effect of grapefruit juice on cyclosporine pharmacokinetics in renal transplant patients. Transplantation 1996 Jul 15; 62 (1): 123-5
22. Yee GC, Stanley DL, Pessa LJ, et al. Effect of grapefruit juice on blood cyclosporin concentration. Lancet 1995 Apr 15; 345 (8955): 955-6
23. Ducharme MP, Warbasse LH, Edwards DJ. Disposition of intravenous and oral cyclosporin after administration with grapefruit juice. Clin Pharmacol Ther 1995 May; 57 (5): 485-91
24. Hollander AA, van Rooij J, Lentjes GW, et al. The effect of grapefruit juice on cyclosporine and prednisone metabolism in transplant patients. Clin Pharmacol Ther 1995 Mar; 57 (3): 318-24
25. Ioannides-Demos LL, Christophidis N, Ryan P, et al. Dosing implications of a clinical interaction between grapefruit juice and cyclosporine and metabolite concentrations in patients with autoimmune diseases. J Rheumatol 1997 Jan; 24 (1): 49-54
26. Proppe DG, Hoch OD, McLean AJ, et al. Influence of chronic ingestion of grapefruit juice on steady-state blood concentrations of cyclosporine A in renal transplant patients with stable graft function. Br J Clin Pharmacol 1995 Mar; 39 (3): 337-8
27. Rau SE, Bend JR, Arnold MO, et al. Grapefruit juice-terfenadine single-dose interaction: magnitude, mechanism, and relevance. Clin Pharmacol Ther 1997 Apr; 61 (4): 401-9
28. Honig PK, Wortham DC, Lazarev A, et al. Grapefruit juice alters the systemic bioavailability and cardiac repolarization of terfenadine in poor metabolizers of terfenadine. J Clin Pharmacol 1996 Apr; 36 (4): 345-51
29. Benton RE, Honig PK, Zamani K, et al. Grapefruit juice alters terfenadine pharmacokinetics, resulting in prolongation of repolarization on the electrocardiogram. Clin Pharmacol Ther 1996 Apr; 59 (4): 383-8
30. Maish WA, Hampton EM, Whitsell TL, et al. Influence of grapefruit juice on caffeine pharmacokinetics and pharmacodynamics. Pharmacotherapy 1996 Nov-Dec; 16 (6): 1046-52
31. Fuhr U, Maier A, Keller A, et al. Lacking effect of grapefruit juice on theophylline pharmacokinetics. Int J Clin Pharmacol Ther 1995 Jun; 33 (6): 311-4
32. Weber A, Jager R, Borner A, et al. Can grapefruit juice influence ethinylestradiol bioavailability? Contraception 1996 Jan; 53 (1): 41-7
33. Schubert W, Cullberg G, Edgar B, et al. Inhibition of 17 beta-estradiol metabolism by grapefruit juice in ovariectomized women. Maturitas 1994 Dec; 20 (2-3): 155-63
34. Kupferschmidt HH, Ha HR, Ziegler WH, et al. Interaction between grapefruit juice and midazolam in humans. Clin Pharmacol Ther 1995 Jul; 58 (1): 20-8
35. Hukkinen SK, Varhe A, Olkkola KT, et al. Plasma concentrations of triazolam are increased by concomitant ingestion of grapefruit juice. Clin Pharmacol Ther 1995 Aug; 58 (2): 127-31
36. Min DI, Ku YM, Geraets DR, et al. Effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of quinidine in healthy volunteers. J Clin Pharmacol 1996 May; 36 (5): 469-76
37. Jakobsen J, Glaus L, Graf P, et al. Unmasking of the hypotensive effect of nifedipine in normotensives by addition of the angiotensin converting enzyme inhibitor benazepril. J Hypertens 1992 Sep; 10 (9): 1045-51
38. Kunzendorf U, Brockmoller J, Jochimsen F, et al. Neurotoxicity caused by a high cyclosporine metabolite level. Transplantation 1989 Sep; 48 (3): 531-2
39. Reynolds JEF, editor. Maritindale. The extra pharmacopoeia. 31st ed. London: Royal Pharmaceutical Society, 1996
40. Bolstein P. Is QT interval prolongation harmful? A regulatory perspective. Am J Cardiol 1993 Aug 26; 72 (6): 50B-2B
41. Fournier P, Pacouret G, Charbonnier B. Une nouvelle cause de torsades de pointes: association terfenadine et troleandomycine. Ann Cardiol Angeiol (Paris) 1993 May; 42 (5): 249-52
42. Hanrahan JP, Choo PW, Carlson W, et al. Terfenadine-associated ventricular arrhythmias and QTc interval prolongation: a retrospective cohort comparison with other antihistamines among members of a health maintenance organization. Ann Epidemiol 1995 May; 5 (3): 201-9
43. Spence JD. Drug interactions with grapefruit: whose responsibility is it to warn the public? Clin Pharmacol Ther 1997 Apr; 61 (4): 395-400
44. The lethal qualities of grapefruit juice. Marketletter 1996 Sep 9: 23
45. Honig PK, Woosley RL, Zamani K, et al. Changes in the pharmacokinetics and electrocardiographic pharmacodynamics of terfenadine with concomitant administration of erythromycin. Clin Pharmacol Ther 1992 Sep; 52 (3): 231-8
46. Honig PK, Wortham DC, Zamani K, et al. Effect of concomitant administration of cimetidine and ranitidine on the pharmacokinetics and electrocardiographic effects of terfenadine. Eur J Clin Pharmacol 1993; 45 (1): 41-6
47. Fuhr U, Doehmer J, Battula N, et al. Biotransformation of caffeine and theophylline in mammalian cell lines genetically engineered for expression of single cytochrome P450 isoforms. Biochem Pharmacol 1992 Jan 22; 43 (2): 225-35
48. Schubert W, Eriksson U, Edgar B, et al. Flavonoids in grapefruit juice inhibit the in vitro hepatic metabolism of 17 beta-estradiol. Eur J Drug Metab Pharmacokinet 1995 Jul-Sep; 20 (3): 219-24
49. Zhang YD, Lorenzo B, Reidenberg MM. Inhibition of 11 beta-hydroxysteroid dehydrogenase obtained from guinea pig kidney by furosemide, naringenin and some other compounds. J Steroid Biochem Mol Biol 1994 May; 49 (1): 81-5
50. Lee YS, Lorenzo BJ, Koufis T, et al. Grapefruit juice and its flavonoids inhibit 11 beta-hydroxysteroid dehydrogenase. Clin Pharmacol Ther 1996 Jan; 59 (1): 62-71
51. Vanakoski J, Mattila MJ, Seppala T. Grapefruit juice does not enhance the effects of midazolam and triazolam in man. Eur J Clin Pharmacol 1996; 50 (6): 501-8
52. Neutel CI. Risk of traffic accident injury after a prescription for a benzodiazepine. Ann Epidemiol 1995 May; 5 (3): 239-44
53. Merkel U, Sigusch H, Hoffmann A. Grapefruit juice inhibits 7-hydroxylation of coumarin in healthy volunteers. Eur J Clin Pharmacol 1994; 46 (2): 175-7
54. Runkel M, Tegtmeier M, Legrum W. Metabolic and analytical interactions of grapefruit juice and 1,2- benzopyrone (coumarin) in man. Eur J Clin Pharmacol 1996; 50 (3): 225-30
55. Oesterheld J, Kallepalli BR. Grapefruit juice and clomipramine: shifting metabolitic ratios. J Clin Psychopharmacol 1997 Feb; 17 (1): 62-3
56. Lown KS, Kolars JC, Thummel KE, et al. Interpatient heterogeneity in expression of CYP3A4 and CYP3A5 in small bowel. Lack of prediction by the erythromycin breath test. Drug Metab Dispos 1994 Nov-Dec; 22 (6): 947-55
57. Morris K. Grapefruit juice: the leveller of drug metabolism. Lancet 1997 May 24; 349 (9064): 1524
58. Edwards DJ, Bellevue FH III, Woster PM. Identification of 6′,7′-dihydroxybergamottin, a cytochrome P450 inhibitor, in grapefruit juice. Drug Metab Dispos 1996 Dec; 24 (12): 1287-90
59. Fukuda K, Ohta T, Oshima Y, et al. Specific CYP3A4 inhibitors in grapefruit juice: furocoumarin dimers as components of drug interaction. Pharmacogenetics 1997 Oct; 7 (5): 391-6
60. Apseloff G, Milliard JB, Gerber N, et al. Inhibition and induction of drug metabolism by psoralens: alterations in duration of sleep induced by hexobarbital and in clearance of caffeine and hexobarbital in mice. Xenobiotica 1991 Nov; 21 (11): 1461-71
61. Apseloff G, Shepard DR, Chambers MA, et al. Inhibition and induction of theophylline metabolism by 8- methoxypsoralen. In vivo study in rats and humans. Drug Metab Dispos 1990 May-Jun; 18 (3): 298-303
62. Mays DC, Nawoot S, Hilliard JB, et al. Inhibition and induction of drug biotransformation in vivo by 8- methoxypsoralen: studies of caffeine, phenytoin and hexobarbital metabolism in the rat. J Pharmacol Exp Ther 1987 Oct; 243 (1): 227-33
63. Böcker RH, Guengerich FP. Oxidation of 4-aryl- and 4-alkyl-substituted 2,6-dimethyl-3,5- bis(alkoxycarbonyl)-1,4-dihydropyridines by human liver microsomes and immunochemical evidence for the involvement of a form of cytochrome P-450. J Med Chem 1986 Sep; 29 (9): 1596-603
64. Fitzsimmons ME, Collins JM. Selective biotransformation of the human immunodeficiency virus protease inhibitor saquinavir by human small-intestinal cytochrome P4503A4: potential contribution to high first-pass metabolism. Drug Metab Dispos 1997 Feb; 25 (2): 256-66
65. Gan LS, Moseley MA, Khosla B, et al. CYP3A-like cytochrome P450-mediated metabolism and polarized efflux of cyclosporin A in Caco-2 cells. Drug Metab Dispos 1996 Mar; 24 (3); 344-9
66. Jurima-Romet M, Crawford K, Cyr T, et al. Terfenadine metabolism in human liver, In vitro inhibition by macrolide antibiotics and azole antifungals. Drug Metab Dispos 1994 Nov-Dec; 22 (6): 849-57
67. Kroemer HK, Gautier JC, Beaune P, et al. Identification of P450 enzymes involved in metabolism of verapamil in humans. Naunyn Schmiedebergs Arch Pharmacol 1993 Sep; 348 (3): 332-7
68. Thummel KE, D OS, Paine MF, et al. Oral first-pass elimination of midazolam involves both gastrointestinal and hepatic CYP3A-medialed metabolism. Clin Pharmacol Ther 1996 May; 59 (5): 491-502
69. Varhe A, Olkkola KT, Neuvonen PJ. Diltiazem enhances the effects of triazolam by inhibiting its metabolism. Clin Pharmacol Ther 1996 Apr; 59 (4): 369-75
70. Kolars JC, Awni WM, Merion RM, et al. First-pass metabolism of cyclosporin by the gut. Lancet 1991 Dec 14; 338 (8781): 1488-90
71. Barry M, Gibbons S, Back D, et al. Protease inhibitors in patients with HIV disease. Clinically important pharmacokinetic considerations. Clin Pharmacokinet 1997 Mar; 32 (3): 194-209
72. Ueda CT, Williamson BJ, Dzindzio BS. Absolute quinidine bioavailability. Clin Pharmacol Ther 1976 Sep; 20 (3): 260-5
73. Hardman JG, Gilman AG, Limbird LE, editors. Goodman & Gilman's the pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill, 1996
74. Ueng YF, Kuwabara T, Chun YJ, et al. Cooperatively in oxidations catalyzed by cytochrome P4503A4. Biochemistry 1997 Jan 14; 36 (2): 370-81
75. Ameer B, Weintraub RA, Johnson JV, et al. Flavanone absorption after naringin, hesperidin, and citrus administration. Clin Pharmacol Ther 1996 Jul; 60 (1): 34-40
76. Fuhr U, Kummert AL. The fate of naringin in humans: a key to grapefruit juice-drug interactions? Clin Pharmacol Ther 1995 Oct; 58 (4): 365-73
77. Larkin M. Out with the jab, in with painless pills. Lancet 1997 Jun 7; 349 (9066): 1676
78. Robinson JWL, L'Herminier ML, Claudet HGA. The effect of naringenin on the intestinal and renal transport of organic solutes. Naunyn Schmiedeberg's Arch Pharmacol 1979; 307: 79-89
79. Ranganna S, Govindarajan VS, Ramana KV. Citrus fruits - varieties, chemistry, technology, and quality evaluation. Part II. Chemistry, technology, and quality evaluation. A. Chemistry. Crit Rev Food Sci Nutr 1983; 18 (4): 313-86
80. Hagen RE, Dunlap WJ, Mizelle JW, et al. A chromatographic-fluorometric method for determination of naringin, naringenin rutinoside, and related flavanone blycosides in grapefruit juice and juice sacs. Anal Biochem 1965 Sep; 12 (3): 472-82
81. Ranganna S, Govindarajan VS, Ramana KV. Citrus fruits. Part II. Chemistry, technology, and quality evaluation. B. Technology. Crit Rev Food Sci Nutr 1983; 19 (1): 1-98
82. 3. Can J Microbiol 1971; 17: 129-31
83. Fuhr U, Hensler S, Weindel M, et al. Biotransformation of naringin to naringenin by bacteria from human feces [abstract]. Naunyn Schmiedeberg's Arch Pharmacol 1996 Mar; 353 Suppl: R156
84. Green MD, Oturu ME, Tephly TR. Stable expression of a human liver UDP-glucuronosyltransferase (UGT2B15) with activity toward steroid and xenobiotic substrates. Drug Metabol Dispos 1994; 22: 709-805
85. Miniscalco A, Lundahl J, Regardh CG, et al. Inhibition of dihydropyridine metabolism in rat and human liver microsomes by flavonoids found in grapefruit juice. J Pharmacol Exp Ther 1992 Jun; 261 (3): 1195-9
86. Guengerich FP, Kim DH. In vitro inhibition of dihydropyridine oxidation and aflatoxin B1 activation in human liver microsomes hy naringenin and other flavonoids. Carcinogenesis 1990 Dec; 11 (12): 2275-9
87. Ghosal A, Satoh H, Thomas PE, et al. Inhibition and kinetics of cytochrome P4503A activity in microsomes from rat, human, and cdna-expressed human cytochrome P450. Drug Metab Dispos 1996 Sep; 24 (9): 940-7
88. Fuhr U, Kroemer HK, Schymanski P. Effects of naringenin and naringin on verapamil metabolism in human liver microsomes [abstract]. Naunyn-Schmiedeberg's Arch Pharmacol 1993 Mar; 347 Suppl: R31
89. Merkel U. Der Einfluß von Fluvonoiden auf die Aktivität und Kinetik ausgewählter Cytochrom P450-Enzyme bei Mensch und Maus. [PhD thesis]. Halle-Wittenberg, Germany: Martin Luther Universität, 1996
90. Fisher JF, Nordby HE, Waiss Jr AC, et al. A new coumarin from grapefruit peel oil. Tetrahedron 1967 Jun; 23 (6): 2523-8
91. Ha HR, Chen J, Leuenberger PM, et al. In vitro inhibition of midazolam and quinidine metabolism by flavonoids. Eur J Clin Pharmacol 1995; 48 (5): 367-71
92. Riov J, Goren R, Monselise SP, et al. Effect of gamma radiation on the synthesis of scopoletin and scopolin in grapefruit peel in relation to radiation damage. Radiat Res 1971 Feb; 45 (2): 326-34
93. Tatum JH, Berry RE. Coumarins and psoralens in grapefruit peel oil. Phytochemistry 1979; 18 (3): 500-2
94. Edwards DJ, Bernier SM. Naringin and naringenin are not the primary CYP3A inhibitors in grapefruit juice. Life Sci 1996; 59 (13): 1025-30
95. Fukuda K, Ohta T, Yamazoe Y. Grapefruit component interacting with rat and human P450 CYP3A: possible involvement of non-flavonoid components in drug interaction. Biol Pharm Bull 1997 May; 20 (5): 560-4
96. Bendriss EK, Bechtel Y, Bendriss A, et al. Inhibition of caffeine metabolism by 5-methoxypsoralen in patients with psoriasis. Br J Clin Pharmacol 1996 May; 41 (5): 421-4
97. Cai Y, Baer-Dubowska W, Ashwood-Smith M, et al. Inhibitory effects of naturally occurring coumarins on the metabolic activation of benzo[a]pyrene and 7,12-dimethylbenz[a]anthracene in cultured mouse keratinocytes. Carcinogenesis 1997 Jan; 18 (1): 215-22
98. Maenpaa J, Juvonen R, Raunio H, et al. Metabolic interactions of methoxsalen and coumarin in humans and mice. Biochem Pharmacol 1994 Oct 7; 48 (7): 1363-9
99. Mays DC, Camisa C, Cheney P, et al. Methoxsalen is a potent inhibitor of the metabolism of caffeine in humans. Clin Pharmacol Ther 1987 Dec; 42 (6): 621-6
100. Mays DC, Hilliard JB, Wong DD, et al. Activation of 8-methoxypsoralen by cytochrome P-450. Enzyme kinetics of covalent binding and influence of inhibitors and inducers of drug metabolism. Biochem Pharmacol 1989 May 15; 38 (10): 1647-55
101. Zaigler M. Charakterisierung von Inhibitoren des Cytochrom P450-Enzyms CYP1A2 beim Menschen. [MD thesis]. Frankfurt am Main, Germany: Johann Wolfgang Goethe Universität, 1996
102. Mays DC, Hilliard JB, Wong DD, et al. Bioactivation of 8-methoxypsoralen and irreversible inactivation of cytochrome P-450 in mouse liver microsomes: modification by monoclonal antibodies, inhibition of drug metabolism and distribution of covalent adducts. J Pharmacol Exp Ther 1990 Aug; 254 (2): 720-31
103. Schmiedlin-Ren P, Edwards DJ, Fitzsimmons ME, et al. Mechanisms of enhanced oral bioavailability of CYP3A4 substrates by grapefruit juice constituents. Decreased enterocyte CYP3A4 concentration and mechanism-based inactivation by furanocoumarins. Drug Metab Dispos 1997; 25 (11): 1228-1233
104. Runkel M, Bourian M, Tegtmeier M, et al. The role of naringin in the interaction of drugs with juices of grapefruit juice [abstract]. Naunyn Schmiedeberg's Arch Pharmacol 1997 Mar; 355 Suppl. 4: R123
105. Steinmetz KA, Potter JD. Vegetables, fruit, and cancer prevention: a review. J Am Diet Assoc 1996 Oct; 96 (10): 1027-39
106. Willett WC. Diet and health: what should we eat? Science 1994 Apr 22; 264 (5158): 532-7
107. Cerda JJ, Robbins FL, Burgin CW, et al. The effects of grapefruit pectin on patients at risk for coronary heart disease without altering diet or lifestyle. Clin Cardiol 1988 Sep; 11 (9): 589-94
108. So FV, Guthrie N, Chambers AF, et al. Inhibition of human breast cancer cell proliferation and delay of mammary tumorigenesis by flavonoids and citrus juices. Nutr Cancer 1996; 26 (2): 167-81
109. Hollander AA, van der Woude FJ, Cohen AH. Effect of grapefruit juice on blood cyclosporin concentration [letter]. Lancet 1995 Jul 8; 346 (8967): 123
110. Johnston A, Holt DW. Effect of grapefruit juice on blood cyclosporin concentration. Lancet 1995 Jul 8; 346 (8967): 122-3
111. Majeed A, Kareem A. Effect of grapefruit juice on cyclosporine pharmacokinetics. Pediatr Nephrol 1996 Jun; 10 (3): 395-6
112. Pisarik P. Blood pressure-lowering effect of adding grapefruit juice to nifedipine and terazosin in a patient with severe renovascular hypertension. Arch Fam Mod 1996 Jul-Aug; 5 (7): 413-6
113. Taniguchi S, Kobayashi H, Ishii M. Treatment of psoriasis by cyclosporine and grapefruit juice [letter]. Arch Dermatol 1996 Oct; 132 (10): 1249