柚子和他汀类的药物不能一起吃吗?

从网上看了报道,柚子和他汀类不能一起吃,是谣言吗?它的作用原理是啥?是吃了他汀类就不能吃柚子还是需要隔几小时就没关系了?所有他汀都是这样吗?

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花公子Dermato-logist,-scopey,C...

2017-01-28 19:05

说法不完全正确,部分他汀类确实不能和葡萄柚同时服用,像立普妥(阿伐他汀钙片)的说明书上就明确提到。这主要是其药代学决定的,阿伐他汀的代谢途径主要是细胞色素P450(CYP) 3A4,而柚汁中有拮抗细胞色素P450 3A4的成分,可增加阿伐他汀的血药浓度,容易药物中毒。相同代谢途径的辛伐他汀也不能与柚汁同服。而氟伐他汀通过CYP替代途径代谢,则不存在此禁忌。

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z1w1j帝都大学PhDing

2017-01-29 18:59

葡萄柚等里面含的呋喃香豆素也是走的这个代谢途径,所以和药物代谢竞争。

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不光是他汀类,葡萄柚会影响很多药品的药效。

FDA官网:

Grapefruit juice and fresh grapefruit can interfere with the action of some prescription drugs, as well as a few non-prescription drugs.

This interaction can be dangerous, says Shiew Mei Huang, acting director of the Food and Drug Administration’s Office of Clinical Pharmacology. With most drugs that interact with grapefruit juice, “the juice increases the absorption of the drug into the bloodstream,” she says. “When there is a higher concentration of a drug, you tend to have more adverse events.”

For example, if you drink a lot of grapefruit juice while taking certain statin drugs to lower cholesterol, too much of the drug may stay in your body, increasing your risk for liver damage and muscle breakdown that can lead to kidney failure.

Drinking grapefruit juice several hours before or several hours after you take your medicine may still be dangerous, says Huang, so it’s best to avoid or limit consuming grapefruit juice or fresh grapefruit when taking certain drugs.

Examples of some types of drugs that grapefruit juice can interact with are:

  • some statin drugs to lower cholesterol, such as Zocor (simvastatin), Lipitor (atorvastatin) and Pravachol (pravastatin)
  • some blood pressure-lowering drugs, such as Nifediac and Afeditab (both nifedipine)
  • some organ transplant rejection drugs, such as Sandimmune and Neoral (both cyclosporine)
  • some anti-anxiety drugs, such as BuSpar (buspirone)
  • some anti-arrhythmia drugs, such as Cordarone and Nexterone (both amiodarone)
  • some antihistamines, such as Allegra (fexofenadine)

Grapefruit juice does not affect all the drugs in the categories above. Ask your pharmacist or other health care professional to find out if your specific drug is affected.

Too High or Too Low Drug Levels

Many drugs are broken down (metabolized) with the help of a vital enzyme called CYP3A4 in the small intestine. Certain substances in grapefruit juice block the action of CYP3A4, so instead of being metabolized, more of the drug enters the bloodstream and stays in the body longer. The result: potentially dangerous levels of the drug in your body.

The amount of the CYP3A4 enzyme in the intestine varies from one person to another, says Huang. Some people have a lot, and others have just a little—so grapefruit juice may affect people differently when they take the same drug.

While scientists have known for several decades that grapefruit juice can cause a potentially toxic level of certain drugs in the body, Huang says more recent studies have found that the juice has the opposite effect on a few other drugs.

https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm292276.htm

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