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1087Re: [METHADONIA ] grapefruit juice and methadone

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  • Dann White
    Jan 16, 2004
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      Well my Mrs. certainly must have known what she was talking about-she likes
      the Ruby Red Tropicana but that is white GF juice with Grape juice added
      for color-didn't know such an offhand remark could get such a response

      Dann and Elizabeth (The Florida Grapefruit Juice Girl)


      > [Original Message]
      > From: James <friendlyfarmer2001@...>
      > To: <DOLOPHINEA_CAFE@yahoogroups.com>
      > Cc: <friendlyfarmer2001@...>
      > Date: 1/15/2004 3:39:15 PM
      > Subject: Re: [METHADONIA ] grapefruit juice and methadone
      >
      > Now there Ms.ssv55 this is indeed some wonderfull news
      > if it's true,I thank you for the 'post of the month'
      > and will give a follow up Sunday and tell all if
      > indeed this "white grapefruit " advice did in fact
      > work on me !
      > Thanks,
      > Jim/friendlyfarmer2001
      >
      > --- ssv55@... wrote:
      > > Hello Dann and RG,
      > > White grapefruit juice also affects drug metabolism.
      > > Some patients
      > > have had
      > > good results potentiating an inadequate dose by
      > > drinking 8 ozs. of
      > > WHITE
      > > grapefruit juice when dosing. �I found this info at
      > > the following
      > > URL:
      > >
      > > http://www.vhpharmsci.com/document/Article22.htm
      > >
      > > When ingested together, grapefruit juice can
      > > interact with various
      > > medications, resulting in potentially toxic drug
      > > levels and
      > > adverse effects.
      > >
      > > Certain bioflavonoids contained in citrus juices can
      > > affect drug
      > > metabolism.
      > > The major bioflavonoid in grapefruit juice is
      > > naringin, which is
      > > partially metabolized
      > > by enteral bacteria to form naringenin.1,2
      > > Naringenin is a potent
      > > inhibitor of the
      > > cytochrome p450 liver enzymes: CYP1A2, CYP3A3 and
      > > CYP3A4. There is
      > > however,considerable inter-individual variability in
      > > the effects of
      > > grapefruit juice on
      > > drug metabolism, in part due to :
      > > 1) amount of naringenin formed by an individual,
      > > 2) amount of naringin present in a brand of
      > > grapefruit juice,
      > > 3) dilution of grapefruit juice used, and
      > > 4) other substances in grapefruit juice accounting
      > > for the
      > > interaction.
      > >
      > > Table 4 lists drugs whose levels may significantly
      > > increase if given
      > > concomitantly with grapefruit juice. CSU
      > > Pharmaceutical Sciences will
      > > place a label
      > > stating "Do not take with grapefruit juice" if a
      > > patient is ordered
      > > any drug listed
      > > below.
      > >
      > > Table 4. Grapefruit Juice-Drug Interactions
      > >
      > > Drug
      > > � � � � � � � � � � � � � �
      > > � � � � � �
      > > Dihydropyridine Calcium Channel Blockers:
      > > -amlodipine�
      > > -felodipine
      > > -nicardipine
      > > -nifedipine�
      > > AVOID grapefruit juice OR monitor for decreased BP,
      > > increased HR if
      > > taken together
      > >
      > > Terfenadine
      > > AVOID grapefruit juice as may result in
      > > cardiotoxicity (prolonged QT
      > > interval)
      > >
      > > Cyclosporine�
      > > �AVOID grapefruit juice, unless prescribed to
      > > specifically
      > > increase cyclosporine levels
      > >
      > > HMG-CoA Reductase Inhibitors (Statins)�:
      > > -atorvastatin
      > > -cerivastatin
      > > -lovastatin
      > > -simvastatin�
      > > AVOID grapefruit juice as potential for myopathy or
      > > rhabdomyolysis�
      > >
      > > Cisapride�
      > > �AVOID grapefruit juice as potential for
      > > cardiotoxicity (torsades
      > > de pointes, prolonged
      > > QT interval)�
      > >
      > > Benzodiazepines
      > > -triazolam
      > > -oral midazolam�
      > > AVOID grapefruit juice or monitor for increased
      > > sedation if used
      > > together
      > >
      > > Quinidine�
      > > AVOID; significance unknown
      > >
      > > Saquinavir
      > > AVOID; signficance unknown
      > >
      > > Estrogens
      > > -ethinyl estradiol�
      > > -17� estradiol
      > > AVOID - significance unknown
      > > ====================================================
      > > ====================================================
      > >  http://www.atforum.com/pages/current_pastissues
      > > /Vol6s97.html#anchor649123
      > >
      > >
      > >
      > >
      > >
      > >
      > >
      > > OTC Drugs, Juice, Vitamins
      > > John St. Peter, PharmD, BCPS - Pharmacist in Charge
      > > for HFA, and
      > > Assistant Professor,
      > > College of Pharmacy at the University of Minnesota -
      > > has previously
      > > expressed
      > > concern in Addiction Treatment Forum (Vol. IV, #2)
      > > about the
      > > potential interactions of
      > > methadone with OTC medications, tobacco, and
      > > caffeine. He noted, for
      > > example, that
      > > acetaminophen (e.g., Excedrin�, Tylenol�) has
      > > inherent
      > > toxicities which can affect
      > > hepatic drug metabolism and impact methadone blood
      > > levels.
      > > St. Peter and his clinical team have also observed
      > > that there are
      > > drug metabolism
      > > differences between ethnic groups, such as Asians,
      > > Caucasians, and
      > > African-
      > > Americans. Age also plays a role affecting changes
      > > in drug
      > > metabolism. Other sources
      > > have noted that some persons are naturally "aberrant
      > > metabolizers"
      > > and "burn away"
      > > methadone up to four times faster than others. The
      > > specific roles of
      > > these differences
      > > regarding methadone metabolism, however, are still
      > > under
      > > investigation by the HFA
      > > team.
      > > There has been some mention, often anecdotally, of
      > > grapefruit juice
      > > intensifying
      > > methadone's effects when the two are regularly taken
      > > together.
      > > According to
      > > Andersen and Payte, grapefruit juice appears to
      > > inhibit certain
      > > enzymes (CYP-450
      > > activity) that metabolize methadone in the liver,
      > > thus slowing its
      > > breakdown. Hence,
      > > higher blood plasma levels of methadone than
      > > expected might possibly
      > > result. Some
      > > sources have attributed naturally high
      > > concentrations of flavonoids
      > > in grapefruit juice
      > > as producing this effect.
      > > Contrary to current myth, there is no accepted
      > > evidence that orange
      > > juice produces
      > > similar potentiating effects. However, Payte
      > > mentions that large
      > > doses of vitamin C
      > > (the amount might vary by individual) could create a
      > > more acidic
      > > urine leading to
      > > decreased methadone blood levels. This is because
      > > the acidic
      > > condition inhibits
      > > reabsorption of methadone by the kidneys, so more of
      > > the drug is lost
      > > in the urine.
      > > The plasma half-life of methadone could be reduced
      > > to as little as
      > > 16-20 hours in an
      > > acid urine. Conversely, in an alkaline urine (pH
      > > 7.8) a half-life of
      > > 42.1 +/- 8.8 hours
      > > has been reported
      > > ====================================================
      > >
      > > I have also read that Tagament can increase the
      > > blood concentration
      > > of methadone,
      > >
      > === message truncated ===
      >
      >
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