Patients had a drug overdose. She took an overdose of orange juice.
42-year-only respond when her husband took her to the emergency room. Her heart rate slowed down, and blood pressure falls. The doctors had to insert a breathing tube, and then the pacemaker to revive him.
They are confused: the husband said he was suffering from migraine patients and taking blood pressure medication called verapamil to help prevent headaches. However, a blood test showed he had an alarming amount of drugs in his system, five times the safe level.
Did he overdose? Is he trying to commit suicide? It was only after I came back from the doctors were able to piece the story together.
"The culprit was orange juice," said Dr. Unni Pillai, a nephrologist at St. Louis, Missouri, who treated her for several years and later published a case report. "He loves orange juice, and he had a bad migraine with nausea and vomiting, can not tolerate anything else."
The previous week had been living mainly orange juice. Then take verapamil, one of dozens of drugs whose strength increases dramatically when taken with grapefruit. In your case, the interaction is ephemeral.
Last month, Dr David Bailey, a Canadian researcher who first described this interaction more than two decades ago, published an updated list of drugs affected by grapefruit. Currently there are 85 such drugs on the market, he said, including the common cholesterol-lowering drugs, a new anticancer and synthetic opiates and some psychiatric medications and certain immunosuppressive drugs taken by organ transplant patients, some AIDS drugs, and some birth control pills and estrogen treatment. (A full list online.)
"What prompted us to write this paper is the number of new drugs that have come in the last four years," said Dr. Bailey, a clinical pharmacologist at the Lawson Health Research Institute, which was discovered by accident in the interaction of the 1990s.
How often the reaction, however, and how often triggered in people who consume a juice regularly debated by scientists. Dr. Bailey believes that many cases are lost because doctors do not think to ask if patients consume grapefruit or grapefruit juice.
Although such incidents are rare, Dr. Bailey argues, totally predictable and avoidable. Many hospitals do not serve juice, and some recipes with a label warning patients to avoid grapefruit.
"The bottom line is that even if the frequency is low, the consequences can be very serious," he said. "Why do we have to have a body count before making the change?"
For 43 of the 85 drugs on the list now, grapefruit consumption can be life threatening, Dr. Bailey. Many of them are associated with increased heart rate, known as torsade de pointes, which can lead to death. This can happen even without underlying heart disease and has been seen in patients taking certain anticancer agents, erythromycin, and other anti-infection, some cardiovascular drugs such as quinidine, antipsychotic lurasidone and ziprasidone, cisapride and domperidone gastrointestinal agents, and solifenacin, serving for the treatment of overactive bladder.
Taken with orange, other drugs such as fentanyl, oxycodone and methadone can cause fatal respiratory depression. Interactions can also be caused by other citrus, such as Seville oranges, limes, and grapefruit, case reports have suggested that pomegranate can increase the potential for certain drugs.
Parents may be more vulnerable because they are more likely to become more and take medications drink orange juice. The body's ability to deal with drugs also weakened with age, experts say.
Under normal circumstances, the drug is metabolized in the gastrointestinal tract and is absorbed relatively little, because intestinal CYP3A4 enzyme calling disabled. But Grapefruit contains natural chemicals called furanocoumarins, which inhibits the enzyme, and the intestines absorb no more than one drug and blood levels increase dramatically.
For example, someone taking simvastatin (Zocor brand) also took a small 200 ml, or 6.7 ounces, a glass of grapefruit juice once a day for three days, could see the blood levels of the three drugs, increase the risk of rhabdomyolysis, muscle disorder that can cause kidney damage.
Estradiol and ethinyl estradiol, a form of estrogen used in oral contraceptives and hormone replacement, also interact with grapefruit juice. In one case in the Lancet, who took birth control pills Yaz 42-year control of developing serious blood clots that threatened her feet for a few days after he started eating oranges a day, said Dr. Lucinda Grande, a doctor in Lacey, Washington, and author of the case report .
But Dr Grande also noted that patients had other risk factors and unusual circumstances. "The reason the case is due to be published as it was very strange," he said. "We must be careful not to overdo it."
Some drugs that have "various therapies" narrow - you have a little too much or too little can have serious consequences - require vigilance on the oranges, says Patrick McDonnell, a clinical associate professor of pharmacy practice at Temple University. These include immunosuppressive agents such as cyclosporine taking transplant patients to prevent rejection of the donated organ, said.
However, Dr McDonnell added, most patients suffering from adverse reactions that consume large amounts of grapefruit. "There is a difference between the occasional orange and someone drank 16 ounces of orange juice per day," he said.
And he warned, "Not all drugs of the same class that fits in the same way." While some statins are affected by grapefruit, for example, others are not.
Here are some tips from experts for orange lovers:
1. If you take oral medication of any kind, check the list to see if it interacts with grapefruit. Make sure you understand the potential side effects of the interaction, and if they are threatening or cause permanent injury, avoid orange. Some drugs, such as clopidogrel, may be less effective when taken with grapefruit.
2. If you are taking one of these drugs on a regular basis, keep in mind that you may want to avoid grapefruit and grapefruit, lime and marmalade. Watch out for symptoms that could be a side effect of the drug. If you are on a statin, this may be an unusual muscle pain.
3. It is not enough to avoid taking your medicine at the same time with oranges. You should avoid eating grapefruit whole period you are on drugs.
4. It's generally a good idea to avoid sudden drastic change in diet and an extreme diet that is based on a small amount of food. If you can not live without oranges, ask your doctor if there is an alternative medicine for you.
42-year-only respond when her husband took her to the emergency room. Her heart rate slowed down, and blood pressure falls. The doctors had to insert a breathing tube, and then the pacemaker to revive him.
They are confused: the husband said he was suffering from migraine patients and taking blood pressure medication called verapamil to help prevent headaches. However, a blood test showed he had an alarming amount of drugs in his system, five times the safe level.
Did he overdose? Is he trying to commit suicide? It was only after I came back from the doctors were able to piece the story together.
"The culprit was orange juice," said Dr. Unni Pillai, a nephrologist at St. Louis, Missouri, who treated her for several years and later published a case report. "He loves orange juice, and he had a bad migraine with nausea and vomiting, can not tolerate anything else."
The previous week had been living mainly orange juice. Then take verapamil, one of dozens of drugs whose strength increases dramatically when taken with grapefruit. In your case, the interaction is ephemeral.
Last month, Dr David Bailey, a Canadian researcher who first described this interaction more than two decades ago, published an updated list of drugs affected by grapefruit. Currently there are 85 such drugs on the market, he said, including the common cholesterol-lowering drugs, a new anticancer and synthetic opiates and some psychiatric medications and certain immunosuppressive drugs taken by organ transplant patients, some AIDS drugs, and some birth control pills and estrogen treatment. (A full list online.)
"What prompted us to write this paper is the number of new drugs that have come in the last four years," said Dr. Bailey, a clinical pharmacologist at the Lawson Health Research Institute, which was discovered by accident in the interaction of the 1990s.
How often the reaction, however, and how often triggered in people who consume a juice regularly debated by scientists. Dr. Bailey believes that many cases are lost because doctors do not think to ask if patients consume grapefruit or grapefruit juice.
Although such incidents are rare, Dr. Bailey argues, totally predictable and avoidable. Many hospitals do not serve juice, and some recipes with a label warning patients to avoid grapefruit.
"The bottom line is that even if the frequency is low, the consequences can be very serious," he said. "Why do we have to have a body count before making the change?"
For 43 of the 85 drugs on the list now, grapefruit consumption can be life threatening, Dr. Bailey. Many of them are associated with increased heart rate, known as torsade de pointes, which can lead to death. This can happen even without underlying heart disease and has been seen in patients taking certain anticancer agents, erythromycin, and other anti-infection, some cardiovascular drugs such as quinidine, antipsychotic lurasidone and ziprasidone, cisapride and domperidone gastrointestinal agents, and solifenacin, serving for the treatment of overactive bladder.
Taken with orange, other drugs such as fentanyl, oxycodone and methadone can cause fatal respiratory depression. Interactions can also be caused by other citrus, such as Seville oranges, limes, and grapefruit, case reports have suggested that pomegranate can increase the potential for certain drugs.
Parents may be more vulnerable because they are more likely to become more and take medications drink orange juice. The body's ability to deal with drugs also weakened with age, experts say.
Under normal circumstances, the drug is metabolized in the gastrointestinal tract and is absorbed relatively little, because intestinal CYP3A4 enzyme calling disabled. But Grapefruit contains natural chemicals called furanocoumarins, which inhibits the enzyme, and the intestines absorb no more than one drug and blood levels increase dramatically.
For example, someone taking simvastatin (Zocor brand) also took a small 200 ml, or 6.7 ounces, a glass of grapefruit juice once a day for three days, could see the blood levels of the three drugs, increase the risk of rhabdomyolysis, muscle disorder that can cause kidney damage.
Estradiol and ethinyl estradiol, a form of estrogen used in oral contraceptives and hormone replacement, also interact with grapefruit juice. In one case in the Lancet, who took birth control pills Yaz 42-year control of developing serious blood clots that threatened her feet for a few days after he started eating oranges a day, said Dr. Lucinda Grande, a doctor in Lacey, Washington, and author of the case report .
But Dr Grande also noted that patients had other risk factors and unusual circumstances. "The reason the case is due to be published as it was very strange," he said. "We must be careful not to overdo it."
Some drugs that have "various therapies" narrow - you have a little too much or too little can have serious consequences - require vigilance on the oranges, says Patrick McDonnell, a clinical associate professor of pharmacy practice at Temple University. These include immunosuppressive agents such as cyclosporine taking transplant patients to prevent rejection of the donated organ, said.
However, Dr McDonnell added, most patients suffering from adverse reactions that consume large amounts of grapefruit. "There is a difference between the occasional orange and someone drank 16 ounces of orange juice per day," he said.
And he warned, "Not all drugs of the same class that fits in the same way." While some statins are affected by grapefruit, for example, others are not.
Here are some tips from experts for orange lovers:
1. If you take oral medication of any kind, check the list to see if it interacts with grapefruit. Make sure you understand the potential side effects of the interaction, and if they are threatening or cause permanent injury, avoid orange. Some drugs, such as clopidogrel, may be less effective when taken with grapefruit.
2. If you are taking one of these drugs on a regular basis, keep in mind that you may want to avoid grapefruit and grapefruit, lime and marmalade. Watch out for symptoms that could be a side effect of the drug. If you are on a statin, this may be an unusual muscle pain.
3. It is not enough to avoid taking your medicine at the same time with oranges. You should avoid eating grapefruit whole period you are on drugs.
4. It's generally a good idea to avoid sudden drastic change in diet and an extreme diet that is based on a small amount of food. If you can not live without oranges, ask your doctor if there is an alternative medicine for you.
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