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Copyright © 2021 Natural Medicines (www.naturalmedicines.com)
August 2021

The Latest on Fruit Juice and Drug Interactions

Certain fruits and fruit juices are notorious for interacting with drugs, but there are many others that fly under the radar. Make sure you’re current on the most concerning interactions.

Goji berry juice is one to keep on your radar, particularly now that some people might be using it for COVID-19 prevention. Just recently there was a case report of a 75-year old patient who ended up in the ER with fainting and arrhythmia. It was determined that the patient was experiencing flecainide toxicity and elevated warfarin levels as a result of drinking 1-2 glasses of concentrated goji berry tea daily for 2 weeks. This was likely due to goji’s ability to slow the breakdown of both of these drugs. This is the first report of goji interacting with flecainide, but there are a number of previous reports describing an interaction with warfarin. And research suggests that goji may interact with a number of other drugs as well. Tell patients to avoid drinking goji juice entirely if they are taking any of these drugs. Simply separating them by a few hours won’t make a difference.

Also talk to your patients about apple juice. Drinking apple juice along with certain drugs can significantly reduce how much of the drug the body absorbs. Atenolol is a good example of this. Drinking about 2.5 cups of apple juice with atenolol can decrease drug levels by more than 58%, depending on how much apple juice is consumed. Similarly, drinking a little over 1.5 cups of apple juice with the allergy drug fexofenadine can reduce levels by up to 78%. Orange juice can also decrease levels of fexofenadine and other drugs. Tell patients to separate apple juice and orange juice from these medications by at least 4 hours.

One of the most notorious fruits that is known for drug interactions is grapefruit. While concerns about grapefruit are fairly well-known among providers, it’s important to continue to reiterate them to patients, especially now that grapefruit is being increasingly marketed as a super fruit. Grapefruit juice can have major interactions with a very long list of drugs, including benzodiazepines, atorvastatin, estrogens, sildenafil, simvastatin, and many more. As with goji, tell patients to avoid drinking grapefruit juice entirely if they are taking any of these drugs.

We’ll keep you up to date as new and notable fruit juice interactions arise – we are constantly adding new interactions to our monographs as they are identified. In the meantime, make sure to take advantage of our Interaction Checker – it allows you to quickly screen for interactions between natural medicines, including fruit juices, and conventional drugs. Using the interaction checker whenever a question or concern arises ensures that you will always be aware of interactions as they are identified.

The information in this brief report is intended for informational purposes only, and is meant to help users better understand health concerns. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions. Copyright © 2021 Natural Medicines Inc. Commercial distribution or reproduction prohibited. Natural Medicines is the leading provider of high-quality, evidence-based, clinically-relevant information on natural medicine, dietary supplements, herbs, vitamins, minerals, functional foods, diets, complementary practices, CAM modalities, exercises and medical conditions. Monograph sections include interactions with herbs, drugs, foods and labs, contraindications, depletions, dosing, toxicology, adverse effects, pregnancy and lactation data, synonyms, safety and effectiveness.