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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Patient on January 14, 2004, at 16:44:41
Hi,
I wanted to post this in case others enjoy eating grapefruit (as I do), or drinking grapefruit juice while taking certain drugs. This information has probably been posted before-this is just a cautionary reminder.
My drug regimen until recent was 25mg trazodone about 8or9A.M., in late afternoon, and bedtime; as well as 10mg citalopram (Celexa) in mid morning. Celexa was just started about a week ago because of deep depression and severe irritability not helped by trazodone. I've been on traz. for a month. As of yesterday I started taking trazodone 25mg only at bedtime since trazodone can cause possible Celexa toxicity. No more depression since taking Celexa, as well as no more irritability. Sleep well from trazodone. Just a bit of daytime sleepiness about an hour or two after Celexa, followed by slight stimulation that lasts until evening-the usual SSRI start-up stimulation. All was well until today:
This late morning I had half a grapefruit with a late breakfast. I forgot about possible drug interactions with this fruit until after I ate the grapefruit. I decided to skip the Celexa. For the rest of the day I was unusually nervous, finger-chewing day, and heart rate up.
I thought it might be from the grapefruit I had first time this citrus season. I doubt it's from skipping Celexa, because it usually makes me a bit stimulated/on the nervous side about 3+ hrs. after taking it. I took 25mg traz. at noon to help relax me, which it always does an hour or less after taking it, as it did when I took it this morning. But this time it didn't do a thing.
From what I've read about Celexa's metabolism and how it has little effect on certain major enzymes, I didn't think I had to worry about eating grapefruit while taking this SSRI. But, it too can have possible reactions. Grapefruit certainly can interact with trazodone.
I did some searching and found the following information:
http://www.mhsource.com/expert/exp1111003e.html
Ask the Expertand how grapefruit's effects can last up to a day, according to some research:
http://216.239.37.104/search?q=cache:QDXj5dO5WcMJ:www.healthcentral.com/peoplespharmacy/pp_guides/PDF/gfruit02.pdf+trazodone+grapefruit&hl=en&ie=UTF-8
Posted by crazychickuk on January 15, 2004, at 2:50:56
In reply to Grapefruit interactions-trazodone and citalopram, posted by Patient on January 14, 2004, at 16:44:41
when i drank grape fruit, or orange juice i must say it sure made me anxious... especially when taking any med... including remeron..
Posted by Ame Sans Vie on January 15, 2004, at 7:11:30
In reply to Grapefruit interactions-trazodone and citalopram, posted by Patient on January 14, 2004, at 16:44:41
Thanks for posting this! Some of us here are well aware of the grapefruit juice interactions with many, many drugs via inhibition of metabolism through the CYP450 3A4 pathway, but it's important to have reminders for those who do not know and don't make a habit of reading through the PB archives.
Though I've known about this interaction for several years (ever since I read "Do not take with grapefruit or grapefruit juice" on the side of a bottle of Xanax and decided to read up on it), it's pretty shocking that only *one* doctor of the two dozen or so I've seen over the past few years ever mentioned this interaction. However, he actually brought it up as a way to increase the effects of the 3mg/day Xanax I was taking at the time so that he wouldn't have to write a larger prescription. I hate grapefruit juice, so he prescribed Serzone instead, which very potently inhibits 3A4 and approximately doubled the effects of the Xanax and increased duration by 150%.
Posted by Patient on January 15, 2004, at 8:48:47
In reply to Re: Grapefruit interactions-trazodone and citalopram, posted by Ame Sans Vie on January 15, 2004, at 7:11:30
Hello,
Yes, I found several old posts at Psycho-babble where doctor's are using the grapefruit effect on that isoenzyme as a way of increasing drug effects--this was for those who would have had to be on a very high dose of med. costing them much money for their drugs-I'd say it would be a tricky way to lower drug costs-tricky in knowing how much to lower the dose.
I hate grapefruit juice as well, but love fresh grapefruit-gotta have the pulp with the fresh juice, as well as the smell of the skin's oils when you raise it up to your mouth to squeeze every last drop of juice in. Yummy!
Posted by PoohBear on January 15, 2004, at 13:22:12
In reply to Grapefruit interactions-trazodone and citalopram, posted by Patient on January 14, 2004, at 16:44:41
I love grapefruit, but after reading the above post regarding the study in Canada and the reference to bergamot (as the suspected enzyme inhibitor in grapefruit...), is there a problem with Earl Grey tea, which also contains bergamot?
TR
Posted by Patient on January 17, 2004, at 19:37:20
In reply to Re: Grapefruit interactions-trazodone and citalopram » Patient, posted by PoohBear on January 15, 2004, at 13:22:12
Hello,
And I'm so glad you asked this question!
You caused me some concern with your question, because I didn't know the answer, and I too drink Earl Grey tea. My husband and I drink all sorts and varieties of hot teas, but lately we have been drinking Earl Grey since we are low on stores of teas, and I have yet to reorder more-lately I've been craving Yunnan, Hyson, Keemun, and Oolong.
Anyway,
Until now, I thought that Earl Grey tea got it's unique flavouring from the herbal mint plant known botanically as monarda (several varieties), commonly known as Begamot, as well as Bee Balm, Oswego Tea, and Horsemint. Now I know it comes from the essential oils of the Bergamot orange. You can read more about Earl Grey's ingredients here:
http://store.yahoo.com/englishteastore/earlgreytea.html
This site
http://www.safer-world.org/e/chem/limones.htm
lists some of the chemicals in citrus bergamia (Bergamot orange): "It contains 35-45% L-linalyl acetate, about 6% linalool, D-limonene, DL-limonene, bergaptene". I don't know if it contains bergamottin (6, 7,-dihydroxybergamottin (DHB), a furanocoumarin, which is sold by some body building sources as an anabolic/hormone enhancer.I'd be on the cautious side since the root word "bergamot" is found in this compound's name, and both are citrus fruits, though one is an oil extraction, the other from the juice. So far, I haven't noticed any reaction like I had a few days ago with that half of grapefruit I ate. I may experiment again and see if the same experience happens, just so I know it wasn't from some other cause. I just know that after taking trazodone to help calm my nervousness, that it didn't do anything--very unusual--for I always feel a "drugged" effect within an hour or less after taking Desyrel (traz.). I've had Earl Grey tea every day for the past week and no nervousness or tachychardia (fast heart rate) from it.
Technical reading about this compound is found here:
http://216.239.37.104/search?q=cache:wIduc8cSNVgJ:www.techtransfer.wayne.edu/96-387NPD2.doc+bergamottin++%22description%22+-buy&hl=en&ie=UTF-8
This is the end of the thread.
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