red apples

When allergy season arrives, what you want is relief. What you don’t need is an interaction between your medicine and the beverage you use to take it.

Years ago we were contacted by a grieving widow. She told us that her husband was in very good health except for allergies. The only non-sedating antihistamine on the market in that time period wasterfenadine (Seldane). It was a hot day and he was cutting the grass. He loved grapefruit juice and drank it several times a week. On this day he was hot and thirsty and consumed two glasses of grapefruit juice to quench his thirst.

Sadly, the combination of grapefruit and Seldane led to his collapse and death from an irregular heart rhythm. The death certificate listed terfenadine intoxication because the blood levels of the antihistamine were so high. In his case, the grapefruit juice affected the metabolism of the medication and raised the levels into the danger zone. The FDA eventually realized that the only way to solve the problem of Seldane interactions with grapefruit and other medications was to eliminate the drug from the market. Grapefruit is not the only juice that interact with medicine.

Juice and Drug Interactions:

Q. I know that grapefruit juice is a problem with my blood pressure pill felodipine. I wonder about other juices like apple and orange juice. Will they affect this or my allergy medication fexofenadine? It is so hard to tell what is safe to eat or drink with your medicine.

A. Grapefruit juice can indeed cause problems with many medications, including felodipine (Plendil), simvastatin (Zocor) and atorvastatin (Lipitor). Blood levels can rise and that may cause unanticipated side effects.

What About Apple Juice?

Other fruit juices may have the opposite effect on certain medications. Fexofenadine (Allegra) is an allergy medicine that might not work very well if taken with apple, orange or grapefruit juice. Such juices may dramatically reduce the absorption of fexofenadine. This could mean there is not enough medicine to relieve allergy symptoms for some people (Pharmacogenetics and Genomics, Feb., 2011).

Of far greater concern is the impact of orange and apple juice on other medications such as the blood pressure drug aliskiren (Tekturna) or the beta blocker heart medicine atenolol (Tenormin). In both cases blood levels were significantly diminished in the presence of apple or orange juice. That could translate into diminished effectiveness. A recent review underscored the potential problems of  juice-drug interactions and how much more there is to learn about such combinations (Journal of Clinical Pharmacology, online, Dec., 2015). Even green tea can have a substantial impact on the absorption of some medicines.

Why Not Water?

Many people get in the habit of taking their medicine with juice. It is probably a better idea to take pills with water. This is especially true for antibiotics, blood pressure medicine and drugs to prevent organ transplant rejection. But even something as seemingly simple as an over-the-counter allergy medicine like Allegra might work better if it were taken with water instead of apple juice.

Why Interactions Matter!

Ever since we first started reporting on grapefruit juice interactions over 20 years ago we have faced resistance by health professionals. At first physicians and pharmacists laughed at us for alerting people to these food, beverage and drug interactions.

When the science confirmed that dozens of drugs could be affected by grapefruit juice, the laughing stopped, but to this day there seems to be little interest in warning people about food and drug interactions or even some drug-drug incompatibilities. If these issues are of concern to you, you may wish to read the chapter on drug interactions in our book, Top Screwups Doctors Make and How to Avoid Them. We provide detailed steps people can take to avoid deadly drug interactions.

Revised March 31, 2016

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  1. TK
    NC
    Reply

    Grapefruit juice with Movantik is a huge no-no, too. But, other juices are supposed to be okay.

  2. MsM
    Reply

    My Mother’s friend died from taking grapefruit juice with her oral diabetes medicine which has since been pulled from the market.

  3. Chris
    Massachusetts
    Reply

    Excellent article! My only suggestion is that you replace apple with grapefruit juice since that was the killer. The title might read “Grapefruit Juice and Allergy Medicine Don’t Mix” instead. Thank you!

  4. Stephanie
    Colorado
    Reply

    I think it’s terrible that a doctor will write a prescription for you but not tell you about specific interactions, with food, drink or other prescriptions. Most have a laptop in front of them while you are in his exam room, so why not look this up before the patient leaves? I know they think they are too busy, but it would be the safe action to take.

  5. Randy
    Baltimore,MD
    Reply

    I drink pineapple/orange juice and I guess pineapple juice has no effect on drugs because I haven’t read anything about it. Am I right?

    • Terry Graedon
      Reply

      You might be right…or the research might not have been done yet.

  6. Larry M
    Raleigh, NC
    Reply

    So many people take Coumadin (Warfarin) that it would be remiss to fail to mention its grapefruit juice interaction. Grapefruit juice profoundly increases the metabolism of Coumadin. My INR went from a well-regulated 2.5 to a life-threatening 5.5 after switching my breakfast juice from 4 oz. of cranberry juice to 4 oz. of grapefruit juice. Fortunately it was caught after a day or two and no harm resulted.

  7. Susan
    SC
    Reply

    Just wanted to let the readers know that the brand name for atenolol is Tenormin, not Toprol as stated in this article.

  8. Deb
    Saginaw, MI
    Reply

    It is important to let readers know that, not only is it important to not take many medications with citrus juice, but avoid citrus juice altogether while on those medications because of the long-lasting effects of both.

  9. Rusti
    Reply

    As an asthmatic, on steroids and inhalers at one time, I learned a few things that work for both asthma and allergies, colds and even flu. I began taking Vitamin C with bioflavanoids and/or wild rosehips (not just ascorbic acid), and it’s worked most times stopping attacks within minutes. I’ve found it also works for most any upper respiratory problem I’ve had actually, in or out of allergy season, and along with apple cider vinegar it’s stopped early onsets of colds and even the flu on one occasion. I’ve taken it for so long I’m still amazed it’s not widespread known today. Perhaps it won’t work for everyone, but, I haven’t spoken to many who actually have tried it, so I really don’t know. And, taking it with fruit juices I’ve had no problem whatsoever. Actually, it may have helped. I also have a wholefood organic diet. Personally I believe allergies are an indication of a lowered immune system and why added vitamins like C are needed. I’ve been accused of working for “Big C”..lol but I assure you I don’t and, it costs pennies. :)

  10. Jennifer Y.
    Reply

    I have been told not to let my son drink orange drinks or citrus drinks with his allergy pills. What exactly can he not have? His allergy meds are Loratadine tablets.

  11. JJ
    Reply

    Is there a fexofenadine free allergy medicine? I (according to doctor-have a very ‘allergic nose’- however, each time I’ve taken that script- I break out in large welts on chest and torso.

  12. ds
    Reply

    I knew grapefruit juice with Lipitor was a no-no, but never knew why. Thanks for the answer.

  13. WW
    Reply

    Are there any foods or juices that I should avoid with Linsinopril/hydrochlorozide? I have recently started taking this for high blood pressure.

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