![]() ![]() Sucrose is a disaccharide that is hydrolyzed into 2 component monosaccharides, glucose and fructose, by sucrase present in the small bowel epithelium. The 4 major sugars in juice are sucrose, glucose, fructose, and sorbitol. Consultation between the physician and pharmacist can be beneficial in considering the potential clinical significance of a juice-drug interaction. The amount and type of juice being ingested, 9 specific information characterizing a given interaction, and whether the drug(s) being taken has a low (eg, antiretrovirals, calcineurin inhibitors, calcium channel blockers, warfarin) or high therapeutic index must be considered in the evaluation of a potential interaction. 10 In evaluating the potential juice-drug interactions, the coadministration of fruit juice and a drug for which metabolism or transport could be affected by a flavonoid should not be considered immediately as a contraindication for treatment. Substantial variability in the duration and magnitude of resultant interactions is a function of multiple factors, including the following: (1) constitutive expression of the effected enzyme or transport protein, (2) significant genetic polymorphism in the enzyme (eg, CYP2C9) or transporter, (3) the relative flavonoid composition and potency among different juices, and (4) the amount of juice ingested and its duration of ingestion (eg, consumption of 1 to 2 L/day of cranberry juice in an adult may be required to produce a significant interaction with warfarin). The clinical significance of any of the aforementioned juice-drug interactions is extremely difficult to predict on the basis of a history of coingestion. 8 Although the grapefruit juice–CYP3A4 substrate interaction and the potential for producing significant nutrient-drug interactions is the most well characterized, it should be noted that, in addition to inhibiting CYP3A4 activity, cranberry, pomegranate, and blueberry juice can inhibit the activity of CYP2C9, 10, 12 a cytochrome P450 isoform that catalyzes the biotransformation of therapeutic drugs such as ibuprofen, flurbiprofen, warfarin, phenytoin, fluvastatin, and amitriptyline. 9 In addition to grapefruit juice, flavonoids present in oranges and apples have also been shown to reduce the activity of the organic acid transporter OATP2B1. ![]() 8, – 12 Although the ingestion of grapefruit juice has been shown to reduce the activity of intestinal cytochrome P450 3A4 (CYP3A4) and produce potential drug-nutrient interactions (eg, increased bioavailability) of drugs that are CYP3A4 substrates (eg, cyclosporine, tacrolimus, atorvastatin, felodipine, fexofenadine, specific antiretroviral agents), recent evidence suggests that grapefruit juice can also inhibit organic acid transporter activity. Trending Questions How many calories in 3 oz of roasted turkey? What is the Perilla leaves calorie count? How much honey is too much and overload? What are proteins and what do they do for your body? What is Generic term use for Breakfast Lunch Dinner? What are bioflavonoids? Insufficient vitamin D during childhood is associated with? What is the ideal weight of a 50 year old man who is 5' 9 tall? What is the RDA for folate for a woman weighing 132 pounds? How are macro nutrients and micro nutrients supplied to plants? You are 19 and 5ft tall.Juices from many fruit (eg, grapefruit, blueberry, pomegranate, apple) contain flavonoids (eg, naringin, naringenin, hesperidin, hesperetin, phloridzin, phloretin, quercetin, and kaempferol), which can decrease the activity of several enzymes and transport proteins important in drug disposition.
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