Grapefruit?

[Harvey]

Greetings!
     I am beginning 8th week of 12 on Harvoni and am trying to incorporate liver-friendly foods into my diet (beets, avocado, broccoli etc.).  I know Grapefruit and its juice can increase/extend the absorption of certain drugs and am curious and somewhat worried about its interaction with Harvoni.  Is it safe?  Is it helpful? Should it be avoided?  Does it matter?  If adding grapefruit while on Harvoni has led to more severe side-effects, what does that suggest?
     Any advice is greatly appreciated!

[Philadelphia]

I've seen other threads that say no to grapefruit - something to do with the absorption of the drugs - but I am not a doctor, nor do I play one on TV. I would steer away from it until I had a chance to ask my medical people, but that's me.

[Harvey]

Thanks Philadelphia,
     Yeah, everything I've read suggests that grapefruit enhances or prolongs the absorption of certain drugs and was curious if there was evidence good or bad with respect to Harvoni.   I hope all is going well with your treatment.   I too have type 1a, very stubborn!
Regards!

[Bree]

I was told not to have grapefruit by Gilead, Support Path nurse.  I going with their answer.

[Harvey]

Interesting Bree. 
I was told just the opposite by Support Path, that grapefruit was fine.  My Insurance Co. nurse/advocate however told me to avoid grapefruit/juice after my physician said it was OK, hence my search for anecdotal evidence one way or the other.  I guess this drug has not been out long enough for us to really know and therefore I should play it safe.  Thanks!

[Lynn K]

personally I tried and tried to find something definitive and was not able to confirm any reason to avoid grapefruit with Harvoni. It is not on the prescribing information sheet but then again I cant remember the last time I had any grapefruit so for me kind of a non issue

[Mugwump]

I drank some while on Harvoni provided it was not within 4 hours prior or after taking the med.  I took my med with just coffee and or water and then ate 4 hours later to make sure my thyroid med was also metabolized correctly. It is known that a lower more acidic ph level is best for the absorption of Lepidasvir which is a component of Harvoni.

I did not know of this possible consequence at the time though so it is indeed fortunate that I avoided the juice for 4hrs after I took the Harvoni! 

Before Harvoni I was drinking whole unsweetened grapefruit juice. It seemed to help keep my energy levels up better than sweeter juices like orange.

According to studies done  in 2008 at the University of Western Ontario, headed up by David G. Bailey, Ph.D., a professor of clinical pharmacology, medications that are absorbed by the liver can be effected by grapefruit. And this seems to be the clinical consensus about the mechanism.


Eric
 

[Lynn K]

Grapefruit Juice: Is It Safe With Your Drug?

http://drugs.about.com/od/medicationabcs/a/gjuice_drugs.htm

"When you order medications in the mail or pick them up at your local pharmacy, you should receive a patient information sheet, which will let you know if your drug is affected by grapefruit juice. Some pharmacies may also put a warning label on your medication bottle. If you are not sure, ask the pharmacist."

Grapefruit Juice is not listed on the Harvoni prescribing information sheet as being affected by Grapefruit Juice but like the article says ask your pharmacist.

http://www.gilead.com/~/media/Files/pdfs/medicines/liver-disease/harvoni/harvoni_pi.pdf

Personally if I drank grapefruit juice I would have had no concerns about taking it with Harvoni I did ask my nurse and she said not a problem.

[Harvey]

Thanks Lynn,
     Congratulations and good luck with continuous SVR! 
I would not be surprised if grapefruit had some impact on the absorption of Harvoni, my question then is if not harmful, is it beneficial and does it somehow assist in the drug's effectiveness?
 

[Lynn K]

I have seen that it could provide some benefit for the liver but I wouldn't make any changes to what you normally do except to avoid acid reducers if you take them or in you must take them follow the prescribing information sheet.

Harvoni is very effective especially for a patient like yourself you will be fine and you will be cured!

Good luck to you
Lynn

[koifish54]

Not sure about  grapefruit  with harvoni  imo  I wouldn't  just because  it's interactions  with other drugs but I'm curious  about  grapefruit  and it's effects  on fatter  liver  I have seen a couple  of posts  about it being  good  for FL and a study  done in Boston  anyone  ever heard  about it

[Lynn K]

http://www.livestrong.com/article/543520-grapefruit-and-fatty-liver/

Fatty Liver Disease

A study published in the March 2011 issue of the “European Journal of Nutrition.” indicates that naringenin extracted from grapefruit can activate the chemicals responsible for fatty acid oxidation, which may be responsible for the lipid-lowering ability of grapefruit in laboratory animals. This may, in turn, help prevent fatty liver disease. Another study in the March 2006 issue of the “Journal of Medicinal Food” indicates that grapefruit juice can significantly lower body fat and attenuate metabolic syndrome, both of which often contribute to fatty liver disease. Nootkatone, another substance found in the grapefruit, also helps control obesity and enhances energy metabolism in laboratory animals, according to an article published in the August 2010 issue of the journal “Endocrinology and Metabolism.” However, the benefits of grapefruits have only been evidenced in animal laboratory studies; actual clinical trials are needed to prove them conclusively

[koifish54]

Thanks  Lynn you know I remember  quite  a few years ago in the 70's I think alot hype about  grapefruit  diet my mom tried  it don't remember  her results  lol she tried  alot of diet plans

[Baxter]

Thanks Lynn,
     Congratulations and good luck with continuous SVR! 
I would not be surprised if grapefruit had some impact on the absorption of Harvoni, my question then is if not harmful, is it beneficial and does it somehow assist in the drug's effectiveness?
 

My guess is that if it has any effect at all, it's more likely to be beneficial. When grapefruit does interact with a drug, the effect that it usually has is to potentiate the drug, to intensify it's effects by slowing the rate at which it is metabolized by the liver. I would think that would be a good thing.

At any rate, my doctor specifically told me that grapefruit juice is good to have while on treatment. He said he didn't think it would have any impact one way or the other on the effect of the drug, but that it's a good, healthy way to hydrate.

[Gaj]

Below is from Gilead's Harvoni information sheet:

Metabolism
In vitro, no detectable metabolism of ledipasvir was observed by human CYP1A2, CYP2C8, CYP2C9, CYP2C19, CYP2D6, and CYP3A4.

Grapefruit acts as a CYP3A4 inhibitor, but Lepidasvir (and Sofosbuvir) is not metabolised by this enzyme so it has no effect.

However, if you are taking Daclatasvir (and possibly some of the other antivirals) then Grapefruit should be avoided because Dac is metabolised by CYP3A4.

This interaction does potentiate (make stronger) the effects of the drug involved but it will vary a lot depending on the drug/inhibitor/patient interaction. In some cases it may be mild but in others can have very serious consequences so seek medical advice.

[Baxter]

Boy, I wish we could rep people here. That's excellent, useful information. Thank you!

[Katie]

I believe it is medication for cardiac issues that it interferes with.  I eat lots of grapefruit and had no issues and am now clear of HCV!

Katie

[HazelAustralia]

So for those on Veikira Pak grapefruit juice is not advised - or there is an amber warning about it, which was enough for me - by the Liverpool mob http://www.hep-druginteractions.org/checker:

"Coadministration has not been studied but it could increase ombitasvir/paritaprevir/ritonavir exposure through inhibition of intestinal CYP3A4."

Similarly some people on certain HIV treatments are advised to avoid it.