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Medical Forum / Diseases and Disorders / AIDS / February 2004

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Cranberry Juice and Grapefruit Juice Question

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Gary Stein - 27 Jan 2004 05:15 GMT
Has anyone heard anything about Cranberry Juice inhibiting the cytochrome

P450 system in the same way that Grapefruit does? My mothers MD told here

that Cranberry Juice and Grapefruit juice have the same impact on the

metabolism of warfarin a blood thinning drug. I have seen the reports about

Grapefruit in AID's literature but have not seen any mention of the same

problems with Cranberry Juice so I am wondering if I just missed it or if

this is something that has not been reported.

The Cranberry issue was reported in the Nov 2003 issue of "Pharmacy Watch" ,

British researchers discovered that cranberry juice can severely interfere

with the metabolism of warfarin (Coumadin), slowing down the normal

breakdown of the drug, dangerously increasing the effect of the drug and

risking hemorrhage.

Signature

Gary Stein
ge.stein@verizon.net

GMCarter - 27 Jan 2004 12:08 GMT
>Has anyone heard anything about Cranberry Juice inhibiting the cytochrome
>P450 system in the same way that Grapefruit does? My mothers MD told here
>that Cranberry Juice and Grapefruit juice have the same impact on the
>metabolism of warfarin a blood thinning drug.

Google search yielded a recent result published in BMJ:
http://www.ukmicentral.nhs.uk/headline/database/story.asp?offset=10&NewsID=2866
linking to
http://bmj.bmjjournals.com/cgi/content/full/327/7429/1454

Inhibits 2C9. Probably not a good substitute for ritonavir
unfortunately. Abbott execs should be put in jail for that. It is
outright grand theft.

        George M. Carter
Baby Peanut - 27 Jan 2004 15:27 GMT
> Has anyone heard anything about Cranberry Juice inhibiting the cytochrome
> P450 system in the same way that Grapefruit does? My mothers MD told here
[quoted text clipped - 3 lines]
> problems with Cranberry Juice so I am wondering if I just missed it or if
> this is something that has not been reported.

What is "AID's literature"?

> The Cranberry issue was reported in the Nov 2003 issue of "Pharmacy Watch",
> British researchers discovered that cranberry juice can severely interfere
> with the metabolism of warfarin (Coumadin), slowing down the normal
> breakdown of the drug, dangerously increasing the effect of the drug and
> risking hemorrhage.

This is the most comprehensive report on Grapefruit juice and CYP3A4 I
know of.

http://www.ualberta.ca/~csps/JPPS4(3)/S.Wanwimolruk/grapefruit.htm

It does not mention cranberry juice.  It does mention bergapten but
not the fact that that chemical appears not only in grapefruits but in
begamot used in Earl Grey tea.

I'm wondering if it's possible to use a combination of
naturally-occurring CYP3A4 inhibitors as a Ritonavir replacement.  The
first point I would like to make is that most people take Ritonavir
plus another PI since it extends the AUC (duration) of the primary PI
which covers up random adherence errors that we are prone to make, not
because they want to take less of the primary PI.  So why cut the dose
of the primary PI and insist on a super-powerful CYP3A4 inhibitor like
Ritonavir, why not instead use a complete dose or a nearly-complete
one of a primary PI and a weaker CYP3A4 inhibitor to get the added
duration of coverage?

BP
Gary Stein - 27 Jan 2004 21:12 GMT
> What is "AID's literature"?

The body of research on HIV/AIDS that has been published in sceintific
journals.

> > The Cranberry issue was reported in the Nov 2003 issue of "Pharmacy Watch",
> > British researchers discovered that cranberry juice can severely interfere
[quoted text clipped - 6 lines]
>
> http://www.ualberta.ca/~csps/JPPS4(3)/S.Wanwimolruk/grapefruit.htm

Yes I have seen this data, I was looking for something dealing directly with
the issue of Cranberry juice. The article George found is the same one that
I referred to in my post, and would seem to indicate that Cranberry juice is
in fact something to be aware of for patients taking PI's.

Gary Stein
Baby Peanut - 28 Jan 2004 14:41 GMT
> > What is "AID's literature"?
>
[quoted text clipped - 20 lines]
>
> Gary Stein

So what PIs are metabolised by P450 CYP2C9?  I can't find any data on
that.

I can find evidence that Ritonavir (Norvir) is an inhibitor of CYP2C9
and I take that concurrently with another PI every other week.

http://www.hospitalist.net/highligh.htm

So if it's so bad to use a CYP2C9 inhibitor with a PI it is a mistake
I thrive on.
Gary Stein - 29 Jan 2004 19:39 GMT
> > > What is "AID's literature"?
> >
[quoted text clipped - 31 lines]
> So if it's so bad to use a CYP2C9 inhibitor with a PI it is a mistake
> I thrive on.

Well as someone else brought up Grapefruit and now Cranberry juice are shown
to inhibit the cytocrhome P450 (the CYP3A4) system thus increasing the
actual uptake of PI's in the same why that Norvir does. These juices would
also be a problem for someone taking Statin drugs to control cholesterol
because they also would see increases in drug levels of those drugs and that
can be very dangerous especially with Lipitor.

Gary Stein
GMCarter - 30 Jan 2004 11:33 GMT
snip,...>
>Well as someone else brought up Grapefruit and now Cranberry juice are shown
>to inhibit the cytocrhome P450 (the CYP3A4) system thus increasing the
>actual uptake of PI's in the same why that Norvir does. These juices would
>also be a problem for someone taking Statin drugs to control cholesterol
>because they also would see increases in drug levels of those drugs and that
>can be very dangerous especially with Lipitor.

Actually, there aren't any data on cranberry interfering with 3A4 that
I could find. That doesn't mean that it doesn't -- just that I either
haven't found the paper on it or the study has not been done. One
study seemed to suggest only 2C9, so one would think that study would
be looking at 3A4--and maybe didn't find anything. But I haven't
looked at the full paper.

The other idea here is to use grapefruit juice or bergamot oil as a
SUBSTITUTE for over-priced, toxic ritonavir sh.t (may Abbott officials
burn in a particularly nasty circle of hell).

        George M. Carter
Baby Peanut - 30 Jan 2004 20:12 GMT
> The other idea here is to use grapefruit juice or bergamot oil as a
> SUBSTITUTE for over-priced, toxic ritonavir sh.t (may Abbott officials
> burn in a particularly nasty circle of hell).
>
>         George M. Carter

George, I know you can be more healthy than that.
GMCarter - 31 Jan 2004 12:43 GMT
>> The other idea here is to use grapefruit juice or bergamot oil as a
>> SUBSTITUTE for over-priced, toxic ritonavir sh.t (may Abbott officials
[quoted text clipped - 3 lines]
>
>George, I know you can be more healthy than that.

LOL. Stop. A girl's gotta have her fun!

In loving kindness for all sentient beings--even the low life nasty
motherf...
Baby Peanut - 01 Feb 2004 18:53 GMT
> >> The other idea here is to use grapefruit juice or bergamot oil as a
> >> SUBSTITUTE for over-priced, toxic ritonavir sh.t (may Abbott officials
[quoted text clipped - 8 lines]
> In loving kindness for all sentient beings--even the low life nasty
> motherf...

There you go!  Atta-girl!
GMCarter - 02 Feb 2004 12:16 GMT
>> In loving kindness for all sentient beings--even the low life nasty
>> motherf...
>
>There you go!  Atta-girl!

Anger is genuine, of course. Must NOT be ignored or downplayed else it
appear in ways of violence, yes? It all, in the end, is just part of
this dream called life, so not to worry too much. Such a tiny speck in
the vastness of all space and the broad field of time(s). So
evanescent!!

Yet we engage with this here before us. This now (slipped already into
a then so quick)...and my hope is for transformation for all. For the
CEOs and Bushes and Cheneys and Wolfowitzs and Rices that bring so
much ugliness and evil to the world, so much pain and suffering for so
many when their energy and power could bring so much healing. But that
karma, of course, will bind their little egos to their bodies and
bring them a share of pain and grief no less than that which they
cause. So I empathize with them as I do the people suffering from
disfiguring lipodystrophy, brutal relationships, inability to access
care, my friends who have died, kids in Africa and India....ah...as
described in that heavy-duty, light as air boddhisatva vow.

Sometimes one must cut through that tight, sad horror of greed, ego
and self-love when they hurt so many other sentient beings with their
actions.

Then breathe, let go again.

Love ya...
George
 
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