Abemaciclib [1], grapefruit juice ---> SmPC of [1] of EMA
Avoid grapefruit or grapefruit juice.
Alectinib [1], grapefruit juice ---> SmPC of [1] of EMA
Appropriate monitoring is recommended for patients taking concomitant strong CYP3A inhibitors
Aliskiren [1], grapefruit juice ---> SmPC of [1] of EMA
Administration of grapefruit juice with aliskiren resulted in a decrease in AUC and Cmax of aliskiren. Grapefruit juice should not be taken together with aliskiren
Aliskiren/amlodipine [1], grapefruit juice ---> SmPC of [1] of EMA
Administration of fruit juice resulted in a decrease in AUC and Cmax of aliskiren. The bioavailability of amlodipine may be increased in some patients. Administration with grapefruit or grapefruit juice is not recommended
Aliskiren/amlodipine/hydrochlorothiazide [1], grapefruit juice ---> SmPC of [1] of EMA
Administration of grapefruit juice with aliskiren resulted in a decrease in AUC and Cmax of aliskiren. Grapefruit juice should not be taken together with aliskiren
Aliskiren/hydrochlorothiazide [1], grapefruit juice ---> SmPC of [1] of EMA
Administration of grapefruit juice with aliskiren resulted in a decrease in AUC and Cmax of aliskiren. Grapefruit juice should not be taken together with aliskiren
Amiodarone, grapefruit juice
The CYP3A4 inhibitors may inhibit the amiodarone metabolism and increase its plasma concentrations. It is recommended to avoid the CYP3A4 inhibitors (e. g. grapefruit juice)
Amlodipine, grapefruit juice ---> SmPC of [amlodipine/valsartan] of EMA
Administration of amlodipine with grapefruit or grapefruit juice is not recommended as bioavailability may be increased in some patients, resulting in increased blood pressure lowering effects.
Amlodipine/valsartan [1], grapefruit juice ---> SmPC of [1] of EMA
Administration of amlodipine with grapefruit or grapefruit juice is not recommended as bioavailability may be increased in some patients, resulting in increased blood pressure lowering effects.
Amlodipine/valsartan/hydrochlorothiazide [1], grapefruit juice ---> SmPC of [1] of EMA
Administration of amlodipine with grapefruit or grapefruit juice is not recommended as bioavailability may be increased in some patients, resulting in increased blood pressure lowering effects.
Astemizole, grapefruit juice
The strong CYP3A4 inhibition may increase the plasma concentrations of astemizole and prolong the QT interval. The intake of grapefruit/grapefruit juice should be avoided
Atenolol/nifedipine [1], grapefruit juice ---> SmPC of [1] of eMC
As with other dihydropyridines, nifedipine should not be taken with grapefruit juice because bioavailability is increased.
Atorvastatin [1], grapefruit juice ---> SmPC of [1] of eMC
Potent CYP3A4 inhibitors have been shown to lead to markedly increased concentrations of atorvastatin. Co-administration of potent CYP3A4 inhibitors should be avoided if possible.
Avanafil [1], grapefruit juice ---> SmPC of [1] of EMA
Other CYP3A4 inhibitors, including grapefruit juice would likely increase avanafil exposure. Patients should be advised to avoid grapefruit juice within 24 hours prior to taking avanafil.
Avapritinib [1], grapefruit juice ---> SmPC of [1] of EMA
Co-administration with strong or moderate CYP3A inhibitors should be avoided because it may increase the plasma concentration of avapritinib
Axitinib [1], grapefruit juice ---> SmPC of [1] of EMA
Co-administration of axitinib with strong CYP3A4/5 inhibitors may increase axitinib plasma concentrations. Selection of concomitant medicinal products with no or minimal CYP3A4/5 inhibition potential is recommended.
Barnidipine, grapefruit juice
The barnidipine pharmacokinetic wasn't significant altered with the concomitant use of grapefruit juice, but a little effect was seen
Bexarotene [1], grapefruit juice ---> SmPC of [1] of EMA
On the basis of the oxidative metabolism of bexarotene by cytochrome P450 3A4, grapefruit juice may theoretically lead to an increase in plasma bexarotene concentrations.
Bilastine [1], grapefruit juice ---> SmPC of [1] of eMC
Medicinal products that are substrates or inhibitors of OATP1A2 may likewise have the potential to decrease bioavailability of bilastine (OATP1A2 substrate).
Bosutinib [1], grapefruit juice ---> SmPC of [1] of EMA
The concomitant use of bosutinib with potent CYP3A inhibitors should be avoided, as an increase in bosutinib plasma levels will occur. Selection of an alternate concomitant medicine with no or minimal CYP3A enzyme inhibition potential is recommended.
Brigatinib [1], grapefruit juice ---> SmPC of [1] of EMA
Grapefruit or grapefruit juice may also increase plasma concentrations of brigatinib and should be avoided
Brotizolam, grapefruit juice
The strong CYP3A4 inhibition may increase the plasma concentrations of brotizolam
Budesonide [1], grapefruit juice ---> SmPC of [1] of EMA
Co-treatment with potent CYP3A inhibitors may cause a marked increase of the plasma concentration of budesonide and is expected to increase the risk of systemic adverse reactions. Therefore, concomitant use should be avoided
Buspirone [1], grapefruit juice ---> SmPC of [1] of eMC
Grapefruit juice increases the plasma concentrations of buspirone. Patients taking buspirone should avoid consuming large quantities of grapefruit juice.
Cabozantinib [1], grapefruit juice ---> SmPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inhibitors (increased plasma cabozantinib exposure (AUC) should be approached with caution.
Carbamazepine [1], grapefruit juice ---> SmPC of [1] of eMC
The active metabolite carbamazepine-10,11-epoxide plasma levels may be increased.
Cariprazine [1], grapefruit juice ---> SmPC of [1] of EMA
Consumption of grapefruit juice should be avoided.
Celiprolol, grapefruit juice
The intake of grapefruit/grapefruit juice should be avoided
Ceritinib [1], grapefruit juice ---> SmPC of [1] of EMA
Patients should be instructed to avoid grapefruit and grapefruit juice as they may inhibit CYP3A in the gut wall and may increase the bioavailability of ceritinib.
Cilostazol [1], grapefruit juice ---> SmPC of [1] of EMA
Administration of a single dose of 100 mg cilostazol with 240 ml grapefruit juice (an inhibitor of intestinal CYP3A4) did not have a notable effect on the pharmacokinetics of cilostazol.
Cisapride, grapefruit juice
The strong CYP3A4 inhibition may increase the plasma concentrations of cisapride and prolong the QT interval. The intake of grapefruit/grapefruit juice should be avoided
Clomipramine [1], grapefruit juice ---> SmPC of [1] of eMC
Concomitant administration of clomipramine with grapefruit, or grapefruit juice may increase the plasma concentrations of clomipramine.
Cobimetinib [1], grapefruit juice ---> SmPC of [1] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Colchicine [1], grapefruit juice ---> SmPC of [1] of eMC
Colchicine is contraindicated in patients with renal or hepatic impairment who are taking a strong CYP3A4 inhibitor
Crizotinib [1], grapefruit juice ---> SmPC of [1] of EMA
Coadministration of crizotinib with grapefruit or grapefruit juice (strong CYP3A inhibitors) may increase crizotinib plasma concentrations and should be avoided.
Cyclophosphamide, grapefruit juice
The CYP3A4 inhibition may decrease the efficacy of cyclophosphamide (prodrug)
Cyclosporine [1], grapefruit juice ---> SmPC of [1] of eMC
The concomitant intake of grapefruit and grapefruit juice has been reported to increase the bioavailability of ciclosporin.
Darifenacin [1], grapefruit juice ---> SmPC of [1] of EMA
When co-administered with moderate CYP3A4 inhibitors the recommended starting dose of darifenacin should be 7.5 mg daily.
Dasatinib [1], grapefruit juice ---> SmPC of [1] of EMA
In vitro studies indicate that dasatinib is a CYP3A4 substrate. Concomitant use of dasatinib and medicinal products which potently inhibit CYP3A4 may increase exposure to dasatinib. Systemic administration of a potent CYP3A4 inhibitor is not recommended.
Dextromethorphan, grapefruit juice
The CYP3A4 inhibition may increase the plasma levels of dextromethorphan
Dextromethorphan/quinidine [1], grapefruit juice ---> SmPC of [1] of EMA
Concomitant administration of medicines that inhibit CYP3A4 can be expected to increase plasma levels of quinidine, which could increase risk relating to QTc prolongation. Strong and moderate CYP3A4 inhibitors should be avoided during treatment.
Diazepam [1], grapefruit juice ---> SmPC of [1] of eMC
The CYP3A4 inhibition may increase the plasma levels of diazepam.
Dihydropyridines, grapefruit juice ---> SmPC of [lercanidipine] of eMC
Dihydropyridines are sensitive to inhibition of metabolism by grapefruit juice, with a consequent rise in their systemic availability and increased hypotensive effect. Dihydropyridines should not be taken with grapefruit juice.
Dronedarone [1], grapefruit juice ---> SmPC of [1] of EMA
Repeated doses of 300 ml of grapefruit juice three times daily resulted in a 3-fold increase in dronedarone exposure. Therefore, patients should be warned to avoid grapefruit juice beverages while taking dronedarone
Efavirenz [1], grapefruit juice ---> SmPC of [1] of EMA
Efavirenz exposure may be increased when given with medicinal products (for example, ritonavir) or food (for example, grapefruit juice), which inhibit CYP3A4 or CYP2B6 activity.
Eliglustat [1], grapefruit juice ---> SmPC of [1] of EMA
Grapefruit products contain one or more components that inhibit CYP3A and can increase plasma concentrations of eliglustat. Consumption of grapefruit or its juice should be avoided.
Encorafenib [1], grapefruit juice ---> SmPC of [1] of EMA
Concomitant administration of encorafenib with strong CYP3A4 inhibitors should be avoided (due to increased encorafenib exposure and potential increase in toxicity, see section 5.2).
Entrectinib [1], grapefruit juice ---> SmPC of [1] of EMA
Rozlytrek can be taken with or without food (see section 5.2) but should not be taken with grapefruit or grapefruit juice (see section 4.5).
Estrogens, grapefruit juice ---> SmPC of [conjugated oestrogens/bazedoxifene] of EMA
Inhibitors of CYP3A4 may increase plasma concentrations of oestrogens and may result in adverse reactions.
Ethinyl estradiol, grapefruit juice ---> SmPC of [ethinylestradiol/norgestimate] of eMC
Increase in plasma hormone levels associated with co-administered drug
Ethinylestradiol/norgestimate [1], grapefruit juice ---> SmPC of [1] of eMC
Increase in plasma hormone levels associated with co-administered drug
Everolimus [1], grapefruit juice ---> SmPC of [1] of EMA
Increase in everolimus concentration is expected (the effect varies widely). Combination should be avoided.
Ezetimibe/atorvastatin [1], grapefruit juice ---> SmPC of [1] of eMC
Concomitant intake of large quantities of grapefruit juice and ATOZET is not recommended.
Ezetimibe/simvastatine [1], grapefruit juice ---> SmPC of [1] of eMC
Grapefruit juice inhibits cytochrome P450 3A4. Concomitant intake of large quantities (over 1 litre daily) of grapefruit juice and simvastatin resulted in a 7-fold increase in exposure to simvastatin acid.
Felodipine [1], grapefruit juice ---> SmPC of [1] of eMC
The strong CYP3A4 inhibition may increase the plasma concentrations of felodipine
Felodipine/metoprolol, grapefruit juice
It has been shown that inhibitors of cytochrome P450-3A4 system increase the plasma concentrations of felodipine. The concomitant use with strong CYP3A4 inhibitors should be avoided
Felodipine/ramipril [1], grapefruit juice ---> SmPC of [1] of eMC
The strong CYP3A4 inhibition may increase the plasma levels of felodipine. The co-administration of felodipine with strong CYP3A4 inhibitors should be avoided
Fenofibrate/simvastatin [1], grapefruit juice ---> SmPC of [1] of EMA
The CYP3A4 inhibition by grapefruit juice may increase the plasma exposure to simvastatin acid. The intake of grapefruit juice should be avoided
Fentanyl [1], grapefruit juice ---> SmPC of [1] of EMA
The concomitant use of fentanyl with moderate CYP3A4 inhibitors may result in increased fentanyl plasma concentrations, potentially causing serious adverse drug reactions including fatal respiratory depression.
Fesoterodine [1], grapefruit juice ---> SmPC of [1] of EMA
Caution should be exercised when prescribing fesoterodine to patients in whom an increased exposure to the active metabolite is expected, e. g. coadministration of moderate CYP3A4 inhibitors. No dosing adjustments are recommended
Flunitrazepam, grapefruit juice
Substances that inhibit hepatic enzymes may enhance the effect of benzodiazepines. Interactions with strong CYP3A4 inhibitors cannot be excluded
Fluvastatin [1], grapefruit juice ---> SmPC of [1] of eMC
Based on the lack of interaction of fluvastatin with other CYP3A4 substrates, fluvastatin is not expected to interact with grapefruit juice.
Fostamatinib [1], grapefruit juice ---> SmPC of [1] of EMA
Concomitant use of fostamatinib with strong CYP3A4 inhibitors increases exposure to R406 (the major active metabolite), which may increase the risk of adverse reactions.
Glasdegib [1], grapefruit juice ---> SmPC of [1] of EMA
Caution should be used when administering concomitantly with strong CYP3A4 inhibitors as an increase in glasdegib plasma concentration may occur.
Grapefruit juice [1], lorazepam ---> SmPC of [1] of eMC
Inhibition of CYP3A4 may increase the plasma concentration of lorazepam (possible increased sedation and amnesia)
Grapefruit juice, guanfacin [2] ---> SmPC of [2] of EMA
Co-administration of Intuniv with moderate and strong CYP3A4/5 inhibitors elevates plasma guanfacine concentrations and increases the risk of adverse reactions such as hypotension, bradycardia, and sedation.
Grapefruit juice, hydrocortisone [2] ---> SmPC of [2] of EMA
Potent CYP 3A4 inhibitors can inhibit the metabolism of hydrocortisone, and thus increase blood levels.
Grapefruit juice, ibrutinib [2] ---> SmPC of [2] of EMA
Grapefruit and Seville oranges should be avoided during IMBRUVICA treatment, as these contain moderate inhibitors of CYP3A4
Grapefruit juice, irinotecan [2] ---> SmPC of [2] of EMA
Co-administration of ONIVYDE with other inhibitors of CYP3A4 may increase systemic exposure of ONIVYDE.
Grapefruit juice, isradipine [2] ---> SmPC of [2] of eMC
The concomitant intake of grapefruit juice may increase the bioavailability of isradipine.
Grapefruit juice, ivabradine [2] ---> SmPC of [2] of EMA
Ivabradine exposure was increased by 2-fold following the co-administration with grapefruit juice. Therefore the intake of grapefruit juice should be avoided.
Grapefruit juice, ivacaftor [2] ---> SmPC of [2] of EMA
Co-administration of ivacaftor with grapefruit juice, which contains one or more components that moderately inhibit CYP3A, may increase exposure to ivacaftor. Food containing grapefruit or Seville oranges should be avoided during treatment with ivacaftor
Grapefruit juice, ivacaftor/tezacaftor/elexacaftor [2] ---> SmPC of [2] of EMA
Co-administration with grapefruit juice, which contains one or more components that moderately inhibit CYP3A, may increase exposure of elexacaftor, tezacaftor and ivacaftor.
Grapefruit juice, ixabepilone
The strong CYP3A4 inhibition may increase the plasma concentrations of ixabepilone. The intake of grapefruit/grapefruit juice should be avoided
Grapefruit juice, lacidipine ---> SmPC of [lercanidipine] of eMC
Dihydropyridines are sensitive to inhibition of metabolism by grapefruit juice, with a consequent rise in their systemic availability and increased hypotensive effect. Dihydropyridines should not be taken with grapefruit juice.
Grapefruit juice, lapatinib [2] ---> SmPC of [2] of EMA
Grapefruit juice may inhibit CYP3A4 in the gut wall and increase the bioavailability of lapatinib
Grapefruit juice, larotrectinib [2] ---> SmPC of [2] of EMA
Larotrectinib is a substrate of cytochrome P450 (CYP) 3A, P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP). Co-administration of VITRAKVI with strong CYP3A inhibitors, P-gp and BCRP inhibitors may increase larotrectinib plasma levels
Grapefruit juice, lefamulin [2] ---> SmPC of [2] of EMA
Medicinal products that are strong CYP3A and P-gp inhibitors may alter absorption of lefamulin and therefore increase lefamulin plasma concentrations. Co- administration is contraindicated
Grapefruit juice, lercanidipine [2] ---> SmPC of [2] of eMC
Lercanidipine is sensitive to inhibition of metabolism by grapefruit juice, with a consequent rise in its systemic availability and increased hypotensive effect. Lercanidipine should not be taken with grapefruit juice.
Grapefruit juice, lomitapide [2] ---> SmPC of [2] of EMA
Grapefruit juice is a moderate inhibitor of CYP3A4 and is expected to substantially increase exposure to lomitapide. Patients taking lomitapide should avoid consumption of grapefruit juice.
Grapefruit juice, lovastatine
The strong CYP3A4 inhibition may increase the plasma levels of lovastatine. The intake of grapefruit/grapefruit juice should be avoided
Grapefruit juice, lurasidone [2] ---> SmPC of [2] of EMA
Grapefruit juice inhibits CYP 3A4 and may increase the serum concentration of lurasidone. Grapefruit juice should be avoided during treatment with lurasidone.
Grapefruit juice, manidipine [2] ---> SmPC of [2] of eMC
Dihydropyridines are sensitive to inhibition of metabolism by grapefruit juice, with a consequent rise in their systemic availability and increased hypotensive effect. Dihydropyridines should not be taken with grapefruit juice.
Grapefruit juice, methadone
Grapefruit juice inhibits intestinal CYP3A4 and G-glycoprotein. Concomitant use may increase the bioavailibility of methadone
Grapefruit juice, methylergometrine
Caution is recommended when methylergometrine is used with moderate CYP3A inhibitors
Grapefruit juice, methylprednisolone
The strong CYP3A4 inhibition may increase the plasma concentrations of glucocorticoid
Grapefruit juice, midazolam [2] ---> SmPC of [2] of EMA
The grapefruit juice decreases the clearance of midazolam and potentiates its action.
Grapefruit juice, mifepristone [2] ---> SmPC of [2] of eMC
On the basis of this drug's metabolism by CYP3A4, it is possible that strong CYP3A4 inhibitors may inhibit its metabolism (increasing serum levels of mifepristone).
Grapefruit juice, naldemedine [2] ---> SmPC of [2] of EMA
Concomitant use of strong CYP3A inhibitors should be avoided. If use with strong CYP3A inhibitors is unavoidable, monitor for adverse reactions
Grapefruit juice, naloxegol [2] ---> SmPC of [2] of EMA
Concomitant consumption of grapefruit juice while taking naloxegol should generally be avoided and considered only in consultation with a healthcare provider
Grapefruit juice, neratinib [2] ---> SmPC of [2] of EMA
Grapefruit juice should be avoided during treatment with Nerlynx
Grapefruit juice, nicardipine [2] ---> SmPC of [2] of eMC
Nicardipine is metabolized by cytochrome P450 3A4. Concomitant administration of nicardipine with inhibitors of cytochrome P450 3A4 may alter the plasma levels of nicardipine.
Grapefruit juice, nifedipine [2] ---> SmPC of [2] of eMC
Nifedipine should not be taken with grapefruit juice because bioavailability is increased.
Grapefruit juice, nilotinib [2] ---> SmPC of [2] of EMA
The CYP3A4 inhibition may increase the plasma concentrations of nilotinib. The intake of grapefruit/grapefruit juice should be avoided
Grapefruit juice, nilvadipine
The strong CYP3A4 inhibition may increase the plasma concentrations of dihydropyridine. The intake of grapefruit/grapefruit juice should be avoided
Grapefruit juice, nimodipine [2] ---> SmPC of [2] of eMC
The intake of grapefruit juice is not recommended in combination with nimodipine as it can result in increased plasma nimodipine concentrations due to the inhibition of the oxidative metabolism of dihydropyridines.
Grapefruit juice, nisoldipine
The co-administration of nisoldipine with medicinal products that inhibit the cytochrome P450 3A4-system may increase the bioavailability of nisoldipine. Concomitant use is contraindicated
Grapefruit juice, nitrendipine ---> SmPC of [lercanidipine] of eMC
Dihydropyridines are sensitive to inhibition of metabolism by grapefruit juice, with a consequent rise in their systemic availability and increased hypotensive effect. Dihydropyridines should not be taken with grapefruit juice.
Grapefruit juice, norgestimate
The strong CYP3A4 inhibition may increase the plasma concentrations of norgestimate
Grapefruit juice, olaparib [2] ---> SmPC of [2] of EMA
It is also not recommended to consume grapefruit juice while on olaparib therapy.
Grapefruit juice, olmesartan medoxomil/amlodipine [2] ---> SmPC of [2] of eMC
Administration of amlodipine with grapefruit or grapefruit juice is not recommended as bioavailability may be increased in some patients resulting in increased blood pressure lowering effects.
Grapefruit juice, palbociclib [2] ---> SmPC of [2] of EMA
Strong inhibitors of CYP3A4 may lead to increased toxicity. Concomitant use of strong CYP3A inhibitors during treatment with palbociclib should be avoided.
Grapefruit juice, panobinostat [2] ---> SmPC of [2] of EMA
Patients should be instructed to avoid star fruit, grapefruit, grapefruit juice, pomegranates and pomegranate juice, as these are known to inhibit cytochrome P450 3A enzymes and may increase the bioavailability of panobinostat.
Grapefruit juice, pazopanib [2] ---> SmPC of [2] of EMA
Grapefruit juice contains an inhibitor of CYP3A4 and may increase plasma concentrations of pazopanib. Grapefruit juice should be avoided during treatment with pazopanib.
Grapefruit juice, phenylalkylamines
Increased plasma levels of phenylalkylamine
Grapefruit juice, pimozide [2] ---> SmPC of [2] of eMC
As grapefruit juice is known to inhibit the metabolism of CYP3A4 metabolised drugs, concomitant use of grapefruit juice with pimozide should be avoided.
Grapefruit juice, piperaquine/artenimol [2] ---> SmPC of [2] of EMA
Piperaquine/dihydroartemisinin should not be taken with grapefruit juice as it is likely to lead to increased piperaquine plasma concentrations.
Grapefruit juice, pirfenidone [2] ---> SmPC of [2] of EMA
Consumption of grapefruit juice is associated with inhibition of CYP1A2 and should be avoided during treatment with pirfenidone.
Grapefruit juice, pitavastatin
Itraconazol and Saint John's wort, strong inhibitors of CYP3A4, had no clinically meaningful effect on the plasma concentrations of pitavastatin.
Grapefruit juice, ponatinib [2] ---> SmPC of [2] of EMA
Caution should be exercised and a reduction of the starting dose should be considered with concurrent use of ponatinib with strong CYP3A inhibitors (modest increases in ponatinib systemic exposure are possible)
Grapefruit juice, prasugrel [2] ---> SmPC of [2] of EMA
CYP3A inhibitors are not anticipated to have a significant effect on the pharmacokinetics of the prasugrel active metabolite.
Grapefruit juice, pravastatine [2] ---> SmPC of [2] of eMC
The absence of a significant pharmacokinetic interaction with pravastatin has been specifically demonstrated
Grapefruit juice, pravastatine/fenofibrate [2] ---> SmPC of [2] of EMA
Absence of a significant pharmacokinetic interaction with pravastatin
Grapefruit juice, propafenone [2] ---> SmPC of [2] of eMC
Drugs that inhibit CYP2D6, CYP1A2 and CYP3A4 may lead to increased levels of propafenone. When propafenone is administered with inhibitors of these enzymes, the patients should be closely monitored and the dose adjusted accordingly.
Grapefruit juice, quetiapine [2] ---> SmPC of [2] of eMC
The strong CYP3A4 inhibition may increase the plasma concentrations of quetiapine. The intake of grapefruit/grapefruit juice should be avoided
Grapefruit juice, ranolazine [2] ---> SmPC of [2] of EMA
Ranolazine is a substrate of cytochrome CYP3A4. Inhibitors of CYP3A4 increase plasma concentrations of ranolazine. Combining ranolazine with potent CYP3A4 inhibitors is contraindicated
Grapefruit juice, regorafenib [2] ---> SmPC of [2] of EMA
It is recommended to avoid concomitant use of strong inhibitors of CYP3A4 activity, as their influence on the steady-state exposure of regorafenib and its metabolites has not been studied.
Grapefruit juice, ribociclib [2] ---> SmPC of [2] of EMA
Patients should be instructed to avoid pomegranates or pomegranate juice and grapefruit or grapefruit juice. These are known to inhibit cytochrome CYP3A4 enzymes and may increase the exposure to ribociclib.
Grapefruit juice, rupatadine [2] ---> SmPC of [2] of eMC
The concomitant administration of rupatadine and grapefruit juice increased 3.5 times the systemic exposure of rupatadine. Grapefruit juice should not be taken simultaneously.
Grapefruit juice, saquinavir [2] ---> SmPC of [2] of EMA
Increase of saquinavir exposition not thought to be clinically relevant. No dose adjustment required.
Grapefruit juice, saquinavir/ritonavir ---> SmPC of [saquinavir] of EMA
Increase of saquinavir exposition not thought to be clinically relevant. No dose adjustment required.
Grapefruit juice, sildenafil [2] ---> SmPC of [2] of EMA
Grapefruit juice is a weak inhibitor of CYP3A4 gut wall metabolism and may give rise to modest increases in plasma levels of sildenafil.
Grapefruit juice, simvastatine [2] ---> SmPC of [2] of eMC
Grapefruit juice inhibits CYP3A4. Concomitant intake of large quantities (over 1 litre daily) of grapefruit juice and simvastatin resulted in a 7-fold increase in exposure to simvastatin acid. Intake of grapefruit juice should be avoided.
Grapefruit juice, sirolimus [2] ---> SmPC of [2] of EMA
Grapefruit juice affects CYP3A4-mediated metabolism, and should therefore be avoided.
Grapefruit juice, sulpiride
The intake of grapefruit juice is contraindicated during the treatment
Grapefruit juice, sunitinib [2] ---> SmPC of [2] of EMA
Administration of sunitinib with potent CYP3A4 inhibitors may increase sunitinib concentrations. Combination with CYP3A4 inhibitors should therefore be avoided
Grapefruit juice, tacrolimus [2] ---> SmPC of [2] of EMA
The inhibition of intestinal and hepatic CYP3A4 increases the bioavaibility and plasma levels of tacrolimus. The intake of grapefruit/grapefruit juice should be avoided
Grapefruit juice, tadalafil [2] ---> SmPC of [2] of EMA
Tadalafil is principally metabolised by CYP3A4. CYP3A4 inhibitors should be co-administered with caution as they would be expected to increase plasma concentrations of tadalafil
Grapefruit juice, tegafur
Grapefruit juice inhibits the CYP2A6 and can decrease the tegafur activation to 5-FU. Grapefruit juice should not be taken
Grapefruit juice, telmisartan/amlodipine [2] ---> SmPC of [2] of EMA
The concomitant use of amlodipine and grapefruit or grapefruit juice is still not recommended in patients as the bioavailability of amlodipine may increase in some and may result in increased hypotensive effects.
Grapefruit juice, temsirolimus [2] ---> SmPC of [2] of EMA
Concomitant treatment with moderate CYP3A4 inhibitors should only be administered with caution in patients receiving 25 mg and should be avoided in patients receiving temsirolimus doses higher than 25 mg
Grapefruit juice, terfenadine
The strong CYP3A4 inhibition may increase the plasma concentrations of terfenadine. The intake of grapefruit/grapefruit juice should be avoided
Grapefruit juice, tezacaftor/ivacaftor [2] ---> SmPC of [2] of EMA
Co-administration with grapefruit juice may increase exposure of ivacaftor and tezacaftor; therefore, food or drink containing grapefruit or Seville oranges should be avoided during treatment
Grapefruit juice, ticagrelor [2] ---> SmPC of [2] of EMA
A 2-fold increase of ticagrelor exposure was observed after daily consumption of large quantities of grapefruit juice (3 x 200 ml). This magnitude of increased exposure is not expected to be clinically relevant to most patients.
Grapefruit juice, tolvaptan [2] ---> SmPC of [2] of EMA
Co-administration of grapefruit juice and tolvaptan resulted in a 1.8-fold increase in exposure to tolvaptan. Patients taking tolvaptan should avoid ingesting grapefruit juice.
Grapefruit juice, trandolapril/verapamil [2] ---> SmPC of [2] of eMC
Verapamil concentrations may be increased by grapefruit juice
Grapefruit juice, triazolam
Concomitant intake with grapefruit juice has increases the bioavailibility of triazolam
Grapefruit juice, vardenafil [2] ---> SmPC of [2] of EMA
Grapefruit juice being a weak inhibitor of CYP3A4 gut wall metabolism, may give rise to modest increases in plasma levels of vardenafil
Grapefruit juice, venetoclax [2] ---> SmPC of [2] of EMA
Grapefruit products, Seville oranges, and starfruit (carambola) should be avoided during treatment with venetoclax as they contain inhibitors of CYP3A.
Grapefruit juice, verapamil [2] ---> SmPC of [2] of eMC
Grapefruit juice may increase the plasma concentrations of verapamil.
Grapefruit juice, vinflunine [2] ---> SmPC of [2] of EMA
The concomitant use of vinflunine and potent CYP3A4 inhibitors should be avoided since they may increase vinflunine and DVFL concentrations
Grapefruit juice, zolpidem
CYP3A4 inhibitors may increase the effect of zolpidem