Question:

Is pomegranate juice contraindicated for patients on cholesterol lowering medications or antihypertensive medications? Is there any food/drug interaction like with grapefruit juice?

Answer:

Pomegranate juice does not interact with drugs as strongly as grapefruit juice but there is a risk. Grapefruit interferes with the breakdown of drug causing a higher level of drug in the body. Cholesterol drugs that grapefruit effects includes: atorvastatin (Lipitor), lovastatin (Mevacor), simvastatin (Zocor). Hypertensive drugs effected are: felodipine (Plendil), nicardipine (Cardene), nifedipine (Procardia), nimodipine (Nimotop), nisoldipine (Sular).

Of the various fruit juices tested at this time the order from strongest effect on a drug to weakest is: grapefruit > black mulberry > wild grape > pomegranate > black raspberry

Available studies on pomegranate juice and drug interactions are very limited so caution should be used.

There is a drug-food interaction with warfarin (Coumadin) and foods high in Vitamin K like spinach.

Food in general can slow down the time before the drug starts to work, but it also can help with side effects depending on the drug.

Other substances that could interact with drugs include the nicotine from smoking, alcohol, and herbal supplements.

It is best to consult your doctor with concerns about specific drug interactions. Keep the doctor informed of all medications, including over-the-counter and herbals, you are taking. The local pharmacy can print out drug information on specific medications you are prescribed that should have information on food/alcohol/smoking/herbal/drug-drug interactions.

Keep in mind an interaction does not mean you have to quit using the drug or eating your favorite fruit. It does mean the doctor and yourself need to keep a closer eye on the dose you are taking and the side effects that can occur.

Submitted by Cincy Lee, Pharm D Candidate, The Ohio State University.

References:

Kim H, Yoon YJ, Shon JH, Cha IJ, Shin JG, Liu KH. “Inhibitory effects of fruit juices on CYP3A activity”. Drug Metabolism and Disposition. 34:4 (2006):521-3.

Bailey, DG. Dresser, GK. “Interactions between grapefruit juice and cardiovascular drugs.” American Journal of Cardiovascular Drugs, 4:5, 2004, 281-97.

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