Grapefruit and Antidepressants: Can They Mix?

Can You Eat Grapefruit While on Antidepressants?

When prescriptions are filled, such as those for antidepressants, you learn that grapefruit are among the prohibited foods. This is because of the interaction between grapefruit juice and antidepressants, which is linked to high medication levels in the blood streams. The levels may either be ordinarily high or abnormally high, where abnormally high levels can cause serious side effects and alter the effect of the medication in the body.

The harmful interactions of grapefruit can occur with many medications, such as medicine for psychiatric disorders, nifedipines which are blood pressure medications, and statins to treat high cholesterol levels among others.¹

When you consume grapefruit with these medications, you may experience side effects such as muscle damage, kidney damage, stomach and intestine bleeding, and dangerous heart rhythms. These interactions with grapefruit are often considered as taking an overdose of medication, and you should seek immediate medical attention. You can either call your healthcare provider or contact Poison Control.

How Do Antidepressants and Grapefruit Interact?

The body has enzymes that help metabolize any medication you take. Upon consumption of grapefruit, it binds with these enzymes called CYP3A4 preventing the metabolism of the medicine consumed. Therefore, the body absorbs the medication raising the concentration in the bloodstream.

You may be surprised by the effect a glass of grapefruit juice would have on your body while taking antidepressants, yet it may look like a small amount consumed. For the body to continue metabolizing the medication, it must manufacture more drug-metabolizing enzymes, which may take up to 36 hours. ²

Therefore, trying to stagger grapefruit consumption and medication timing may be ineffective because of the time taken by the body to manufacture enzymes to break down the medication.

Here are four important things to know about consuming grapefruit while taking antidepressants: 

• Only a small amount can negatively impact you: You may experience side effects even with a single glass of grapefruit juice.
• Effects can last up to several days: The side effects of consuming grapefruit juice with medication can last up to three days. Therefore, it becomes challenging to stagger grapefruit consumption and medication timings.
• Effects can be severe: There is a risk of experiencing side effects such as kidney damage and gastrointestinal bleeding. You might require emergency medical response depending on the severity and amount consumed.
• CYP3A4 takes a while to be produced hence increased interactions– The enzyme production may take up to 36 hours; therefore, once you take the grapefruit, you risk an antidepressant rise in the blood up to 36 hours later before production of the metabolism enzyme.

What Happens If You Eat Grapefruit While On Antidepressants?

An interaction between grapefruit and some medications may result in adverse side effects hence why the fruit is among the food to be avoided while taking antidepressants. Due to the high levels of the medicine in your body, you may start experiencing symptoms similar to overdose side effects.³ Therefore, in this case, you may need immediate healthcare attention or call your doctor for advice.

Eating grapefruit while on antidepressants can cause these adverse effects:

• Respiratory depression
• Gastrointestinal bleeding
• Fast heart rate rhythm.
• Kidney damage
• Muscle tissue breakdown

Antidepressants That Interact with Grapefruit

Some medications taken with grapefruit interact and can block the enzyme increasing their levels in the blood. One of the medications that interact with grapefruit is Zoloft (sertraline). The medication is used to treat anxiety, and according to older research, it is known to interact with grapefruit juice.⁴ This leads to blocking the enzyme metabolizing the sertraline, increasing the levels in the blood.

When the levels of Zoloft are high, you may start experiencing side effects such as dizziness and drowsiness which last several days. If you are suffering from anxiety, a doctor may prescribe other anti-anxiety medications that have little to zero reported interaction with grapefruit that include Lexapro, Paxil, and Prozac. Therefore, a healthcare provider may prescribe these medications as an alternative.

Here are antidepressants that may interact with grapefruit:⁴

• Clomipramine (Anafranil)*
• Sertraline (Zoloft)*
• Bupropion (Wellbutrin)*
• Paroxetine*
• Paxil*

*Antidepressant medications have a risk of side effects, including serious side effects. You should talk with your healthcare professional about the benefits and risks of any medication before starting treatment.

Other Psychiatric Medications That Interact With Grapefruit

Grapefruit may also interact with some psychiatric medications, which may increase their levels in the blood causing side effects similar to those of an overdose. These side effects may last up to several days. Therefore, as the doctor shares the prescription, it is helpful to ask whether there are any foods you should avoid while taking these medications to prevent these side effects.

Here are other psychiatric medications that may interact with grapefruit:

Anti-anxiety Medications

Buspirone (Buspar) is an anti-anxiety medication that may interact with grapefruit juice. In research where healthy people were given 10mg of Buspar with 200ml of grapefruit juice, there was a noticeable increase in the level of the medication in the blood. The increased strength in the medication lasted for two days.⁵

For patients taking this medication, they are advised to avoid taking large amounts of grapefruit juice. The interaction may increase Buspar’s effects and side effects in the body. Notably, not all anti-anxiety medications interact with grapefruit juices, and examples may include Prozac and Lexapro.

Here are anti-anxiety medications that may interact with grapefruit: ⁴

• Buspirone (Buspar): In practice, this medication is used for anxiety and depression and as a sleep aid.
• Xanax*

*This medication has black box warnings, the most serious kind of warnings from the FDA for abuse or misuse, risk of physical dependence, and risk of serious side effects, including death, when combined with an opioid.

Benzodiazepines

Benzodiazepines are medications that are used to treat conditions such as anxiety and they do this by bringing a calming effect to the brain. It is safe to take medication such as lorazepam, temazepam, and oxazepam, which have little or at times no interactions with grapefruit. Some of these medications, however, interact with grapefruit increasing their levels in the blood.

Here are benzodiazepines that may interact with grapefruit:

• Diazepam (Valium)
• Midazolam (Versed)
• Triazolam (Halcion)

*These medications have a black box warning, the most serious kind of warnings from the FDA for abuse or misuse, risk of physical dependence, and risk of serious side effects, including death, when combined with an opioid.

Antipsychotics

Grapefruit juice is known to interact with some antipsychotics. This medication treats hallucinations and delusions as a mood stabilizer for bipolar disorder. Some of the antipsychotic medication, when taken with grapefruit juice, may cause a high level of the medicine, causing side effects. Some medications such as clozapine (Clozaril) and aripiprazole (Abilify) do not interact with grapefruit juice although research is still ongoing on this medication. This is because most medicines have a confirmed interaction with grapefruit juice.

 Here are antipsychotics* that may interact with grapefruit:

• Quetiapine (Seroquel)
• Lurasidone (Latuda)
• Ziprasidone (Geodon)
• Olanzapine
• Risperidone

*Antipsychotic medications have a risk of side effects, including serious side effects. You should talk with your healthcare professional about the benefits and risks of any medication before starting treatment.

Other Medications That Interact With Grapefruit

Antidepressants are not the only medications that interact with grapefruits. Some other medication categories that interact with grapefruits are medication to lower blood pressure, anti-anxiety medication, cholesterol medication, and antipsychotics. The reaction is often similar, where the levels of these medications rise in the blood.

The risks vary depending on the type of medication. Some cause manageable side effects while others require immediate medical care. These interactions may cause harmful long-term effects. Therefore, it is important to ask your doctor some of the risks of taking medicine and grapefruit juice.

 Other medications that may interact with grapefruit include:

• Pain Medications
• Blood thinners
• Blood pressure medications
• Some anti-infection medications such as antivirals
• A few heart rhythm medications

Do Any Other Fruits Interact with Medications?

Other fruits that may interact with medication are mostly citrus fruits. Some of these fruits include lime, pomelo juice, and Seville oranges. The chemical that may cause these interactions in these fruits is called bergamottin. However, confirmation of these interactions by bergamottin is still under research. Therefore, continued checking on food to be avoided while taking certain medications is still very important to prevent these interactions.

Questions to Ask Your Health Team About Antidepressants and Grapefruit

Before any qualified healthcare provider prescribes medication with the potential of grapefruit interaction, they will tell you why you should avoid it. It is helpful to understand the risk of eating grapefruits when taking these antidepressants, which will help you avoid that little amount you may plan to take with the expectation of no effects. Before changing or receiving any additional medication from a different provider, inform them about your medication to prevent these interactions. In cases where you need further support in your recovery journey, there are online psychiatry services to support you.

Questions to ask your care team about eating grapefruit while taking antidepressants include:

• Is there a safe amount of grapefruit that I can consume while taking antidepressants?
• If someone wants to eat grapefruit, should they stop taking antidepressants for the day?
• Is there anxiety medication or depression medication that isn’t negatively affected by grapefruit?
• Is it true grapefruit and drug interaction antidepressants cause severe side effects?
• What should I do if I eat grapefruit anyway and have an adverse reaction?
• Does taking grapefruit and antidepressants cause overdose?
• Can grapefruit and antidepressants combination cause serious side effects?
• Does taking antidepressants and grapefruit Effexor in particular have any side effects?
• Can I take grapefruit seed extract and antidepressants? Is it safer?
• What are grapefruit and antidepressants side effects?