You should avoid taking certain medications with orange juice, especially fexofenadine (Allegra), beta-blockers (like atenolol, celiprolol), fluoroquinolone antibiotics (ciprofloxacin), aliskiren (Tekturna), alendronate (Fosamax), and montelukast (Singulair), as the juice can reduce their absorption and effectiveness; calcium-fortified OJ can further worsen this for some antibiotics. The interaction often involves the juice's acidity or minerals blocking drug transporters, so timing separation (often 2-4 hours) is key, but it's best to check with your pharmacist.
Here are examples of some types of drugs that grapefruit juice can cause problems (interact) with:
Fruit juices
The main interactions are with enzymes (proteins) in your body called cytochromes (CYPs) that are used to break down (metabolize) many medications. Orange juice can lower how well your body absorbs alendronate (Fosamax) — a medication used for osteoporosis.
Another note when drinking orange juice to improve health is to not drink it immediately before or after drinking milk. The amount of protein in milk can react when interacting with the amount of tartaric acid and vitamin C in orange juice, leading to symptoms such as bloating, indigestion, diarrhea, or abdominal pain.
In addition to avoiding orange juice late at night, you should also avoid drinking it during the following times: On an empty stomach: The acidic nature of orange juice can harm the stomach lining and exacerbate gastritis or ulcers.
Certain Fruit Juices
Other fruit juices, including apple and citrus ones like orange, may also affect how your body absorbs and processes certain blood pressure medications, said David Maron, MD, a cardiologist with the Preventive Cardiology Clinic at Stanford Medicine.
Citrus fruits
Flavonoids are a form of plant chemicals that function as antioxidants in the body, protecting against free radicals' damaging effects. Studies reported drinking two glasses of orange juice a day lowered blood pressure in people with hypertension.
Two drugs that can't be taken together include opioids and alcohol, or benzodiazepines and alcohol, as this combination severely slows breathing and increases overdose risk, and also aspirin and ibuprofen (or other NSAIDs), which heighthens the danger of serious bleeding or stomach ulcers, highlighting the importance of checking all medications for dangerous interactions.
The main exception is grapefruit and its juice, which contain compounds that can interfere with the metabolism of certain statins. Pummelos have a similar profile to grapefruit and also should be avoided. However, other citrus fruits like oranges do not contain these compounds and are generally safe to consume.
A study examined the effect of different juices on paracetamol dissolution (Deepak et al., 2019). The study found that the maximum drug dissolution in orange juice did not exceed 29% of the drug, compared to 98% of the drug at 120 min (Deepak et al., 2019).
Limes, pomegranates, pomelos, and Seville oranges can also interact with some medications, including statins such as atorvastatin. There just hasn't been as much research published regarding how other types of citrus (apart from grapefruit) interact with statins.
High acid foods – Citrus fruits and juices like orange and grapefruit, soda, chocolate and tomato products have a high acid content, which could decrease how much medicine is absorbed into your system for certain antibiotics.
Certain statin drugs used to lower cholesterol such as atorvastatin (Lipitor), lovastatin, simvastatin (Zocor). Loratadine (Claritin Allergy), a common OTC non-sedating antihistamine. Felodipine, nifedipine, verapamil - calcium channel blockers used to treat high blood pressure.
Which foods or drinks should be avoided while taking statin drugs? Grapefruit juice is the only food or drink that has a direct interaction with statins.
Antibiotics are usually taken with water because taking them together with fruit juices, dairy products or alcohol can affect how the body absorbs some of them.
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One of the recommendations to reduce medication errors and harm is to use the “five rights”: the right patient, the right drug, the right dose, the right route, and the right time.
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A note of caution: Excessive juice consumption can pose special dangers to people who are on blood thinners or have kidney disease. Speak to your doctor before consuming a lot of juice, no matter what kind. Finally, ignore the marketing hype around juice.
Fruit juice and some blood pressure drugs/ antihistamines
Also, if you're taking the beta-blocker atenolol (Tenormin) or the renin inhibitor aliskiren (Tekturna), you should know that drinking apple juice or orange juice could decrease levels of the drug in your body.
Just remember that natural sugars are found in fruit, vegetable, and milk-based drinks. Watch out for added sugars in sweetened beverages such as energy drinks, regular sodas, and flavored teas, which may increase blood pressure and heart disease risk.
Like pomegranates, berries contain polyphenols, and research has found that berry juice can lower blood pressure. Cranberry and cherry juices came out on top in one study.
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The problem is that chemicals in the fruit can get in the way of the medicine breaking down, called metabolizing, in the digestive system. As a result, the medicine can stay in the body for too long or too short a time. More often, the problem is medicine staying in the body too long.