Beverages you need to be careful with Drug Interaction (1)

Beverages you need to be careful with Drug Interaction (1)

Beverages you need to be careful with Drug Interaction (1)

There is a legitimate reason why we are told to “take medicines with water.” Beverages excluding water often contain the nutrients, which easily interact with medicines, such as vitamins, minerals, fat, or caffeine. Even mineral water could decrease the medical effectiveness.

In this article, we will explain about the dangerous drug interactions with beverages.

Grapefruit juice strengthens the side effects of a variety of medicines

Nothing is more incompatible with medicines than grapefruit juice. Including antihypertensive, it reinforces the functions of medicines such as for cardiac disease or migraine, etc. The concentration of medicine could increase ten time more than normal condition, and lead to dangerous side effects. For patients with high blood pressure, sudden blood pressure drop could cause vertigo or headache, etc.

These side effects are caused by the nutrients called “furanocoumarin”,  which is contained in the flesh of grapefruit. The furanocoumarin content is higher in juice but there is still a risk of side effects even eating grapefruit as is. White grapefruit contains more furanocoumarin than ruby red grapefruit. It is better to stagger the timing of medicine intake.

How grapefruit juice increases the concentration of medicine: For the case of hypertension medicine, felodipine (Product name: Plendil), approximately 15% of medicine transmit into blood normally and works the most effectively. Intaking with grapefruit juice, however, leads more that 30% of medicine transmitting into blood, and blood concentration becomes too high.

If you cannot help drinking, leave at least one hour before or after taking medicine and take a little amount. It is a fundamental not to drink at all if a dosage instruction indicates, “take once a day,” because the effect of grapefruit juice lasts long and more likely to cause the dangerous drug interactions.

*Refer the article, Foods you need to be careful with Drug Interaction (2) 

Other than the medicine introduced above, there are a lot more of other medicines that are incompatible. Regardless of the kind of medicine, it is safer to avoid drinking grapefruit juice at the same or close time of the day. There are some reports that similar citrus fruits like sweetie or hassaku orange also reinforce the efficacy of medicine.

Example(s) of incompatible medicine with grapefruit juice and symptoms):

Hypertension medicine - headache, faint, dizziness, edema of hands and feet

*Once-a-day type is now a standard dosage, so it is still dangerous even staggering the timing.

Felodipine (Product name: Plendil), Nicardipine (Product name:Cardibloc-SR), Nifedipine (Product name: Adalat LA), Losartan potassium (Product name: Cozaar), Eplerenone(Product name:Inspra), etc.

Cardiovascular medicine - headache, dizziness, feeling sick, bradycardia

*Often used for arrhythmia or angina treatment and a pulse becomes slow as an interaction with grapefruit juice.

Verapamil hydrochloride (Product name: Isoptin SR), Amiodarone hydrochloride (Product name: Cordarone), etc.

Hyperlipidemia medicine - gastric distress (as cholesterol falls down too much), rhabdomyolysis (disease that skeletal muscle dissolves in)

Atorvastatin calcium hydrate (Product name: Lipitor), Simvastatin (Product name: Zocor), etc.

Migraine medicine - dizziness, drowsy, nausea

Eletriptan hydrobromide (Product name: Relpax), Ergotamine tartrate (Product name: Cafergot), etc.

Antibiotics - nausea, diarrhea, stomachache

Erythromycin (Product name: Ermycin), Clarithromycin (Product name:Klacid), etc.

Antithrombotic - abnormal bleeding (as drug interaction makes blood flow smooth)

Apixaban (Product name: Eliquis), Rivaroxaban (Product name: Xarelto), Ticagrelor (Product name: Brilinta), etc.

Antianxiety medicine - drowsy, dizziness, tachycardia

Diazepam (Product name: Diapine), etc.

Erectile dysfunction (ED) medicines - hot flashes of face, headache

Sildenafil citrate (Product name: Viagra), Tadalafil (Product name: Cialis), Vardenafil hydrochloride hydrate (Product name: Levitra), etc.

Sleeping pills - dizziness, languor

Zopiclone (Product name: Imovane), etc.

Orange juice interfere with medicines to work effectively

Orange juice sometimes weakens the efficacy of medicines, and osteoporosis medicine is particularly incompatible. It also lowers the medical functions of a certain kind of antiallergics. This is because orange juice interferes with absorption of medical nutrients.

Example(s) of osteoporosis medicine: Alendronate sodium hydrate (Product name: Fosamax), Sodium risedronate hydrate (Product name: Actonel), etc.

Example(s) of antiallergics: Fexofenadine hydrochloride (Product name: Telfast), etc.

When we have our kids to take medicines, some might have used orange juice to hide the bitterness of medicines. Beverages with strong acidity like orange juice, however, peels off the coating and strengthen the bitter taste of medicines like antibiotics. We should never take or have our kids to take with macrolide antibiotics particularly.

Example(s) of macrolide antibiotics: Clarithromycin (Product name: Klacid), Azithromycin (Product name: Zithromax), etc.

Beverage(s) that affects the taste of medicine: *Acidic juice reinforces the bitterness, especially the granule or fine granule type of macrolide antibiotics. Ex. Orange juice, fermented milk drinks like yogurt, soda

If that is the case, is apple or grape juice safe?

The answer is “No.” Although not a lot but there are a few reports of drug interaction of apple juice. Rather than experimenting the undiscovered side effect, just avoid taking medicines with juice.


In this article, we discussed about the compatibility of juice (grapefruit and orange) with the certain medicines. We hope you now have the idea that there are incompatible combinations of medicine and beverages.

Grapefruit juice, especially, is incompatible with the most of medicines, so it is just better not to drink at all while on medication. If you are craving for grapefruit juice, please confirm with your doctor or pharmacist.

In next article, we will continue the dangerous drug interaction with beverages.

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