Influence of fruit juices on drug disposition: discrepancies between in vitro and clinical studies

Background: Grapefruit juice is known to alter the pharmacokinetics of over 30 prescription drugs by increasing their bioavailabilities. After the discovery of this interaction almost 20 years ago, there have been many reports investigating the effects of fruit juices on drug disposition. Objective: This article reviews the literature on fruit juice-prescription drug interaction studies to determine which juices are likely to cause clinically significant interactions. Methods: We examined the results from in vitro and clinical studies regarding the interactions between prescription drugs and over ten fruit beverages. Results/conclusions: Grapefruit juice and Seville orange juice caused several clinically significant interactions with cytochrome P4503A (CYP3A). The OATP drug transporter was inhibited by grapefruit juice, orange juice, and apple juice. Other fruit juices also interacted with drug metabolizing enzymes and transporters in vitro, but more studies are needed to determine whether these interactions are clinically significant.