Can I Have Grapefruit Juice if I Take Plavix?

A look at whether Plavix and grapefruit juice mix

grapefruit

Although Plavix (Clopidogrel) interacts with a number of other medications and dietary supplements, I cannot find any evidence that it interacts with grapefruit juice.

To learn more about grapefruit juice and medications read my article: Grapefruit Juice: Is It Safe with Your Drug?

I would recommend that you carefully read the printed handout that came with the Plavix. There should be a section about interactions between Plavix and other medications.

If you did not receive a package insert, ask your pharmacist for a copy.

If you are using any over-the-counter (OTC) medications or dietary supplements, you should talk to your pharmacist and doctor about potential interactions. You should be especially careful about using medications for inflammation like ibuprofen and OTC supplements that contain ginkgo. A side effect of these products is bleeding.

Additional Notes

Plavix is the brand name for clopidogrel. This medication is an anticoagulant (blood thinner) which is used to decrease the prevalence of stroke and myocardial infarction.

In the body, clopidogrel is metabolized using the CYP2C19 enzyme. However, certain people are CYP2C19 poor metabolizers. These people are resistant to clopidogrel. Although there is a blood test to identify clopidogrel-resistant patients before the institution of therapy with the medication, this test is not widely used.

Of note, people who are poor clopidogrel metabolizers, also have an increased relative risk of dying of cardiovascular events or stent thrombosis.

Grapefruit juice is an inhibitor of cytochrome P450 CYP3A4 enzyme. Although a grapefruit juice messes with a lot of medications--approximately 50 percent of all prescription medications, in fact--it doesn't mess with the CYPC19 enzyme that metabolizes or breaks down clopidogrel.

In other words, because grapefruit juice affects a different enzyme of metabolism than that of Plavix, Plavix will remain unaffected by grapefruit juice.

However, grapefruit juice can affect heart medications other than Plavix including the following:

  • statins (such as Zocor and Lipitor)
  • blood-pressure medications like nifedipine
  • anti-arrhythmia medications like amiodarone

In addition to heart medications, grapefruit juice also affects the following drugs:

  • medications used for organ transplant like cyclosporine
  • anti-anxiety medications like buspirone
  • antihistamines like Allegra

Grapefruit juice can be a healthy component of any diet. If you are on heart medications, please discuss whether it's a good idea to drink grapefruit juice with your physician or other healthcare provider. Be sure to inform your health-care provider of all medications you're taking and the dosages of these medications.

Content Updated by Naveed Saleh, MD, MS, in 10/2015.

Selected Sources

Krasowski MD. Pharmacogenomics. In: South-Paul JE, Matheny SC, Lewis EL. eds. CURRENT Diagnosis & Treatment: Family Medicine, 4e. New York, NY: McGraw-Hill; 2015. . Accessed October 25, 2015.

Trevor AJ, Katzung BG, Kruidering-Hall M. Pharmacogenomics. In: Trevor AJ, Katzung BG, Kruidering-Hall M. eds. Katzung & Trevor's Pharmacology: Examination & Board Review, 11e. New York, NY: McGraw-Hill; 2015. Accessed October 25, 2015.

FDA Consumer Health Information document titled "Grapefruit Juice and Medicine May Not Mix."  Accessed on October 25, 2015.

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