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All TopicsForum: Hormonal Therapy - Before, During and After → Topic: Orange Juice and Anti-Cancer Drugs??

Topic: Orange Juice and Anti-Cancer Drugs??

Forum: Hormonal Therapy - Before, During and After — Risks and benefits, side effects, and costs of anti-estrogen medications.

Posted on: Aug 25, 2008 01:54PM

Catherine8718 wrote:

I just watched a video on Comcast from Fox News.  There was a physician talking about the effect various juices has on certain medications.  He mentioned "anti-cancer drugs" and how orange juice could affect it's effectiveness.  The part I heard was, "cuts the effectiveness in half.....orange juice can do this for 4 hours after drinking."  I take my arimidex in the am, first thing, and then within the 1/2 hour I have oj with my vitamins. 

 Sooo, my question to all of you is, have you heard anything from your doctors about OJ effecting Arimidex if taken together?  I know I can call my Onc but thought I'd check with the real experts first!

Thank you!

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Aug 25, 2008 02:32PM badboob67 wrote:

Holy cow...I hope not! Orange juice is the only liquid I can stomach on the first few days of XELODA.  UGH

When you're down to nothing, GOD is up to something! http://bb67.wikispaces.com/

Dx 2/15/2006, IDC, 5cm, Stage IV, Grade 2, 24/27 nodes, mets, ER+/PR-, HER2-
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Aug 25, 2008 06:57PM, edited Aug 25, 2008 06:59PM by otter

Catherine, we'll have to check that out (not that I don't trust a doctor making general statements like that on FOX News!).

One thing I do know is that a component in grapefruit juice (not orange juice) can interfere with certain types of drugs.  Usually, that interference is on the form you get from the pharmacist, or in the package insert.

I'll see what I can find out about your question, and get back to y'all.

otter 

[Edited to add:  I wonder what "anticancer drugs" the doctor was talking about.  That would make a huge difference.  Many of us who got chemo were told not to take anti-oxidants during chemo.  Maybe the concern was the Vitamin C as an anti-oxidant?  Who knows....] 

Dx IDC, Stage I, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Aug 25, 2008 08:26PM, edited Aug 25, 2008 08:30PM by otter

OK, I found it!

The FOX News piece was similar to others appearing in other news reports in the past few days.  All of them were highlighting a paper that was presented at the annual meeting of the American Chemical Society this past week.  Some of the news reports, like one I saw on the CBS website, were based on an on-line article on WebMD that summarized the ACS paper.  Here's a link to the WebMD article.  I'll also include part of the WebMD the article:  http://www.webmd.com/news/20080819/fruit-juices-block-common-drugs

Fruit Juices Block Common Drugs

Grapefruit, Orange, Apple Juices Decrease Absorption of Many Often-Used Drugs
By Daniel J. DeNoon
WebMD Health News
Reviewed by Louise Chang, MD
 
Aug. 19, 2008 -- Grapefruit, orange, and apple juices block drugs commonly used to treat infections, allergy, transplant rejection, cancer, and high blood pressure.
 

In 1991, David G. Bailey, PhD, and colleagues found that grapefruit juice increased blood concentrations of the blood pressure drug Plendil to possibly dangerous levels. Grapefruit juice, they later learned, slows down a key liver enzyme that clears Plendil -- and about 40 other drugs -- from the body.

Now Bailey reports that grapefruit, orange, and apple juices decrease the absorption of several important medications:

  • The allergy drug Allegra, available generically as fexofenadine
  • The antibiotics ciprofloxacin (Cipro, Proquin), levofloxacin (Levaquin), and itraconazole (Sporanox)
  • The beta-blocker blood pressure drugs atenolol (Tenormin), celiprolol, and talinolol
  • The transplant-rejection drug cyclosporine (Gengraf, Neoral)
  • The cancer chemotherapy etoposide (Toposar, Vepesid)

"This is just the tip of the iceberg. I'm sure we'll find more and more drugs that are affected this way," Bailey says in a news release.

Bailey revealed the new findings in a report to the 236th annual meeting of the American Chemical Society.

A substance in grapefruit juice called naringin seems to be the culprit. The compound apparently blocks OATP1A2, a transporter molecule in the gut, which carries some drugs from the small intestine into the blood. Orange juice contains hesperidin, a naringin-like substance. The culprit in apple juice remains unidentified. ...

People should take their pills only with water, advises Bailey, a professor of clinical pharmacology at the University of Western Ontario, London, Canada. ...

+++++++++++++++++++ 

There have been lots of other news reports about the American Chemical Society paper.  One of them, from www.dailymail.co.uk, included this statement:

"Professor Bailey said: 'Juice taken four hours prior to drug intake did not have an effect. Thus, it should be possible still to take grapefruit, orange and apple juices while on affected medications provided there is a sufficient time interval.' "

One thing we need to keep in mind is that the information about the effect of orange juice (and apple and grapefruit juices) on absorption of drugs from the intestine has not been published in a peer-reviewed research journal yet.  That's the gold standard for communication of research findings.  Simply presenting a report at a meeting does not give it the same level of credibility as having it evaluated thoroughly by experts in that area of study, and getting it published in a journal that is read by thousands of other scientists.

We should expect to hear more about this issue, though.  In the meantime, it probably is a good idea to take our drugs with a glass of water, rather than O.J.  Good find, Catherine!

otter 

Dx IDC, Stage I, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Aug 25, 2008 08:38PM, edited Apr 29, 2009 10:26AM by yellowrose

This Post was deleted by yellowrose.

You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, 'I have lived though this horror. I can take the next thing that comes along.' Eleanor Roosevelt

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Aug 25, 2008 09:04PM BMac wrote:

When I was doing chemo for ovarian I was told I couldn't drink orange juice.

Barbara

Dx 10/23/2007, IDC, 2cm, Stage IIIc, Grade 3, 1/13 nodes, ER-/PR-, HER2+
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Aug 26, 2008 01:40PM Catherine8718 wrote:

Thanks for all of your checking and reporting back Otter!  I was concerned it may affect my Arimidex - but because of your checking, I now know not to let my son drink oj in the morning when he's taking his Allegra!  Such a shame...OJ w/calcium is a part of our routine every day.

 Thanks again Otter :-)

Dx 2/20/2006, IDC, 2cm, Stage IIb, Grade 2, 1/5 nodes, ER+/PR+, HER2-
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Aug 26, 2008 04:05PM awb wrote:

my pharmacist always told me no grapefruit or grapefruit juice while on tamoxifen--decreases it's effectiveness----never heard anything about a problem with orange or apple juice.  My son, who drinks a lot of orange juice, always took his allegra at night.

"I don't know what the future holds, but I know who holds the future"

Dx 9/5/2003, LCIS, Stage 0, 0/0 nodesSurgery 09/16/2003 Lumpectomy (Right)Hormonal Therapy 10/30/2003 TamoxifenSurgery 04/05/2005 Prophylactic Ovary Removal (Both)Hormonal Therapy 02/28/2009 Evista
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Aug 26, 2008 05:11PM Keenie wrote:

That's what I was told too - no grapefruit juice while on Tamoxifen.

Good thing I don't like the juice - glad it's not vanilla lattes.Wink

Christine

Be still and know that I am God!

Dx 12/6/2006, IDC, 1cm, Stage I, Grade 2, 0/7 nodes, ER+/PR+, HER2-
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Aug 26, 2008 05:23PM Lucy47 wrote:

I'm also on Tamoxifen....but was told to stay away from soy products only because I'm ER+. While I was doing chemo I was told no grapefruit juice.

I have an appt with my onc in sept so I will asks him about this.

Lucy

Lucy

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Aug 26, 2008 05:49PM Isabella4 wrote:

Yikes....I can put away 2 cartons of oj a day, most days.

Have known not to drink grapefruit juice when on a lot of drugs, but not oj.

I love it, and also am on Arimidex (nearly 5 years)

Isabella.  

Dx 5/14/2003, IDC, 1cm, Stage I, Grade 1, 0/26 nodes, ER+/PR+, HER2-
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Aug 26, 2008 06:10PM, edited Aug 26, 2008 06:12PM by otter

It's all very confusing.  There are 3 different things going on with citrus fruits (juices, mostly).

The most obvious one is that Vitamin C is an antioxidant, so our oncos might want us to back off from the citrus fruits and Vitamin C supplements during chemo.   If we take antioxidants during chemo, the antioxidants can interfere with effectiveness of some chemo drugs.  Tumor cells are "protected" by antioxidants just like normal cells are, and some chemo drugs act by generating oxidant molecules.  Anticancer drugs that act by some other mechanism (i.e., that don't "kill" cells with oxidant molecules) shouldn't be affected by this problem.

The next-oldest information is that grapefruit juice contains something which interferes with metabolism of some drugs.  The interference actually increases the length of time those drugs are in our system, effectively increasing the concentration of the drugs in our bodies.  Those higher drug concentrations can even approach toxic levels.  That problem is usually noted in the printed information we receive from the pharmacist about the drugs that are susceptible to the interference.  Not all drugs are vulnerable--it depends on what enzymes are used to metabolize and clear them.

The third, and most recent, finding is the stuff in this summer's American Chemical Society report that Catherine found.  Grapefruit juice, orange juice, and apple juice, contain substances that interfere with absorption of some drugs across the wall of our intestine and into the blood.  Thus, taking those drugs while the effect of the juice is still in our gut can decrease the amount of drug we absorb, effectively decreasing the drug concenration in our blood.  This would only be a problem with drugs taken orally, of course, and only for drugs that are absorbed via the receptor that is blocked by the fruit juice molecule (whatever it is).

Like I said, this is all pretty confusing; and it seems like more information comes out every year, making things even worse.

otter 

Dx IDC, Stage I, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Aug 26, 2008 07:52PM amberyba wrote:

I was trying to drink a lot of fresh juices right at the time of my diagnosis and after. then came accross information that grapefruit eaters tend to have higher breast cancer occurances.

here is an artiticle to check out:

http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Grapefruit_Linked_to_Breast_Cancer.asp

Estrogen -- the hormone that fuels most breast cancers -- is one of the substances that interacts with grapefruit. At least two previous studies have found higher estrogen levels in women consuming grapefruit or grapefruit juice, and the US Food and Drug Administration requires hormone replacement products to carry warning labels stating that grapefruit juice may increase the concentration of estrogen in the body.

My rad onc suggested orange juice instead. she knew about the estrogen/grapefruit connection.

I will have to google tamoxifen and citrus juice to check it out.

Amber Almond

Dx 2/2008, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR+, HER2-