Pomegranate Juice Interacts With Medications

saluki · July 2007

I was going online to order some Pomegranate molasses and I ran across this

Pomegranate Juice Interacts With Medications

But a report published in the September 1 2006 issue of the American Journal of Cardiology suggests that we don't know enough about how pomegranate interacts with common medications.

A 48-year-old man was taking ezetimibe (trade name Zetia) 10 mg a day and rosuvastatin (trade name Crestor) 5 mg every other day for 17 months. Both medications are used to treat high cholesterol.

He began drinking pomegranate juice (200 ml twice weekly) and three weeks later, was admitted to emergency with thigh pain and an elevated serum creatine kinase level (138,030 U/L, normal < 200 U/L).

Both are symptoms of rhabdomyolysis, a serious condition that causes the breakdown of muscle fibers and may lead to kidney failure.

Rosuvastatin belongs to a group of medicines called HMG-CoA reductase inhibitors, or 'statins'. Grapefruit juice is known to increase the risk of statin-induced myopathy, but up until now, there was little information about whether pomegranate juice might also increase the risk.

Pomegranate juice and grapefuit juice, are both known to block the cytochrome P450 3A4 enzyme systems in the intestines. By inhibiting these enzymes, the juices may increase blood levels of many medications.
Potential Pomegranate-Drug Interactions

* Antiarrhythmics - Amiodarone (Cordarone), disopyramide (Norpace), quinidine

* Calcium channel blockers - Felodipine (Plendil), nicardipine (Cardene), nifedipine (Procardia), nimodipine (Nimotop), nisoldipine (Sular)

* Statins - Atorvastatin (Lipitor), lovastatin (Mevacor), simvastatin (Zocor)

* Immunosuppressants - Cyclosporine (Sandimmune, Neoral), tacrolimus (Prograf)

* Protease inhibitors - Saquinavir (Fortovase)

However, pomegranate juice may also interact with medications not on this list. The drugs ezetimibe and rosuvastatin are not thought to be broken down by cytochrome P450 3A4.

Based on the limited evidence about the potential drug interactions, it would be wise to talk with your doctor if you use pomegranate products regularly, and to avoid taking pomegranate products within 72 hours of taking the above medications.

Sources

Hidaka M, Okumura M, Fujita K, Ogikubo T, Yamasaki K, Iwakiri T, Setoguchi N, Arimori K. Effects of pomegranate juice on human cytochrome p450 3A (CYP3A) and carbamazepine pharmacokinetics in rats. Drug Metabolism and Disposition. 33.5 (2005):644-8.

Kim H, Yoon YJ, Shon JH, Cha IJ, Shin JG, Liu KH. Inhibitory effects of fruit juices on CYP3A activity. Drug Metabolism and Disposition. 34.4 (2006):521-3.

Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis associated with pomegranate juice consumption. American Journal of Cardiology. 98.5 (2006):705-6.
Updated: September 19, 2006

Reply Forward

Rosemary44 · July 2007

Thanks Susie,

Good find. There goes the pom juice I so love. We have to start drinking the pom juice before we need meds, so we won't need the meds in the first place.

Rosemary44 · July 2007

"but up until now, there was little information about whether pomegranate juice might also increase the risk."

Now that I think about it some more, there still is little information about the risk. One person does not make an entire human research project to see if pom juice interferes with meds to make them stronger.

If it does work that way, we can save money and get lower doses of the drug it effects, and down it with some pom juice. The pom industry needs to respond to this with its own research. I hope they use more than one person.

Rosemary44 · July 2007

http://www.ncbi.nlm.nih.gov/sites/entrez...p;dopt=Abstract

I'm going back to my pom juice again. I had this feeling that if there were more experiences like the one that fellow had, we'd hear all about it right here on these boards.

saluki · July 2007

I wish they would give us the parameters of the studies so we would know how seriously to take this stuff. Particularly how many were in the study.

For me, I'll continue to have my Pomegranate molasses drinks.
I enjoy them (unlike the Kombucha tea. LOL) and they are very refreshing---if they are healthy--
all the better--(I feel the same way about flax seeds).

Susie

Anonymous · July 2007

I love pom juice....what is Pomegranate molasses drinks????

Jule

saluki · July 2007

Julie, I buy Pomegranate molasses in the middle eastern grocery stores. Its very concentrated and I use it in cooking,
but during the summer. I like to mix it with seltzer water and ice much like a wine spritzer. I find the sweet-tart very refreshing.

Susie

Anonymous · July 2007

Hmmmm, I will have to check to see if I can find a place to get it here...

There is a community about 20 miles away that is entirely vegitarian and I purchase alot of items in their grocery that are not available in other stores here so Im thinking they may have it ....

I really sounds like something I would like....
Thank you for telling me about it.

Any other suggestions for pom use would be appreciated as well...I just enjoy the taste of it so have always drank it...

Jule

saluki · July 2007

Here is a little blurb about it and if you can't get it in the market amazon carries it.

We quote expert Paula Wolfert, a fine cookbook author: "Pomegranate molasses is an essential ingredient...has a wonderful flavor and a heady aroma, and its thickness and dark color make food look very appealing. It keeps almost indefinitely in the refrigerator. The uses for this thick, tangy, piquant syrup are many. It blends well with walnuts, adds a tart and pungent flavor to beans, sharpens the taste of poultry, gives a clean, tart taste to fish, gives an astringent edge to salads and vegetables, and is a great tenderizer for lamb and pork. It can also be diluted and used for sharp drinks and tart sorbets."

It can be used for sauces or diluted to make pomegranate drinks.

http://www.amazon.com/exec/obidos/search...process=default

Anonymous · July 2007

Thank you so much!!!!

Jule

BlindedByScience · July 2007

I use the pom molasses on my oatmeal, along with ground flaxseed, walnuts and cinnamon. I also mix it into rice milk smoothies with frozen blueberries and raspberries. It works well mixed into balsamic vinegar for dressing green salads or over chicken salad.

I'm thinking about making my own pomegranate ice cream (well, rice cream) with dark chocolate bits.

I haven't found any studies to show it interferes with Armidex and my estradiol level just tested at

.

JoanofArdmore · July 2007

QUOTE:"I'm going back to my pom juice again. I had this feeling that if there were more experiences like the one that fellow had, we'd hear all about it right here on these boards. "

Rosemary, me too! I very much dislike taking results of small , possibly inefficient, studies as a holy grail!These alarmists & killjoys, I think, get lists of the latest good things, and do studies to prove them "bad for us".
I was appalled but refused to quit my daily 3 oz of Pom.

You're my hero, Rosemary!
THANKS!!

CaliforniaKate · July 2007

I ordered a bottle of pomegranate capsules, and then found out that you can't take them while on tamoxifen. Kate

Rosemary44 · July 2007

Joan,

News like this gets out very slowly, so there must be quite a few people happily taking their statins and having their pom too, like myself. I've been doing this for years. This might have more to do with Crestor then it does with pom. Who's to say?

I'd like to read the full research report too but I don't think we should have to pay for it. The pom industry should just be making it available to whomever asks for a copy. Or just post it on their web site. Pay the copyright fee and let us have it.

Rosemary44 · August 2007

I think that gentleman should dump his crestor and keep the pom juice. Look how pom got blamed for something that crestor is in deep water for:

http://www.injury-help-usa.com/crestor.htm

Pomegranate Juice Interacts With Medications

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