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Grapefruit

What is it?

Grapefruit is a citrus fruit. People use the fruit, oil from the peel, and extracts from the seed as medicine. Grapefruit seed extract is processed from grapefruit seeds and pulp obtained as a byproduct from grapefruit juice production. Vegetable glycerin is added to the final product to reduce acidity and bitterness.

Grapefruit juice is used for high cholesterol, “hardening of the arteries” (atherosclerosis), cancer, a skin disease called psoriasis, and for weight loss and obesity.

Grapefruit seed extract is taken by mouth for bacterial, viral, and fungal infections including yeast infections.

Grapefruit oil is applied to the skin for muscle fatigue, hair growth, toning the skin, and for acne and oily skin. It is also used for the common cold and flu (influenza).

Grapefruit seed extract is applied to the skin as a facial cleanser, first-aid treatment, remedy for mild skin irritations, and as a vaginal douche for vaginal yeast infections (candidiasis). It is also used as an ear or nasal rinse for preventing and treating infections; as a gargle for sore throats; and a dental rinse for preventing gingivitis and promoting healthy gums; and as a breath freshener.

Some people inhale grapefruit vapors to help the body retain water, for headache, stress, and depression. Grapefruit seed extract vapor has also been inhaled for the treatment of lung infections.

In food and beverages, grapefruit is consumed as a fruit, juice, and is used as a flavoring component.

In manufacturing, grapefruit oil and seed extract are used as a fragrance component in soaps and cosmetics; and as a household cleaner for fruits, vegetables, meats, kitchen surfaces, dishes, etc.

In agriculture, grapefruit seed extract is used to kill bacteria and fungus, fight mold growth, kill parasites in animal feeds, preserve food and disinfect water.

It’s important to remember that drug interactions with grapefruit juice are well documented. The chemistry of the grapefruit varies by the species, the growing conditions, and the process used to extract the juice. Before adding grapefruit to your diet or your list of natural medicines, check with your healthcare provider if you take medications.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for GRAPEFRUIT are as follows:

Insufficient evidence to rate effectiveness for...

  • Asthma. There is some evidence that drinking vitamin C-rich citrus fruits, including grapefruit and others, might improve lung function in people with asthma. Some studies have found this benefit, but others have not.
  • Eczema (atopic dermatitis). Developing evidence suggests that a grapefruit seed extract (ParaMicrocidin) can decrease constipation, gas, and stomach discomfort possibly due to changes in intestinal bacteria, in people with eczema.
  • High cholesterol. Early research suggest that taking grapefruit capsules daily for 16 weeks decreases total cholesterol and the ratio of low-density lipoprotein (LDL or “bad”) cholesterol to high-density lipoprotein (HDL or “good”) cholesterol. Eating one grapefruit daily appears to reduce total cholesterol, LDL cholesterol and triglyceride levels in people with high cholesterol.
  • Weight loss. Early research suggests that eating fresh grapefruit daily increases weight loss in overweight people.
  • Lowering cholesterol.
  • Hardening of the arteries (atherosclerosis).
  • Preventing cancer.
  • Psoriasis.
  • Muscle fatigue.
  • Promoting hair growth.
  • Toning the skin.
  • Reducing acne and oily skin.
  • Treating headaches.
  • Stress.
  • Depression.
  • Infections.
  • Digestive complaints in people with eczema.
  • Yeast infections (as a vaginal douche).
  • Other conditions.
More evidence is needed to rate the effectiveness of grapefruit for these uses.

How does it work?

Grapefruit is a source of vitamin C, fiber, potassium, pectin, and other nutrients. Some components might have antioxidant effects that might help protect cells from damage or reduce cholesterol.

It is not clear how the oil might work for medicinal uses.

Are there safety concerns?

Grapefruit is LIKELY SAFE in the amounts normally used as food and POSSIBLY SAFE when taken by mouth for medicinal purposes.

Grapefruit is POSSIBLY UNSAFE when taken by mouth in high amounts. If you take any medications, check with your healthcare provider before adding grapefruit to your diet or using it as a medicine. Grapefruit interacts with a long list of medications (see “Are there any interactions with medications?” below).

Special precautions & warnings:

Pregnancy and breast-feeding: Not enough is known about the use of grapefruit during pregnancy and breast-feeding. Stay on the safe side and avoid use.

Breast cancer: There is concern about the safety of drinking excessive amounts of grapefruit juice. Some research suggests that postmenopausal women who consume a quart or more of grapefruit juice every day have a 25% to 30% increased chance of developing breast cancer. Grapefruit juice decreases how estrogen is broken down in the body and might increase estrogen levels in the body. More research is needed to confirm these findings. Until more is known, avoid drinking excessive amounts of grapefruit juice, especially if you have breast cancer or are at higher than usual risk for developing breast cancer.

Hormone sensitive cancers and conditions: Consuming large amounts of grapefruit might increase hormone levels and therefore increase the risk of hormone sensitive conditions. Women with hormone sensitive conditions should avoid grapefruit.

Are there interactions with medications?

Major
Do not take this combination.
Amiodarone (Cordarone)
Grapefruit juice can increase how much amiodarone (Cordarone) the body absorbs. Drinking grapefruit juice while taking amiodarone (Cordarone) might increase the effects and side effects. Avoid drinking grapefruit juice if you are taking amiodarone (Cordarone).
Artemether (Artenam, Paluther)
The body breaks down artemether (Artenam, Paluther) to get rid of it. Grapefruit juice can decrease how quickly the body breaks down artemether (Artenam, Paluther). Drinking grapefruit juice while taking artemether (Artenam, Paluther) might increase the effects and side effects of artemether (Artenam, Paluther). Do not drink grapefruit juice if you are taking artemether (Artenam, Paluther).
Atorvastatin (Lipitor)
The body breaks down some medications used for lowering cholesterol ("statins") to get rid of them. Grapefruit juice might decrease how quickly the body breaks down some medications used for lowering cholesterol. Drinking grapefruit juice while taking these medications might increase the effects and side effects of these medications.

Grapefruit might interact with some of these medications including lovastatin (Mevacor), simvastatin (Zocor), and atorvastatin (Lipitor), but grapefruit juice does not interact with some other medications used for lowering cholesterol including pravastatin (Pravachol), fluvastatin (Lescol), and rosuvastatin (Crestor).
Buspirone (BuSpar)
Grapefruit juice might increase how much buspirone (BuSpar) the body absorbs. Drinking grapefruit juice while taking buspirone (BuSpar) might increase the effects and side effects of buspirone (BuSpar).
Carbamazepine (Tegretol)
Grapefruit juice might increase how much carbamazepine (Tegretol) the body absorbs. Drinking grapefruit juice while taking carbamazepine (Tegretol) might increase the effects and side effects of carbamazepine (Tegretol).
Carvedilol (Coreg)
The body breaks down carvedilol (Coreg) to get rid of it. Grapefruit juice seems to decrease how quickly the body breaks down carvedilol (Coreg). Drinking grapefruit juice while taking carvedilol (Coreg) might increase the effects and side effects of carvedilol (Coreg).
Cisapride (Propulsid)
Grapefruit juice might decrease how quickly the body gets rid of cisapride (Propulsid). Drinking grapefruit juice while taking cisapride (Propulsid) might increase the effects and side effects of cisapride (Propulsid).
Clomipramine (Anafranil)
The body breaks down clomipramine (Anafranil) to get rid of it. Grapefruit juice might decrease how quickly the body gets rid of clomipramine (Anafranil). Taking grapefruit juice along with clomipramine (Anafranil) might increase the effects and side effects of clomipramine (Anafranil).
Cyclosporine (Neoral, Sandimmune)
Grapefruit might increase how much cyclosporine (Neoral, Sandimmune) the body absorbs. Drinking grapefruit juice while taking cyclosporine (Neoral, Sandimmune) might increase the side effects of cyclosporine.
Dextromethorphan (Robitussin DM, and others)
The body breaks down dextromethorphan (Robitussin DM, others) to get rid of it. Grapefruit might decrease how quickly the body breaks down dextromethorphan (Robitussin DM, others). Drinking grapefruit juice while taking dextromethorphan (Robitussin DM, others) might increase the effects and side effects of dextromethorphan (Robitussin DM, others).
Estrogens
The body breaks down estrogens to get rid of them. Grapefruit juice seems to decrease how quickly the body breaks down estrogens and increase how much estrogen the body absorbs. Drinking grapefruit juice while taking estrogens might increase estrogen levels and side effects associated with estrogen such as breast cancer.

Some estrogen pills include conjugated equine estrogens (Premarin), ethinyl estradiol, estradiol (Climara, Vivelle, Estring), and others.
Etoposide (VePesid)
Grapefruit might decrease how much etoposide (VePesid) the body absorbs. Drinking grapefruit juice while taking etoposide (VePesid) might decrease the effectiveness of etoposide (VePesid). To avoid this interaction, separate taking this medication from consuming grapefruit by at least 4 hours.
Halofantrine
The body breaks down halofantrine to get rid of it. Grapefruit juice seems to decrease how quickly the body breaks down halofantrine. Drinking grapefruit juice while taking halofantrine might increase halofantrine levels and side effects associated with halofantrine, including abnormal heartbeat.
Lovastatin (Mevacor)
The body breaks down some medications used for lowering cholesterol ("statins") to get rid of them. Grapefruit juice might decrease how quickly the body breaks down some medications used for lowering cholesterol. Drinking grapefruit juice while taking these medications might increase the effects and side effects of these medications.

Grapefruit might interact with some of these medications including lovastatin (Mevacor), simvastatin (Zocor), and atorvastatin (Lipitor), But grapefruit juice does not interact with some other medications used for lowering cholesterol including pravastatin (Pravachol), fluvastatin (Lescol), and rosuvastatin (Crestor).
Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates)
Some medications are changed and broken down by the liver. Grapefruit juice might decrease how quickly the liver breaks down some medications. Drinking grapefruit juice while taking some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking grapefruit, talk to your healthcare provider if you are taking any medications that are changed by the liver.

Some medications changed by the liver include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and many others.
Medications for high blood pressure (Calcium channel blockers)
Grapefruit juice might increase how much medication for high blood pressure the body absorbs. Drinking grapefruit juice while taking some medications for high blood pressure might cause your blood pressure to go too low.

Some medications for high blood pressure include nifedipine (Adalat, Procardia), verapamil (Calan, Isoptin, Verelan), diltiazem (Cardizem), isradipine (DynaCirc), felodipine (Plendil), amlodipine (Norvasc), and others.
Medications moved by pumps in cells (Organic anion-transporting polypeptide substrates)
Some medications are moved by pumps in cells. Grapefruit might change how these pumps work and decrease how much of some medications get absorbed by the body. This could make these medications less effective. To avoid this interaction, separate taking these medications from consuming grapefruit by at least 4 hours.

Some of these medications that are moved by pumps in cells include bosentan (Tracleer), celiprolol (Celicard, others), etoposide (VePesid), fexofenadine (Allegra), fluoroquinolone antibiotics, glyburide (Micronase, Diabeta), irinotecan (Camptosar), methotrexate, paclitaxel (Taxol), saquinavir (Fortovase, Invirase), rifampin, statins, talinolol, torsemide (Demadex), troglitazone, and valsartan (Diovan).
Methylprednisolone
The body breaks down methylprednisolone to get rid of it. Grapefruit juice can decrease how quickly the body gets rid of methylprednisolone. Drinking grapefruit juice while taking methylprednisolone might increase the effects and side effects of methylprednisolone.
Pratavastatin
The body breaks down some medications used for lowering cholesterol ("statins") to get rid of them. Grapefruit juice might decrease how quickly the body breaks down some medications used for lowering cholesterol. Drinking grapefruit juice while taking these medications might increase the effects and side effects of these medications.

Grapefruit might interact with some of these medications including lovastatin (Mevacor), simvastatin (Zocor), and atorvastatin (Lipitor), But grapefruit juice does not interact with some other medications used for lowering cholesterol including pravastatin (Pravachol), fluvastatin (Lescol), and rosuvastatin (Crestor).
Praziquantel (Biltricide)
The body breaks down praziquantel (Biltricide) to get rid of it. Grapefruit juice can decrease how quickly the body breaks down praziquantel (Biltricide). Drinking grapefruit juice while taking praziquantel (Biltricide) might increase the effects and side effects of praziquantel (Biltricide).
Quinidine
The body breaks down quinidine to get rid of it. Grapefruit juice might decrease how fast the body gets rid of quinidine. Drinking grapefruit juice while taking quinidine might increase the chance of side effects.
Scopolamine (Transderm Scop)
The body breaks down scopolamine to get rid of it. Grapefruit juice can decrease how fast the body breaks down scopolamine. Drinking grapefruit juice while taking scopolamine might increase the effects and side effects of scopolamine.
Sedative medications (Benzodiazepines)
Sedative medications can cause sleepiness and drowsiness. Grapefruit juice can decrease how quickly the body breaks down some medications. Drinking grapefruit juice while taking some sedative medications can increase the effects and side effects of some sedative medications.

Some sedative medications (benzodiazepines) that might interact with grapefruit juice include diazepam (Valium), midazolam (Versed), quazepam (Doral), and triazolam (Halcion).
Sildenafil (Viagra)
The body breaks down sildenafil (Viagra) to get rid of it. Grapefruit can decrease how quickly the body breaks down sildenafil (Viagra). Drinking grapefruit juice while taking sildenafil (Viagra) can increase the effects and side effects of sildenafil.
Simvastatin (Zocor)
The body breaks down some medications used for lowering cholesterol ("statins") to get rid of them. Grapefruit juice might decrease how quickly the body breaks down some medications used for lowering cholesterol. Drinking grapefruit juice while taking these medications might increase the effects and side effects of these medications.

Grapefruit might interact with some of these medications including lovastatin (Mevacor), simvastatin (Zocor), and atorvastatin (Lipitor), But grapefruit juice does not interact with some other medications used for lowering cholesterol including pravastatin (Pravachol), fluvastatin (Lescol), and rosuvastatin (Crestor).
Terfenadine (Seldane)
Grapefruit can increase how much terfenadine (Seldane) that the body absorbs. Drinking grapefruit juice while taking terfenadine (Seldane) might increase the effects and side effects of terfenadine (Seldane).
Moderate
Be cautious with this combination.
Aliskiren (Tekturna, Rasilez)
Aliskiren (Tekturna, Rasilez) is moved by pumps in cells in the body. Grapefruit might change how these pumps work and decrease how much aliskiren (Tekturna, Rasilez) gets absorbed by the body. This could make this medication less effective. To avoid this interaction, separate taking this medication from consuming grapefruit by at least 4 hours.
Caffeine
The body breaks down caffeine to get rid of it. Grapefruit might decease how quickly the body gets rid of caffeine. Drinking grapefruit while taking caffeine might increase the side effects of caffeine including jitteriness, headache, and a fast heartbeat.
Erythromycin
The body breaks down erythromycin to get rid of it. Grapefruit can decrease how quickly the body gets rid of erythromycin. Taking grapefruit juice along with erythromycin might increase the effects and side effects of erythromycin.
Fexofenadine (Allegra)
Grapefruit might decrease how much fexofenadine (Allegra) the body absorbs. Drinking grapefruit juice while taking fexofenadine (Allegra) might decrease the effectiveness of fexofenadine (Allegra). To avoid this interaction, separate taking this medication from consuming grapefruit by at least 4 hours.
Fluvoxamine (Luvox)
Grapefruit juice can increase how much fluvoxamine (Luvox) the body absorbs. Drinking grapefruit juice while taking fluvoxamine (Luvox) might increase the effects and side effects of fluvoxamine (Luvox).
Itraconazole (Sporanox)
Itraconazole (Sporanox) is used to treat fungal infections. Grapefruit juice might affect how much itraconazole (Sporanox) the body absorbs. However, there is not enough reliable information to know if this is an interaction to be concerned about.
Levothyroxine (Synthroid, others)
Levothyroxine (Synthroid, others) is moved by pumps in cells in the body. Grapefruit might change how these pumps work and decrease how much levothyroxine (Synthroid, others) gets absorbed by the body. This could make this medication less effective. To avoid this interaction, separate taking this medication from consuming grapefruit by at least 4 hours.
Losartan (Cozaar)
The liver activates losartan (Cozaar) to make it work. Grapefruit juice might decrease how quickly the body activates losartan (Cozaar). Drinking grapefruit juice while taking losartan (Cozaar) might decrease the effectiveness of losartan.
Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates)
Some medications are changed and broken down by the liver. Grapefruit juice might decrease how quickly the liver breaks down some medications. Taking grapefruit juice along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking grapefruit juice talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include amitriptyline (Elavil), haloperidol (Haldol), ondansetron (Zofran), propranolol (Inderal), theophylline (Theo-Dur, others), verapamil (Calan, Isoptin, others), and others.
Medications changed by the liver (Cytochrome P450 2C19 (CYP2C19) substrates)
Some medications are changed and broken down by the liver. Grapefruit juice might decrease how quickly the liver breaks down some medications. Taking grapefruit juice along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking grapefruit juice talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include omeprazole (Prilosec), lansoprazole (Prevacid), and pantoprazole (Protonix); diazepam (Valium); carisoprodol (Soma); nelfinavir (Viracept); and others.
Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates)
Some medications are changed and broken down by the liver. Grapefruit juice might decrease how quickly the liver breaks down some medications. Taking grapefruit juice along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking grapefruit juice talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include diclofenac (Cataflam, Voltaren), ibuprofen (Motrin), meloxicam (Mobic), and piroxicam (Feldene); celecoxib (Celebrex); amitriptyline (Elavil); warfarin (Coumadin); glipizide (Glucotrol); losartan (Cozaar); and others.
Methadone (Dolophine)
Grapefruit juice might increase how much methadone (Dolophine) the body absorbs. Drinking grapefruit juice while taking methadone (Dolophine) might increase the effects and side effects of methadone (Dolophine).
Nilotinib (Tasigna)
Grapefruit juice can increase how much Nilotinib (Tasigna) the body absorbs. Drinking grapefruit juice while taking Nilotinib (Tasigna) might increase the effects and side effects. Avoid drinking grapefruit juice if you are taking Nilotinib (Tasigna).
Primaquine
Grapefruit juice can increase how much primaguine is available in the body. It is unclear what effects this might have. Be cautious with this combination.
Saquinavir (Fortovase, Invirase)
Drinking grapefruit juice can increase how much saquinavir (Fortovase, Invirase) the body absorbs. Drinking grapefruit juice while taking saquinavir (Fortovase, Invirase) might increase the effects and side effects of saquinavir.
Sertraline
Grapefruit juice might decrease how fast the body processes sertraline. Drinking grapefruit juice while taking sertraline might increase the chance of side effects.
Tacrolimus
Drinking grapefruit juice might increase the concentration of tacrolimus in the blood. Drinking grapefruit juice while taking tacrolimus might increase the risk for side effects.
Talinolol
Grapefruit juice can reduce how much talinolol is available in the body. Drinking grapefruit juice with talinolol might reduce the effects of talinolol.
Theophylline
Drinking grapefruit juice might decrease the effects of theophylline. There's not enough information to know if this is a big concern.
Warfarin (Coumadin)
Warfarin (Coumadin) is used to slow blood clotting. Drinking grapefruit juice might increase the effects of warfarin (Coumadin) and increase the chances of bruising and bleeding. Be sure to have your blood checked regularly. The dose of your warfarin (Coumadin) might need to be changed.
Minor
Be watchful with this combination.
Acebutolol (Sectral)
Acebutolol (Sectral) is moved by pumps in cells in the body. Grapefruit might change how these pumps work and decrease how much acebutolol (Sectral) gets absorbed by the body. This could make this medication less effective. To avoid this interaction, separate taking this medication from consuming grapefruit by at least 4 hours.
Amprenavir (Agenerase)
Grapefruit might slightly decrease how much amprenavir (Agenerase) is absorbed by the body. However, this probably is not an important interaction to be concerned about.

Are there interactions with herbs and supplements?

Licorice
Drinking grapefruit juice when taking licorice might increase licorice's ability to cause potassium depletion.
Red yeast
Grapefruit (juice or fruit) changes the way the body processes red yeast. Grapefruit can increase the amount of lovastatin from red yeast in the blood.

Are there interactions with foods?

Tonic water
Grapefruit might interfere with the way the body processes the quinine that is contained in tonic water. People who have a heart rhythm disorder (long QT syndrome, for example) should avoid taking grapefruit and tonic water together, since that combination might worsen their heart condition.
Wine
Grapefruit juice might decrease how quickly the liver breaks down some medications. This might increase the side effects of these medications. Adding red wine to the mix can increase these side effects even more. White wine, however, does not seem to interact with grapefruit or medications that are broken down by the liver.

What dose is used?

The appropriate dose of grapefruit depends on several factors such as the user's age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for grapefruit. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.

Other names

Agrume, Bioflavonoid Complex, Bioflavonoid Concentrate, Bioflavonoid Extract, Bioflavonoids, Bioflavonoïdes, Bioflavonoïdes d’Agrumes, Citrus, Citrus Bioflavones, Citrus Bioflavonoid, Citrus Bioflavonoid Extract, Citrus Bioflavonoids, Citrus decumana, Citrus Extract, Citrus Flavones, Citrus Flavonoids, Citrus Grandis Extract, Citrus maxima, Citrus paradisi, Citrus Peel Extract, Citrus Seed Extract, Cold-Pressed Grapefruit Oil, Complexe Bioflavonoïde, Complexe Bioflavonoïde de Pamplemousse, Concentré de Bioflavonoïde, CSE, Expressed Grapefruit Oil, Extrait d’Agrume, Extrait de Bioflavonoïde, Extrait de Bioflavonoïdes d’Agrumes, Extrait de Graines de Pamplemousse, Extrait de Pamplemousse, Extrait de Zeste d’Agrume, Extrait Normalisé de Pamplemousse, Flavonoïdes d’Agrumes, Grapefruit Bioflavonoid Complex, Grapefruit Extract, Grapefruit Oil, Grapefruit Seed Extract, Grapefruit Seed Glycerate, GSE, Huile de Pamplemousse, Huile de Pamplemousse Pressée à Froid, Pamplemousse Rose, Paradisapfel, Pink Grapefruit, Pomelo, Shaddock Oil, Standardized Extract of Grapefruit, Toronja.

Methodology

To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.

References

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Last reviewed - 02/14/2015