14 Medications You Shouldn’t Take With Grapefruit

Mixing grapefruit, whether as a juice or in a dietary supplement, with some medications can disrupt how the drugs are processed in your body, potentially causing dangerous side effects or loss of effectiveness.

1. Certain Statins

Certain statins and grapefruit do not mix well. For instance, consuming grapefruit while taking Lipitor (atorvastatin) can lead to high atorvastatin levels in your bloodstream. This increases your risk of rhabdomyolysis, which is muscle breakdown.

This interaction is more likely when you drink or eat more than 1.2 liters of grapefruit daily.

The following is a list of statins that interact with grapefruit:

• Atorvastatin
• Lovastatin
• Zocor (simvastatin)

However, there are alternative statins with a lower risk of interacting with grapefruit, including:

• Crestor (rosuvastatin)
• Fluvastatin
• Pravastatin

2. Calcium Channel Blockers

Grapefruit may interact with some blood pressure medications—specifically the calcium channel blocker drug class.

For example, grapefruit can raise levels of Procardia (nifedipine), a calcium channel blocker, in your bloodstream. This increases your risk of side effects like low blood pressure and swelling.

Some alternatives to calcium channel blockers with little to no interaction with grapefruit include:

• Cardizem (diltiazem)
• Norvasc (amlodipine)
• Verelan (verapamil)

3. Estrogen-Containing Medications

Grapefruit can increase estrogen levels in estrogen-containing medications, such as hormonal contraceptive pills or estradiol tablets. High estrogen levels may lead to more side effects.

High doses of estrogen are linked to risks like heart attacks and blood clots. Too much estrogen may also cause nausea, vomiting, and vaginal bleeding.

4. Certain Immunosuppressants

Grapefruit interacts with certain immunosuppressants—drugs that reduce the immune system’s activity. This can raise the levels of some immunosuppressive drugs, increasing the risk of issues like kidney toxicity.

The following is a list of example immunosuppressants that interact with grapefruit:

• Afinitor, Zortress (everolimus)
• Neoral (cyclosporine)
• Prograf (tacrolimus)
• Rapamune (sirolimus)

You’ll likely need to avoid or limit grapefruit while taking any of the above medications.

5. Buspirone

Grapefruit interacts with a medication called buspirone, which is used to treat anxiety disorders. It does this by increasing the amount of the drug in your bloodstream.

High levels of buspirone may increase your risk of side effects, such as:

• Dizziness
• Drowsiness
• Headache
• Nausea
• Nervousness
• Restlessness

If you take buspirone, avoid drinking large amounts of grapefruit juice.

6. Corticosteroids

Grapefruit can raise the levels of certain oral corticosteroids (steroids) in the body. This includes budesonide, a steroid used in treating the inflammatory bowel disease Crohn’s disease, and Medrol (methylprednisolone), which treats several inflammatory conditions.

Too much steroid in the bloodstream can cause Cushing’s syndrome, a hormonal disorder caused by high cortisol levels, or increase the risk of side effects like high blood pressure or fluid retention.

7. Anti-Arrythmic Medications

Grapefruit can interact with some anti-arrhythmic medications, such as Multaq (dronedarone) and Pacerone (amiodarone). Grapefruit raises the drug levels in your body. This may increase the risk of side effects, including severe heart rhythm problems.

8. A Few Diabetes Medications

Saxagliptin is a diabetes medication in the dipeptidyl peptidase 4 (DPP4) inhibitor drug class. Grapefruit might increase saxagliptin levels by blocking the CYP3A4 liver protein that breaks down this drug.

Common side effects of saxagliptin include:

• Headache
• Upper respiratory tract infection—like the common cold
• Urinary tract infection (UTI)

If taken with something that strongly blocks the CYP3A4 liver protein—like grapefruit—the saxagliptin dosage should be low at 2.5 milligrams (mg) daily.

Alternatives may include a similar but different class of diabetes medication called glucagon-like peptide 1 (GLP-1) agonists. Examples include Victoza (liraglutide) and Ozempic (semaglutide).

9. Allegra (Fexofenadine)

Allegra (fexofenadine) is an example of an OTC antihistamine that interacts with grapefruit. Grapefruit can limit how much fexofenadine enters the bloodstream. This decreases the drug’s effectiveness.

An alternative antihistamine that is likely safe against grapefruit is Claritin (loratadine).

10. Blood Thinners (Anticoagulants)

Grapefruit might increase the levels of certain blood thinners by blocking the CYP3A4 liver protein that breaks them down. As a result, you might be at an increased risk of bleeding.

Blood thinners that can interact with grapefruit include:

• Eliquis (apixaban)
• Plavix (clopidogrel)
• Xarelto (rivaroxaban)

11. Some Cancer Medications

Grapefruit can interact with some cancer medications, such as dasatinib and nilotinib, used for chronic myeloid leukemia (CML). Grapefruit can raise the amount of these medications in your body. This can increase the risk of side effects, such as severe heart rhythm problems and toxicity.

Some dosage adjustments are possible with dasatinib.

12. Certain Drugs Used to Treat Infections

Grapefruit can interact with certain drugs used to treat infections, such as:

• An antibiotic called Ery-Tab (erythromycin)
• Certain human immunodeficiency virus (HIV) medications, such as Edurant (rilpivirine), Selzentry (maraviroc), bictegravir, and doravirine
• Paxlovid (nirmatrelvir and ritonavir)

The product labels do not list grapefruit as an interaction. However, grapefruit might raise these anti-infective drug levels by blocking the CYP3A4 liver protein that breaks down these medications.

High drug levels can lead to more side effects, like severe heart rhythm problems with erythromycin and rilpivirine, or dangerously low blood pressure with maraviroc.

As for Paxlovid, bictegravir, and doravirine, some of the common side effects are related to the digestive system.

13. Certain Opioids

Grapefruit can interact with some pain medications, including opioids like oral oxycodone, fentanyl, and methadone. Grapefruit might raise levels of these medications in the blood. In some cases, this can increase the risk of a dangerously slow breathing rate, which is a side effect of an opioid overdose.

14. Erectile Dysfunction and Urinary Tract Drugs

Grapefruit juice may interact with the following medications:

• Flomax (tamsulosin)
• Rapaflo (silodosin)
• Uroxatral (alfuzosin)
• Viagra (sildenafil)

The product labels may not specifically list grapefruit as an interaction. However, grapefruit can lead to high drug levels by blocking the CYP3A4 liver protein. This could result in increased side effects, such as low blood pressure.