The Colon Club

Hello everyone - so I just had a call from my dad who has accompanied my mom to the infusion clinic for her "disconnect" ... she hasn't been drinking a lot of water the past week and or any liquids for that matter and the only juice she seems willing to entertain the thought of is freshly squeezed grapefruit juice which she has now had every night for the past 2-3 weeks.

Apparently her nurse today got wind of this information and told her that grapefuit is contraindicated with chemotherapy ... as in, it interferes with chemotherapy rendering it ineffective.

Do you have any information about this?

I'd appreciate your feedback - J.

Grapefruit and its juice is contraindicated for Lipitor and most other statin drugs, used for cholesterol control.

There are no warnings/contraindications about grapefruit for these major drugs used for CRC:
5-FU, Leucovorin, Oxaliplatin, Avastin, Erbitux, and Vectibix.

For Irinotecan, from http://www.nlm.nih.gov/medlineplus/drug ... al-dietary there is this warning:
"What special dietary instructions should I follow?
* Your doctor will tell you about a special diet to follow to help control diarrhea during your treatment. Follow these instructions carefully.
* Talk to your doctor about eating grapefruit and drinking grapefruit juice while receiving this medicine."
(Underlining is mine).

AND, there are some PRE-meds, given at infusion for control of side-effects, especially nausea, so they might be the concern.

Two things here:
* What chemo regimen is your DM on: Folfox, Folfiri, other?
And what premeds is she receiving?
Folfiri is the regimen that has the grapefruit-cautioned Irinotecan.
* For every one of the drugs she's receiving, the clinic should have given her an Info Sheet, describing the drug, how it works, it's likely side-effects and how to control them, and foods and other drugs to avoid.

One thing to consider is that chemo nurses, angels that they are, deal with dozens of different cancer treatments every day, and often they have a mindset of 'Never do/take xxxxxx when on chemo.'

Your parents need to confirm with the nc if there are any dietary restrictions for the medications she's receiving.

HTH, Rick

Grapefruit is just one of the things which can interfere with drug metabolism in the body (Cytochrome P450 enzymes, of which there are many.) When the liver is trying process things ( to either break them down or metabolize them to make them active ) if something else "gets in the way" so to speak, the metabolism does not go as planned....the drug you WANT in your system may not get activated....or the drug you WANT in your system may not get broken down and the levels stay dangerously high, leading to toxicity.

Always best to check with your oncs for any precautions, and never any harm in mentioning everything you are taking to your onc. This can be a problem when folks start or use "herbals" etc. without their oncs knowledge. For more specifics on your mom's case ask your onc or infusion center nutritionist directly what her status is and get them to give her a list of drugs / meds to avoid.

here is a link if you want more of the "nuts 'n bolts " : grapefruit and drug interactions

In Harmony
CRguy

Hi Rick - thanks so much for posting. Mom's on FOLFOX 6 + avastin ... she gets decadron, calcium, magnesium and ativan prior to start of her chemo drugs. She gets one more shot of Ativan right before they start the 5FU bolus and avastin. Zofran for 2-3 days following the comletion of her chemo.

I knew about the lipitor warning interestingly enough through my dad but it never occurred to me that this may also be an issue with chemotherapy drugs so this was the ONLY thing I didn't run by her oncologist. My internet search didn't turn up anything specifically related to the contraindication with Folfox just that sometimes, grapefruit can mess with chemo drug metabolism ... making it more difficult to clear out of system.

Thank you, CRguy ... that link is very helpful. Thankfully, there doesn't seem to be a connection/interaction with any of the CRC drugs that mom has been on but I'll be sure to raise this question with her doctor when we go in next week for follow up.

I take medicine for high blood presure. Grapefruit is the only thing I was told to stay away from. I am told, if I remember corectly, that graprfruit of any kind, will keep this medicine in the liver, and may harm the liver. I really am too new to chemo, to advise on those drugs, but I really miss my grapfruit.

Regards,
Michael

Sorry for the edit, all other citrus is OK, as grapefruit is the only one that contains this restrictive chemical.

I am on folfori for a while and I just had my oncologist confirm today that I can't have grapefruit because of the 5fu. Bummer. I was just recently eating them as a nice change. I had heard another parient at chemo saying this which is what made me ask my onc.
Wondering now if theres anything else I should be avoiding because of effects on chemo....