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enalapril maleate-felodipine oral

Felodipine/Grapefruit

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug, changing your diet or commencing any course of treatment.

Medical warning:

Very important. A change in your diet, medicine, or dosage may be necessary. Promptly consult your doctor or pharmacist.

How the interaction occurs:

When grapefruit or grapefruit juice is taken with felodipine (a calcium channel blocker), it may increase the amount of this medicine absorbed into your bloodstream.

What might happen:

Your blood levels of this medicine may increase. Increased blood levels may cause a lower-than-desired blood pressure or a faster-than-desired heartbeat.

What you should do about this interaction:

While you are taking this medicine, do not eat grapefruit or drink grapefruit juice at any time. You may choose an alternative citrus beverage (such as orange juice). In the event that you are instructed by a healthcare professional (e.g., doctor, pharmacist, or dietitian) to eat grapefruit or drink grapefruit juice, you should immediately discuss with your doctor the the effects of grapefruit on the blood levels of this medicine.Tell your doctor immediately if symptoms of low blood pressure (such as rapid heartbeat or dizziness) occur. Contact your healthcare professional for more information.Your healthcare professional may be aware of this interaction and may be monitoring you for it. Do not start, stop, or change your medicine or diet before checking with them first.

References:

1.Bailey DG, Spence JD, Edgar B, Bayliff CD, Arnold JM. Ethanol enhances the hemodynamic effects of felodipine. Clin Invest Med 1989 Dec;12(6):357-62.
2.Bailey DG, Spence JD, Munoz C, Arnold JM. Interaction of citrus juices with felodipine and nifedipine. Lancet 1991 Feb 2;337(8736):268-9.
3.Edgar B, Bailey D, Bergstrand R, Johnsson G, Regardh CG. Acute effects of drinking grapefruit juice on the pharmacokinetics and dynamics of felodipine--and its potential clinical relevance. Eur J Clin Pharmacol 1992;42(3):313-7.
4.Bailey DG, Malcolm J, Arnold O, Spence JD. Grapefruit juice-drug interactions. Br J Clin Pharmacol 1998 Aug;46(2):101-10.
5.Dresser GK, Wacher V, Wong S, Wong HT, Bailey DG. Evaluation of peppermint oil and ascorbyl palmitate as inhibitors of cytochrome P4503A4 activity in vitro and in vivo. Clin Pharmacol Ther 2002 Sep;72(3):247-55.
6.Lundahl J, Regardh CG, Edgar B, Johnsson G. Relationship between time of intake of grapefruit juice and its effect on pharmacokinetics and pharmacodynamics of felodipine in healthy subjects. Eur J Clin Pharmacol 1995;49(1-2):61-7.
7.Dresser GK, Bailey DG, Carruthers SG. Grapefruit juice--felodipine interaction in the elderly. Clin Pharmacol Ther 2000 Jul;68(1):28-34.
8.Lundahl JU, Regardh CG, Edgar B, Johnsson G. The interaction effect of grapefruit juice is maximal after the first glass. Eur J Clin Pharmacol 1998 Mar;54(1):75-81.
9.Bailey DG, Arnold JM, Munoz C, Spence JD. Grapefruit juice--felodipine interaction: mechanism, predictability, and effect of naringin. Clin Pharmacol Ther 1993 Jun;53(6):637-42.
10.Paine MF, Widmer WW, Hart HL, Pusek SN, Beavers KL, Criss AB, Brown SS, Thomas BF, Watkins PB. A furanocoumarin-free grapefruit juice establishes furanocoumarins as the mediators of the grapefruit juice-felodipine interaction. Am J Clin Nutr 2006 May;83(5):1097-105.
11.Goosen TC, Cillie D, Bailey DG, Yu C, He K, Hollenberg PF, Woster PM, Cohen L, Williams JA, Rheeders M, Dijkstra HP. Bergamottin contribution to the grapefruit juice-felodipine interaction and disposition in humans. Clin Pharmacol Ther 2004 Dec;76(6):607-17.
12.Bailey DG, Dresser GK, Kreeft JH, Munoz C, Freeman DJ, Bend JR. Grapefruit-felodipine interaction: effect of unprocessed fruit and probable active ingredients. Clin Pharmacol Ther 2000 Nov;68(5):468-77.
13.Lundahl J, Regardh CG, Edgar B, Johnsson G. Effects of grapefruit juice ingestion--pharmacokinetics and haemodynamics of intravenously and orally administered felodipine in healthy men. Eur J Clin Pharmacol 1997; 52(2):139-45.
14.Bailey DG, Dresser GK, Bend JR. Bergamottin, lime juice, and red wine as inhibitors of cytochrome P450 3A4 activity: comparison with grapefruit juice. Clin Pharmacol Ther 2003 Jun;73(6):529-37.
15.Kakar SM, Paine MF, Stewart PW, Watkins PB. 6'7'-Dihydroxybergamottin contributes to the grapefruit juice effect. Clin Pharmacol Ther 2004 Jun; 75(6):569-79.

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