Hi all -
I haven't seen this topic discussed on the forum and am curious. My husband is about to restart his maintenance therapy (Revlimid and dexamethasone). He loves grapefruit, which he eats daily. A few people have recently suggested to us that eating grapefruit might interfere with medication.
Has anybody heard of this, and is it true that he should avoid eating grapefruit?
Thank you!
Laurie
Forums
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lwem - Name: Laurie
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 68
Re: Avoiding grapefruit during multiple myeloma treatment?
I'm not a grapefruit eater, so the details did not stick, but during my pharmacy consult for my newest medications, I was told to avoid eating grapefruit.
As I say, I don't recall why or what medication it conflicted with, but I specifically remember being told to avoid grapefruit.
As I say, I don't recall why or what medication it conflicted with, but I specifically remember being told to avoid grapefruit.
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Mark Pouley - Name: Mark
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 53
Re: Avoiding grapefruit during multiple myeloma treatment?
My sister was told to avoid raw fruits and vegetables and any herbal teas / infusions during treatment. She is in Russia.
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Gala - Name: Gala
- Who do you know with myeloma?: sister, LgA-k
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 48
Re: Avoiding grapefruit during multiple myeloma treatment?
Hello Laurie:
I think that there was a documented issued with vitamin C having a potential adverse impact on the effectiveness of Velcade. As I recall, it was only for extra doses on the day of treatment.
I have not heard of any such issues with Revlimid.
Regards, JPC
I think that there was a documented issued with vitamin C having a potential adverse impact on the effectiveness of Velcade. As I recall, it was only for extra doses on the day of treatment.
I have not heard of any such issues with Revlimid.
Regards, JPC
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JPC - Name: JPC
Re: Avoiding grapefruit during multiple myeloma treatment?
Laurie,
My information is the same as JPC's, except that I read that if one is taking Velcade, grapefruit is definitely off limits. There is a substance in grapefruit that is different from, let's say, oranges. I am on Velcade and do try to limit my overall citric acid intake, but I do eat lots of other foods, in moderation, that contain Vitamin C. I did not have this concern while on Revlimid.
My information is the same as JPC's, except that I read that if one is taking Velcade, grapefruit is definitely off limits. There is a substance in grapefruit that is different from, let's say, oranges. I am on Velcade and do try to limit my overall citric acid intake, but I do eat lots of other foods, in moderation, that contain Vitamin C. I did not have this concern while on Revlimid.
Re: Avoiding grapefruit during multiple myeloma treatment?
Grapefruits are known to interfere with the dosing of a lot of drugs because they affect the way those drugs are metabolized. Grapefruit and grapefruit juice inhibits enzymes known as cytochrome P450, particularly CYP3A4. This is mentioned, for example, in the Wikipedia article about grapefruit juice.
If you check the Velcade prescribing information, it says:
"Co-administration with strong CYP3A4 inhibitors can increase Velcade exposure. Closely monitor patients receiving Velcade in combination with strong CYP3A4 inhibitors."
Basically, eating grapefruits or drinking grapefruit juice on the day you get Velcade could make it like you were given a higher dose of Velcade than you were actually given. That could be a good thing if you tolerate Velcade really well. But it could be a bad thing in terms of side effects like blood cell counts and neuropathy.
This effect of grapefruits and grapefruit juice is why you find cautions like this,
"Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medicine."
in information about Velcade such as on this page.
Grapefruit also can interfere with the metabolism of warfarin (Coumadin), so, if you're taking warfarin to avoid blood clots from Revlimid or thalidomide, that could be a problem. I don't believe Revlimid is metabolized in a way, however, that would be affected by grapefruit.
If you check the Velcade prescribing information, it says:
"Co-administration with strong CYP3A4 inhibitors can increase Velcade exposure. Closely monitor patients receiving Velcade in combination with strong CYP3A4 inhibitors."
Basically, eating grapefruits or drinking grapefruit juice on the day you get Velcade could make it like you were given a higher dose of Velcade than you were actually given. That could be a good thing if you tolerate Velcade really well. But it could be a bad thing in terms of side effects like blood cell counts and neuropathy.
This effect of grapefruits and grapefruit juice is why you find cautions like this,
"Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medicine."
in information about Velcade such as on this page.
Grapefruit also can interfere with the metabolism of warfarin (Coumadin), so, if you're taking warfarin to avoid blood clots from Revlimid or thalidomide, that could be a problem. I don't believe Revlimid is metabolized in a way, however, that would be affected by grapefruit.
Re: Avoiding grapefruit during multiple myeloma treatment?
I have read that drinking green tea while on Velcade can "counteract" the effects of the treatment. I called the patient support services number for Velcade and the rep said they have no reference in their documentation regarding the interaction of green tea and Velcade. However, there are some postings on the internet that do refererence the interaction.
I've not seen anything about grapefruit, so we all learn something new when we read the forums.
I've not seen anything about grapefruit, so we all learn something new when we read the forums.
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CabinGirl - Who do you know with myeloma?: Self
- When were you/they diagnosed?: Sept. 2014
- Age at diagnosis: 57
Re: Avoiding grapefruit during multiple myeloma treatment?
The issue of green tea and Velcade has been around for ages, and there are different opinions on it. Here's an article from 2009 about the study that got people worried about green tea and Velcade,
"Green Tea Blocks Effectiveness Of Velcade Treatment," The Myeloma Beacon, Feb 5, 2009
And here is a more recent forum discussion suggesting that green tea is probably not an issue when it comes to Velcade:
"Velcade and green tea" (started Nov 26, 2013)
"Green Tea Blocks Effectiveness Of Velcade Treatment," The Myeloma Beacon, Feb 5, 2009
And here is a more recent forum discussion suggesting that green tea is probably not an issue when it comes to Velcade:
"Velcade and green tea" (started Nov 26, 2013)
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Jonah
Re: Avoiding grapefruit during multiple myeloma treatment?
Thank you all so much for these helpful replies. I appreciate how much support the forum provides to us all.
Laurie
Laurie
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lwem - Name: Laurie
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 68
Re: Avoiding grapefruit during multiple myeloma treatment?
Gala:
I am most surprised that your sister was told to avoid raw fruits and vegetables. This is the first time I have heard of such advice. Is there any supporting evidence for it? I think that in America, except in special circumstances, we are encouraged to eat more fruits and vegetables regardless of whether they are cooked or not.
I am most surprised that your sister was told to avoid raw fruits and vegetables. This is the first time I have heard of such advice. Is there any supporting evidence for it? I think that in America, except in special circumstances, we are encouraged to eat more fruits and vegetables regardless of whether they are cooked or not.
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