Millions of women in England on a common medication have been warned of the risk one type of fruit could pose and its potentially unpleasant side effects. Before you enjoy a refreshing glass of grapefruit juice or enjoy slices of it for breakfast, consider how this tangy fruit could impact your health if taking a certain pill.
Grapefruits and their juice are recognised for interacting with many medications, including birth control tablets. So, anyone who takes the common form of contraception is urged to be aware of the risks of consuming large amounts of the fruit or its juice.
The pill is the most popular contraceptive in England, offering women a reliable option with a 99% effectiveness rate, when used correctly. According to the latest NHS stats from 2023-24, 28% of women using sexual and reproductive health services used the pill. This is an increase of one percentage point from 27% in 2022-23 but down from 39% in 2020-21.
Chemicals found in grapefruit may disrupt an enzyme in the intestines known as CYP3A4, which is crucial in how your body processes and absorbs certain medications. Consuming grapefruit or its juice, especially in large amounts, may lead to an excessive and potentially ‘toxic’ absorption of these drugs. Equally, it could cause insufficient absorption.
As a result, you might experience heightened side effects or find the medication isn’t as effective as it should be. Specifically regarding birth control, grapefruit and its juice could slow down the breakdown of estrogen in your body, potentially leading to higher levels of this hormone.
This shouldn’t make the pill less effective. However, it may raise the risk of side effects, including breast tenderness, nausea, changes in uterine bleeding, blood clots and breast cancer, although this has not been conclusively proven.
Duncan Reid, Senior Pharmacist and Head of Patient Safety at Pharmacy2U, said: “The contraceptive pill continues to be a popular choice due to its convenience and reversibility. It also offers additional benefits, such as regulating menstrual cycles and, in some cases, improving acne.
“However, its effectiveness isn’t guaranteed if certain conditions are overlooked. By recognising potential risks and staying informed, users can take proactive steps to ensure consistent protection.”
It’s worth mentioning that individuals have different levels of CYP3A4 in their intestines. This variation means that grapefruit can impact people in different ways, with some experiencing a stronger effect than others – grapefruit does not pose an immediate danger to the majority of people on birth control pills.
In 2009, CBC News covered a story of a woman who suffered a nasty blood clot that was triggered by a range of factors, including a grapefruit diet, birth control pills and a genetic mutation. She nearly lost her leg in the process.
However, at the time, Dr Lucinda Grande, a medical resident at Providence St Peter Hospital, said: “‘This woman’s story is so unique it should not discourage people in any way from eating grapefruit.” In a statement, the Florida Department of Citrus added: “We are aware of no validated evidence that grapefruit affects oral contraceptives, and they are generally considered to be safe to consume with grapefruit.”
Besides contraception pills, there are many other medications that grapefruit may interfere with, such as:
- nifedipine, nimodipine and nisoldipine (high blood pressure)
- fexofenadine (allergies)
- buspirone and sertraline (antidepressants)
- atorvastatin, lovastatin and simvastatin (high cholesterol)
- amiodarone (irregular heartbeat)
- cyclosporine and tacrolimus (prevents organ transplant rejection)
- saquinavir (HIV)
- erythromycin, primaquine and quinine (infections)
- sildenafil (Viagra)
The way these medications interact with grapefruit varies based on the specific drug you’re taking. Additionally, individual factors play a role, as your genetics could affect how grapefruit impacts your body’s drug metabolism.
Grapefruit isn’t the only substance that may interfere with the pill. Though the evidence is limited pomelos, tangelos, and Seville oranges might have effects comparable to those of grapefruit. Others that may interact with its effectiveness include medicines that are used to treat diarrhoea, seizures griseofulvin and infections.
A herbal remedy called St John’s wort, which has been known to help with depression, could also cause issues. Speak to your GP if you take any of the medications mentioned above as well as birth control. If you have any questions about the pill, there is plenty of information on the NHS website, or you could speak to a sexual health professional.