On December 7 2021, a Facebook user shared the following status update, warning that eating grapefruit while on antidepressants could have major unintended consequences:
Since grapefruit season is coming up soon, this is a friendly reminder that you CANNOT eat grapefruit if you’re on antidepressants. It can cause a fatal overdose.
Variations on that claim also circulated on Twitter:
Since grapefruit season is coming up soon, this is a friendly reminder that you CANNOT eat grapefruit if you're on antidepressants. It can cause a fatal overdose.
— 👾 Angel👾 (@Aliofonzy43) December 13, 2021
As of December 13 2021, the Facebook post had been shared more than 20,000 times. It did not include a citation or reference (despite the relatively high frequency of grapefruit consumption and antidepressant usage, at least in the United States), and it did not mention any specific antidepressants with which grapefruit adversely reacts.
Google Trends data for the seven-day period ending on December 13 2021 indicated “Breakout” interest for “grapefruit antidepressants” and related searches. Those included:
- “Can you eat grapefruit on antidepressants”;
- “Can you eat grapefruit while on antidepressants”;
- “Eating grapefruit on antidepressants”;
- “Can you eat grapefruit while taking antidepressants,” and;
- “Eating grapefruit while on antidepressants.”
Moreover, grapefruit’s reputation for broadly having drug interactions had already been well known for some time, likely driving shares of the post coupled with the warning. A Food and Drug Administration (FDA) advisory last updated in June 2021 was titled “Grapefruit Juice and Some Drugs Don’t Mix,” and it explained:
Grapefruit juice and grapefruit can affect the way your medicines work, and that food and drug interaction can be a concern. The U.S. Food and Drug Administration has required that some prescription and over-the-counter (OTC) drugs generally taken by mouth include warnings against drinking grapefruit juice or eating grapefruit while taking the drug.
Here are examples of some types of drugs that grapefruit juice can cause problems (interact) with:
- Some statin drugs to lower cholesterol, such as Zocor (simvastatin) and Lipitor (atorvastatin).
- Some drugs that treat high blood pressure, such as Procardia and Adalat CC (both nifedipine).
- Some organ-transplant rejection drugs, such as Neoral and Sandimmune capsule or oral solution (both cyclosporine).
- Some anti-anxiety drugs, such as BuSpar (buspirone).
- Some corticosteroids that treat Crohn’s disease or ulcerative colitis, such as Entocort EC and Uceris tablet (both budesonide).
- Some drugs that treat abnormal heart rhythms, such as Pacerone and Cordarone tablet (both amiodarone).
- Some antihistamines, such as Allegra (fexofenadine).
Grapefruit juice does not affect all the drugs in the categories above. The severity of the interaction can be different depending on the person, the drug, and the amount of grapefruit juice you drink.
Antidepressants as a class were not in the list of medications with which the FDA advised grapefruit juice (not grapefruit itself) might not “mix.” In addition to specifying “juice” (which is presumably more concentrated than grapefruit itself), the FDA added that the warning did not apply to “all drugs” in the categories listed.
Although antidepressants were not mentioned, one specific anti-anxiety medication (buspirone) was listed; other anti-anxiety medications were not listed. Subsequently, the FDA’s advisory noted:
With most drugs that are affected by grapefruit juice, “the juice lets more of the drug enter the blood,” says Shiew Mei Huang, Ph.D., of the FDA. “When there is too much drug in the blood, you may have more side effects.”
For example, if you drink a lot of grapefruit juice while taking certain statin drugs to lower cholesterol, too much of the drug may stay in your body, increasing your risk for liver and muscle damage that can lead to kidney failure.
Although scientists have known for several decades that grapefruit juice can cause too much of certain drugs in the body, more recent studies have found that the juice has the opposite effect on a few other drugs.
“Grapefruit juice can cause less fexofenadine to enter the blood,” decreasing how well the drug works, Huang says. Fexofenadine (brand name Allegra) is available as both prescription and OTC to relieve symptoms of seasonal allergies. Fexofenadine may also not work as well if taken with orange or apple juice, so the drug label says, “Do not take with fruit juices.”
Why this opposite effect? Instead of changing metabolism, grapefruit juice can affect proteins in the body known as drug transporters, some of which help move a drug into our cells for absorption. As a result, less of the drug enters the blood and the drug may not work as well, Huang says.
Likewise, an undated Healthline.com piece (“Grapefruit Warning: It Can Interact with Common Medications”) noted:
Most antidepressants and anti-anxiety drugs are safe to use with grapefruit.
However, several mood medications do interact with it, including:
- Quetiapine (Seroquel)
- Lurasidone (Latuda)
- Ziprasidone (Geodon)
- Buspirone (Buspar)
- Diazepam (Valium)
- Midazolam (Versed)
- Triazolam (Halcion)
Drugs like quetiapine and lurasidone are used to treat mood and behavioral disorders. Increased levels of these drugs can cause heart rhythm changes or sleepiness.
Furthermore, diazepam, midazolam, and triazolam are sedatives that are sometimes used for panic attacks or other forms of anxiety.
One study compared some of these drugs in nine patients, some of whom consumed grapefruit. It showed that grapefruit can increase these drugs’ effects, resulting in excessive drowsiness.
The “mood medications” listed (such as Seroquel, Latuda, Valium, and Versed) did not contain warmings about a potentially fatal overdose. Healthline said that one study suggested that grapefruit could amplify drug potency, causing “excessive drowsiness,” adding:
Make sure your doctor and pharmacist know if you regularly consume grapefruit. They can help you decide whether it’s safe to consume it while on certain medications.
Finally, we asked a pharmacist about the grapefruit antidepressant rumor. They emphasized asking a doctor or pharmacist whether your specific prescriptions have an interaction warning with grapefruit.
A December 2021 viral Facebook post claimed that grapefruit and antidepressants can “cause a fatal overdose,” which seemed implausible due to the popularity of grapefruit and antidepressants (separately). The FDA and health advisory sites warned of the well-known ability of grapefruit juice to interact with specific medications from many classes — not necessarily “antidepressants,” which were not mentioned by the FDA. No resources mentioned the risk of “fatal overdose” pertaining to antidepressants, and a pharmacist reiterated the importance of asking prescribers or pharmacies about prescription drugs and their potential interactions with foods — grapefruit included.