Bitter Orange and Felodipine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Felodipine
Bitter Orange
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased felodipine adverse effects
Interaction Deep Dive
Seville (sour) orange juice increased the bioavailability of felodipine to a similar extent as grapefruit juice in 10 healthy subjects1. Bitter orange preparations may similarly affect felodipine, though the content of the furocoumarins thought to be responsible for the interaction in these preparations is unknown.
Why it happens (mechanism)
Inactivation of intestinal CYP3A4 by furocoumarins bergamottin, 6',7'-dihydroxybergamottin, and/or bergapten in Seville orange juice
Literature reports
1 report — tap to read
a) Compared with common orange juice, Seville (sour) orange juice and grapefruit juice increased the AUC of felodipine and the dehydrofelodipine-felodipine ratio. A three-way randomized crossover study design was used in which each subject (n=10) received single-dose extended-release felodipine 10 mg with 240 mL of Seville orange juice, diluted grapefruit juice, or common orange juice. On average, the AUC and Cmax of felodipine were increased by 76% and 61%, respectively, with Seville orange juice and by 93% and 88%, respectively, with grapefruit juice compared with common orange juice. The differences in AUC and Cmax observed between Seville orange juice and grapefruit juice were not significant. The Tmax and terminal half-life of felodipine were not different among juice treatments. The AUC of dehydrofelodipine was increased by 30% with Seville orange juice and by 35% with grapefruit juice. There was no significant difference between the Cmax and terminal half-life of dehydrofelodipine among the juices. Seville orange juice and grapefruit juice probably interact with felodipine as a result of inactivation of intestinal CYP3A4 1.
Common questions
Can I take Bitter Orange and Felodipine together?
Increased felodipine adverse effects Always confirm with your pharmacist or prescriber before making any change.
How serious is the Bitter Orange and Felodipine interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Bitter Orange or Felodipine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (1)
- Malhotra S, Bailey DG, Paine MF, et al: Seville orange juice-felodipine interaction: comparison with dilute grapefruit juice and involvement of furocoumarins. Clin Pharmacol Ther 2001; 69(1):14-23. PubMed
Keep reading about Felodipine
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist