Drug & supplement interaction

Breadfruit + Treprostinil

Moderate Interaction
The bottom line Moderate

Treprostinil falls into 3 drug categories that Breadfruit can interact with; the most serious is rated moderate. Theoretically, concomitant use with antihypertensive drugs might increase the risk of hypotension.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions3
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Breadfruit and Treprostinil

These two interact in 3 distinct ways. Each one is explained separately below.

Why Are There 3 Interactions?

Breadfruit interacts with whole categories of medication. Treprostinil falls into 3 of those categories, so it can interact with Breadfruit in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

ANTIHYPERTENSIVE DRUGS

1 of 3

Why this applies to Treprostinil

Treprostinil falls under ANTIHYPERTENSIVE DRUGS — the group Breadfruit interacts with.

Theoretically, concomitant use with antihypertensive drugs might increase the risk of hypotension. Animal research shows that breadfruit leaf extract can decrease heart rate and weaken the force of heart muscle contractions, which may lower blood pressure.
Some antihypertensive drugs include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), amlodipine (Norvasc), hydrochlorothiazide (HydroDIURIL), furosemide (Lasix), and many others.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the thing to keep in mind with breadfruit and Treprostinil (Orenitram). Treprostinil already works by relaxing and widening your blood vessels to ease the pressure in your lungs, and a side effect of that is it can lower your overall blood pressure too. Breadfruit leaf products may push in the same direction. In animal studies, breadfruit leaf extract slowed the heart and weakened how hard it pumped, which can nudge blood pressure down.

Stack those two together and you could feel lightheaded, dizzy, flushed, or get a headache. I'll be honest though, this is theoretical and based on lab and animal work, not human studies. Eating breadfruit as a normal food is very different from concentrated leaf teas or extracts. If you're considering those, check with your pharmacist or doctor first.

References
  1. Young RE, Williams LAD, Gardner MT, Fletcher CK. An extract of the leaves of the breadfruit Artocarpus altilis (parkinson) fosberg exerts a negative inotropic effect on rat myocardium. Phytother Res 2006;7(2):190-193.
Moderate

ANTICOAGULANT/ANTIPLATELET DRUGS

2 of 3

Treprostinil also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.

Theoretically, concomitant use with anticoagulant/antiplatelet drugs might increase the risk of bleeding. In vitro research shows that certain flavonoid constituents from breadfruit root extract can inhibit thromboxane formation and reduce platelet aggregation.
Some of these drugs include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), warfarin (Coumadin), and others.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the connection worth knowing. Treprostinil (Orenitram) already works on your platelets and can make it a little harder for blood to clot, which is part of how it helps in conditions like pulmonary hypertension. Breadfruit, mainly in concentrated leaf or root extracts, contains flavonoids that lab studies suggest may also slow platelets from clumping together. Stack those two effects and you could theoretically bruise more easily or bleed a bit longer than usual.

I want to keep this in perspective. This is a theoretical concern based on test-tube research, not real patient cases, and eating breadfruit as a regular food is unlikely to matter. Concentrated supplement doses are the bigger question. If you take Treprostinil, just check with your pharmacist or doctor before using breadfruit products, and watch for unusual bleeding or bruising.

References
  1. Weng JR, Chan SC, Lu YH, et al. Antiplatelet prenylflavonoids from Artocarpus communis. Phytochemistry 2006;67(8):824-829. PubMed
Moderate

CYTOCHROME P450 2C8 (CYP2C8) SUBSTRATES

3 of 3

Treprostinil also falls under CYTOCHROME P450 2C8 (CYP2C8) SUBSTRATES.

Breadfruit might increase the levels of drugs metabolized by cytochrome P450 2C8 (CYP2C8) enzymes. So far, this interaction has not been reported in humans. However, in vitro evidence shows that the breadfruit constituent artocarpin inhibits CYP2C8 enzymes, which might increase the levels of CYP2C8 substrates. Some drugs metabolized by CYP2C8 include amiodarone (Cardarone), paclitaxel (Taxol); nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac (Voltaren) and ibuprofen (Motrin), rosiglitazone (Avandia), and others.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist for your oral treprostinil (Orenitram). Your liver uses an enzyme called CYP2C8 to help clear this medicine out of your body. A natural compound in breadfruit (artocarpin) has been shown to slow that same enzyme down, at least in lab dish studies. In theory, if that enzyme works more slowly, treprostinil could build up a bit higher than usual, which might mean stronger drug effects and more side effects like headache, flushing, nausea, diarrhea, jaw pain, or low blood pressure.

I want to keep this in perspective, though. This has never actually been seen in people, and the evidence so far is only from test tubes. Eating breadfruit as a food is very different from taking concentrated leaf extracts. Still, since treprostinil is a potent medicine, it's worth a quick chat with your pharmacist or doctor before using any breadfruit supplements.

References
  1. Qu W, Liu X. Identification of cytochrome P450 isoforms involved in the metabolism of artocarpin and assessment of its drug-drug interaction. Biomed Chromatogr. 2018;32(4). PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Breadfruit Also Interacts With Other Medications

Breadfruit has 437 moderate, 504 minor known drug interactions in our database — the Treprostinil one above is among them. If you take anything else, check it against the full list below.

Taking anything else?

Check Another of Your Medications Against Breadfruit

Covers the 2,830 medications we’ve checked against Breadfruit. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Treprostinil

This page covers Breadfruit only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Treprostinil page lists 291 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), American Mistletoe (major), Danshen (major) and Piracetam (major).

By severity: 6 major · 258 moderate · 27 minor.

Open the Treprostinil interaction page

How much people look this up

Where Breadfruit and Treprostinil Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Breadfruit
Top half

#469 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Treprostinil
Steady interest

#2,289 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Breadfruit

What is Breadfruit?

  • Source of nutrition and energy
  • High blood pressure
  • Diabetes and blood sugar support
  • Inflammation and joint discomfort
  • Skin conditions

Breadfruit is a starchy tropical fruit eaten as a staple food, and its leaves are used in traditional medicine for conditions like high blood pressure and diabetes. As a food it is nutritious and generally safe, but the medicinal use of leaf teas or extracts has very little human research to back it up. Talk with your pharmacist or doctor before using breadfruit products for a health condition.

Read the full Breadfruit monograph & all interactions
Medication

About Treprostinil

What Is Treprostinil Used For?

Treprostinil treats pulmonary arterial hypertension (PAH; WHO Group 1) — high blood pressure in the arteries of the lungs. Depending on the product and route, it is used to improve exercise ability, delay disease progression, or reduce symptoms tied to physical activity. Remodulin and treprostinil injection products are also indicated for patients who need to transition away from another PAH medicine called epoprostenol.

Tyvaso, Tyvaso DPI, and Yutrepia (inhaled forms) are additionally approved to treat pulmonary hypertension associated with interstitial lung disease (PH-ILD; WHO Group 3) — lung-pressure problems caused by scarring or inflammation in the lung tissue itself. Orenitram (extended-release oral tablet) is specifically indicated to delay disease progression and improve exercise capacity in PAH.

See full Treprostinil drug information
Keep checking

Other Drugs & Breadfruit

Browse every other medication we’ve checked against Breadfruit — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
437Moderate
504Minor
1,888No known interaction
Moderate

437 interactions

Showing 60 of 437 moderate interactions — see all 437 on the Breadfruit page.

Minor

504 interactions

Showing 60 of 504 minor interactions — see all 504 on the Breadfruit page.

No interaction 1,888 drugs checked — show the list
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

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Pharmacist Counseling Corner

Taking Breadfruit and Treprostinil Together: Common Questions

Can you take Breadfruit with Treprostinil?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 3 interactions listed for Breadfruit and Treprostinil?
Treprostinil belongs to more than one drug category, and Breadfruit interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Breadfruit and Treprostinil interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.