Can You Eat Grapefruit While Taking Zoloft (Sertraline)?
In our latest question and answer, the pharmacist discusses whether or not grapefruit can be safely consumed while taking Zoloft (sertraline).
I’m taking Zoloft and recently ate something that contained grapefruit. Can I take my medication?
Nov 27, 2022- Grapefruit can increase Zoloft levels in your body by interfering with how your body breaks down the medication, which may increase side effects like nausea, dizziness, and anxiety.
- It is generally recommended to avoid consuming grapefruit or grapefruit juice while taking Zoloft, and even small amounts or juice can cause this interaction.
- While studies show the interaction occurs, how much it actually affects most people taking Zoloft is not completely clear, but it is safest to avoid grapefruit altogether rather than try to separate the timing of consumption.
Answer
Grapefruit and grapefruit juice are known to interact with many different prescription medications via several mechanisms.
Perhaps most significantly, grapefruit inhibits the CYP3A metabolizing enzyme. Inhibition of this enzyme can decrease the metabolism of certain medications, potentially increasing concentrations to dangerous levels, which can increase the risk of side effects.
In addition to CYP3A inhibition, studies have shown that grapefruit also inhibits OATP (organic anion transporting peptide), an important drug transporter. OATP transports drugs into cells and when inhibited, drugs may have significantly decreased effects. The potential issue with combining Zoloft and grapefruit is the first mechanism described above (grapefruit can increase Zoloft concentrations).
Zoloft (Sertraline) Grapefruit Interaction
There is a known interaction between grapefruit (and grapefruit juice) and Zoloft (sertraline).
Grapefruit has been shown to affect Zoloft (sertraline) concentrations via inhibition of the CYP3A enzyme. Inhibition of this enzyme can potentially elevate Zoloft (sertraline) levels in the body, increasing the risk of adverse reactions. It is generally recommended not to consume significant amounts of grapefruit while on Zoloft (sertraline) due to the potential interaction.
At the very least, it is recommended not to significantly alter your grapefruit intake from normal to avoid fluctuating Zoloft (sertraline) levels. Potential side effects from Zoloft that could happen with more frequency or severity when combined with grapefruit include:
- Nausea
- Vomiting
- Diarrhea
- Anxiety
- Insomnia
- Flu-like symptoms
- Headache
- Serotonin syndrome
- Dizziness
What The Studies Show
Having said all of the above, it is currently not well known how clinically significant the interaction between Zoloft and grapefruit really is. One study suggests that while Zoloft (sertraline) metabolism is likely affected by grapefruit intake to some degree, in most cases, it isn't clinically significant. Zoloft (sertraline) is metabolized in our bodies by multiple enzymes and, according to the study:
"[there is] no single agent that could substantially alter the pharmacokinetics of sertraline...".
Other small studies have definitively shown that combining grapefruit does increase Zoloft concentrations in most individuals but these studies generally stop short of describing the clinical impact or what the potential risks will be.
Overall, it does seem there is some reason for concern, but just how much concern is still not completely known. Interaction Management
If you are looking to avoid the potential interaction between grapefruit and Zoloft (sertraline), it is important to know that it only takes a small amount of grapefruit consumption to alter metabolizing enzyme levels.
One study showed that it takes at most one whole grapefruit or 200 mL (about seven ounces) of juice to cause a clinically important interaction for most medications.
Additionally, enzyme inhibition seems to occur for a considerable amount of time, at least 24 hours in some cases, so simply separating grapefruit administration from your drugs likely won't avoid the interaction.
As discussed above, it is unclear just how significant the interaction is with Zoloft (sertraline), but in order to avoid it, you really want to avoid consuming any amount of grapefruit while taking the medication.
Final Words
I hope you found this helpful! Reach back out anytime.
References & sources
- Sertraline is metabolized by multiple cytochrome P450 enzymes, monoamine oxidases, and glucuronyl transferases in human: an in vitro study — PubMed
- The effects of grapefruit juice on sertraline metabolism: an in vitro and in vivo study — PubMed
- Time course of recovery of cytochrome p450 3A function after single doses of grapefruit juice — PubMed
- Duration of effect of grapefruit juice on the pharmacokinetics of the CYP3A4 substrate simvastatin — PubMed
Glossary — Terms in This Answer
- CYP3A
- A metabolizing enzyme in the body that breaks down certain medications; when inhibited, drugs may stay in the system longer at higher levels.
- Metabolism
- The process by which the body breaks down and eliminates drugs and other substances.
- OATP
- A protein that transports drugs into cells; when inhibited, drugs may have weaker effects in the body.
- Sertraline
- The generic name for the medication Zoloft, used to treat depression and anxiety.
- Adverse reactions
- Unwanted or harmful side effects caused by a medication or drug interaction.
- Serotonin syndrome
- A potentially serious condition caused by excessive serotonin in the brain, which can occur when taking certain medications like Zoloft.
- Pharmacokinetics
- The study of how the body absorbs, distributes, metabolizes, and eliminates drugs.
- Enzyme inhibition
- The blocking or slowing down of an enzyme's ability to break down substances in the body.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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