title: Dosing implications of a clinical interaction between grapefruit juice and cyclosporine and metabolite concentrations in patients with autoimmune diseases.
abstract: OBJECTIVE
  To determine the effect of chronic grapefruit juice administration on steady state blood concentrations of cyclosporine and metabolites in patients with autoimmune diseases.
  
  
  METHODS
  9 patients stabilized on administration of cyclosporine (range 0.7-6.7 mg/kg/day) were given either grapefruit juice or water using randomized crossover design. Whole blood samples were collected before the morning cyclosporine dose and during the 12 h interdose interval. Cyclosporine concentrations were measured using a relatively specific assay (Emit) and total metabolite concentrations were estimated using a nonspecific assay (polyclonal Abbott-TDx).
  
  
  RESULTS
  Exposure to grapefruit juice produced significant increases in predose cyclosporine concentrations (p < 0.01) and total metabolite concentrations (p = 0.03) and the area under the cyclosporine and metabolite blood concentration-time curves (p = 0.005, p = 0.001, respectively). One patient developed significant neurological side effects associated with a 68.9 and 214% increase in predose cyclosporine and metabolite concentrations, respectively, during grapefruit juice co-administration.
  
  
  CONCLUSIONS
  Grapefruit juice causes an increase in both parent and metabolite profiles, indicating an alteration in the disposition of cyclosporine and metabolites. This interaction is of potential clinical importance in terms of mechanism, side effects, and dosing.
authors.affiliation: Department of Pharmacy, Monash University, Prahran, Victoria, Australia.
authors.forename: L L
authors.initials: LL
authors.lastname: Ioannides-Demos
authors.forename: N
authors.initials: N
authors.lastname: Christophidis
authors.forename: P
authors.initials: P
authors.lastname: Ryan
authors.forename: P
authors.initials: P
authors.lastname: Angelis
authors.forename: L
authors.initials: L
authors.lastname: Liolios
authors.forename: A J
authors.initials: AJ
authors.lastname: McLean
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000378:metabolism*; D001628:Beverages; D002957:Citrus / Q000378:metabolism*; D016572:Cyclosporine / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D016572:Cyclosporine