title: Grapefruit juice and licorice increase cortisol availability in patients with Addison's disease.
abstract: OBJECTIVE
  Failure to mirror the diurnal cortisol profile could contribute to the impaired subjective health status in Addison's disease (AD). Some patients report benefit from the use of various nutritional compounds. The objective of this study was to investigate the impact of licorice and grapefruit juice (GFJ) on the absorption and metabolism of cortisone acetate (CA).
  
  
  METHODS
  Patients (n=17) with AD on stable CA replacement therapy were recruited from the outpatient clinic at Haukeland University Hospital, Norway. They were assessed on their ordinary CA medication and following two 3-day periods of co-administration of licorice or GFJ.
  
  
  METHODS
  Time series of glucocorticoids (GCs) in serum and saliva were obtained, and GCs in 24 h urine samples were determined. The main outcome measure was the area under the curve (AUC) for serum cortisol in the first 2.6 h after orally administered CA.
  
  
  RESULTS
  Compared with the ordinary treatment, the median AUC for serum cortisol increased with licorice (53 783 vs 50 882, P<0.05) and GFJ (60 661 vs 50 882, P<0.05). Median cortisol levels in serum were also elevated 2.6 h after tablet ingestion (licorice 223 vs 186 nmol/l, P<0.05; GFJ 337 vs 186 nmol/l, P<0.01). Licorice increased the median urinary cortisol/cortisone ratio (0.43 vs 0.21, P<0.00001), whereas GFJ increased the (allo-tetrahydrocortisol+tetrahydrocortisol)/tetrahydrocortisone ratio (0.55 vs 0.43, P<0.05).
  
  
  CONCLUSIONS
  Licorice and in particular GFJ increased cortisol available to tissues in the hours following oral CA administration. Both patients and physicians should be aware of these interactions.
authors: Institute of Medicine, University of Bergen, 5021 Bergen, Norway. paal.methlie@med.uib.no)
authors: Paal
authors: P
authors: Methlie
authors: Eystein E S
authors: EE
authors: Husebye
authors: Steinar
authors: S
authors: Hustad
authors: Ernst A
authors: EA
authors: Lien
authors: Kristian
authors: K
authors: Løvås
mesh_terms: D000224:Addison Disease / Q000097:blood* / Q000188:drug therapy; D000328:Adult; D000368:Aged; D001628:Beverages; D032083:Citrus paradisi / Q000502:physiology*; D003348:Cortisone / Q000031:analogs & derivatives* / Q000378:metabolism / Q000627:therapeutic use; D005260:Female; D018565:Food-Drug Interactions / Q000502:physiology*; D006035:Glycyrrhiza / Q000502:physiology*; D006801:Humans; D006854:Hydrocortisone / Q000096:biosynthesis / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015854:Up-Regulation / Q000502:physiology
chemical_list: D003348:Cortisone; D006854:Hydrocortisone