얼마 전 친구가 병원에서 수술을 받고 회복 기간 동안 약을 먹으면서 자몽을 마시면 안 된다고 교육받았다고 해서 깜짝 놀랐어요.
저는 자몽이라는 과일을 아주 좋아하지만 자몽 특유의 달지 않은 씁쓸한 떫은 맛이 매력이기 때문입니다.
이번 포스팅은 ‘자몽은 도대체 왜 위험한 과일일까’에 대해서 알아보도록 하겠습니다.
위험한 자몽 1개 혹은 자몽 주스 200밀리리터를 마셔도 복용하는 약이 독이 되는 것은 사실입니다.Bailey, D. G.; Dresser, G.; Arnold, J. M. O. (2013). “Grapefruit-medication interactions: Forbidden fruit or avoidable” – Grapefruit에 먹었던 Arapefrions: Forbidn fruit에 대한 효과와 Aruit(주스포커를 더 먹었던 Aruit or avoidable?Greenblatt DJ , von Moltke LL , Harmatz JS , et al . ( August 2003 ) . ” Time course of recovery of cytochrome p450 3A function after single doses of grapefruit juice ” . Clinical Pharmacology and Therapeutics . 74 ( 2 ) : 121 – 9 .
자몽 중에는 ‘프라노쿠마린'(furanocoumarins)이라는 성분이 있어 신체 대사에 약 50%의 영향을 미치는 효소인 CYP3A4의 기능을 저해합니다.
이 효소가 제 역할을 하지 못하면 특정 약물이 정상보다 체내에 오래 머물게 되는데 경우에 따라서는 치명적일 수도 있어 자몽 섭취에 의해 저해된 CYP3A4의 기능은 새롭게 살릴 수 없으며 새로운 CYP3A4를 생산하기 위해서는 최소 3일은 필요하다고 합니다.
우리가 약의 복용을 예측할 수 있는 경우는 사실 드물 거예요.미래의 몸상태를 예측하기가 어렵기 때문입니다.
하지만 예정된 수술 시에는 수술 전후에 항생제나 진통제 등의 복용을 생각할 수 있습니다.따라서 최소 수술 3일 전에는 자몽이나 자몽 주스를 피해 주시기 바랍니다.
자몽을 피하는 백기약·고혈압·고지혈증·부정맥약을 복용 중인 경우는 자몽을 마시거나 자몽 주스를 마시면 안 됩니다.
고지혈증 치료제인 아토르바스타틴, 로바스타틴, 심바스타틴, 부정맥 치료제로 자주 쓰이는 벨라파밀과 아미오다론 등과 고혈압 치료제인 아무로지핀, 페로지핀, 니페디핀 등이 있으며,
위장약에 익숙하지 않을 수도 있지만, 자주 처방을 받고 있는 약입니다.
이 의약품 외에도 다수의 의약품을 복용할 때는 자몽을 피해야 합니다
편두통 약:ergotamine(Cafergot, Ergomar), amitriptyline(Elavil, Endep, Vanatrip)and nimodipine(Nimotop)발기 부전 약:sildenafil(Viagra), tadalafil(Cialis)and vardenafil(Levitra)타이레놀:Acetaminophen/paracetamol(Tylenol)concentrations were found to be increased in murine blood by white and pink grapefruit juice, with the white juice acting faster.[62]”The bioavailability of paracetamol was significantly reduced following multiple GFJ administration”in mice and rats. This suggests that repeated intake of grapefruit juice reduces the efficacy and bioavailability of acetaminophen/paracetamol in comparison with a single dose of grapefruit juice, which conversely increases the efficacy and bioavailability of acetaminophen/paracetamol.[63][64]의 구충제:praziquantel건선 치료제 Apremilast(Otezla):Used to treat psoriasis. 진통제(아편 중독에 의한 금단 증상 완화)Buprenorphine:Metabolized into norbuprenorphine by CYP3A4[67]진통제 Codeine is a prodrug that produces its analgesic properties following metabolism to morphine entirely by CYP2D6.[69]면역 억제제 Ciclosporin(cyclosporine, Neoral):Blood levels of ciclosporin are increased if taken with grapefruit juice, orange juice, or apple juice.[7]A plausible mechanism involves the combined inhibition of enteric CYP3A4 and MDR1, which potentially leads to serious adverse events(e.g., nephrotoxicity). Blood levels of tacrolimus(Prograf)can also be equally affected for the same reason as ciclosporin, as both drugs are calcineurin inhibitors.[70]표적 항암제 Erlotinib(Tarceva)[71]호르몬제 Exemestane, aromasin, and by extension all estrogen-like compounds and aromatase inhibitors which mimic estrogen in function will be increased in effect, causing increased estrogen retention and increased drug retention.[72]항암제 Etoposide interferes with grapefruit, orange, and apple juices.[7], 항히스타민제 Fexofenadine(Allegra)concentrations are decreased rather than increased as is the case with most grapefruit-drug interactions.[73][74]항우울제 Fluvoxamine(Luvox, Faverin, Fevarin and Dumyrox)[75]항암제 Imatinib(Gleevec):Although no formal studies with imatinib and grapefruit juice have been conducted, the fact that grapefruit juice is a known inhibitor of the CYP 3A4 suggests that co-administration may lead to increased imatinib plasma concentrations. Likewise, although no formal studies were conducted, co-administration of imatinib with another specific type of citrus juice called Seville orange juice(SOJ)may lead to increased imatinib plasma concentrations via inhibition of the CYP3A isoenzymes. Seville orange juice is not usually consumed as a juice because of its sour taste, but it is found in marmalade and other jams. Seville orange juice has been reported to be a possible inhibitor of CYP3A enzymes without affecting MDR1 when taken concomitantly with ciclosporin.[76]마취 유도제 Ketamine [ 77 ] 甲状 腺 ホルモン 剤 Levothyroxine ( Eltroxin 、 Levoxyl 、 Synthroid ) : ” Grapefruit juice may slightly delay the absorption of levothyroxine 、 but it seems to have only a minor effect on its bioavailability . ” [ clarification needed ][78]고혈압 약 Losartan(Cozaar)[60]헤로인 중독 치료제 Methadone:Inhibits the metabolism of methadone and raises serum levels.[79]위 궤양 약 Omeprazole(Losec, Prilosec)[80]진통제 Oxycodone:grapefruit juice enhances the exposure to oral oxycodone.And a randomized, controlled trial 12 healthy volunteers ingested 200 mL of either grapefruit juice or water three times daily for five days. On the fourth day 10 mg of oxycodone hydrochloride were administered orally. Analgesic and behavioral effects were reported for 12 hours and plasma samples were analyzed for oxycodone metabolites for 48 hours. Grapefruit juice and increased the mean area under the oxycodone concentration-time curve (AUC(0-∞)by 1.7 fold、the peak plasma concentration by 1.5-fold and the half-life of oxycodone by 1.2-fold as compared to water.The metabolite-to-parent ratios of noroxycodone and noroxymorphone decreased by 44%and 45%respectively.Oxymorphone AUC(0-∞)increased by 1.6-fold but the metabolite-to-parent ratio remained unchanged. 비쵸은효은적 정신병 약물 Quetiapine(Seroquel)당뇨병 약 Repaglinide(Prandin)호르몬제 Tamoxifen(Nolvadex):Tamoxifen is metabolized by CYP2D6 into its active metabolite 4-hydroxytamoxifen.Grapefruit juice may potentially reduce the effectiveness of tamoxifen . 抗うつ 剤 Trazodone ( Desyrel ) : Little or no interaction with grapefruit juice . 、 高 血圧 の 薬 Verapamil ( Calan SR 、 Covera HS 、 Isoptin SR 、 Verelan ) 、 ワファリン Warfarin ( coumadin )
위에 기술된 약은 정확한 성분명에 따른다를 영어로 기술했습니다.
상당히 많은 약이고, 이 목록의 항목이 계속 증가하고 있는 것입니다.
따라서 현재 저는 약의 종류에 관계없이 약을 먹는 기간 중이나 복용이 예상될 때 자몽이나 자몽 주스를 피하고 있습니다.
이 의약품 외에도 다수의 의약품을 복용할 때는 자몽을 피해야 합니다
편두통 약:ergotamine(Cafergot, Ergomar), amitriptyline(Elavil, Endep, Vanatrip)and nimodipine(Nimotop)발기 부전 약:sildenafil(Viagra), tadalafil(Cialis)and vardenafil(Levitra)타이레놀:Acetaminophen/paracetamol(Tylenol)concentrations were found to be increased in murine blood by white and pink grapefruit juice, with the white juice acting faster.[62]”The bioavailability of paracetamol was significantly reduced following multiple GFJ administration”in mice and rats. This suggests that repeated intake of grapefruit juice reduces the efficacy and bioavailability of acetaminophen/paracetamol in comparison with a single dose of grapefruit juice, which conversely increases the efficacy and bioavailability of acetaminophen/paracetamol.[63][64]의 구충제:praziquantel건선 치료제 Apremilast(Otezla):Used to treat psoriasis. 진통제(아편 중독에 의한 금단 증상 완화)Buprenorphine:Metabolized into norbuprenorphine by CYP3A4[67]진통제 Codeine is a prodrug that produces its analgesic properties following metabolism to morphine entirely by CYP2D6.[69]면역 억제제 Ciclosporin(cyclosporine, Neoral):Blood levels of ciclosporin are increased if taken with grapefruit juice, orange juice, or apple juice.[7]A plausible mechanism involves the combined inhibition of enteric CYP3A4 and MDR1, which potentially leads to serious adverse events(e.g., nephrotoxicity). Blood levels of tacrolimus(Prograf)can also be equally affected for the same reason as ciclosporin, as both drugs are calcineurin inhibitors.[70]표적 항암제 Erlotinib(Tarceva)[71]호르몬제 Exemestane, aromasin, and by extension all estrogen-like compounds and aromatase inhibitors which mimic estrogen in function will be increased in effect, causing increased estrogen retention and increased drug retention.[72]항암제 Etoposide interferes with grapefruit, orange, and apple juices.[7], 항히스타민제 Fexofenadine(Allegra)concentrations are decreased rather than increased as is the case with most grapefruit-drug interactions.[73][74]항우울제 Fluvoxamine(Luvox, Faverin, Fevarin and Dumyrox)[75]항암제 Imatinib(Gleevec):Although no formal studies with imatinib and grapefruit juice have been conducted, the fact that grapefruit juice is a known inhibitor of the CYP 3A4 suggests that co-administration may lead to increased imatinib plasma concentrations. Likewise, although no formal studies were conducted, co-administration of imatinib with another specific type of citrus juice called Seville orange juice(SOJ)may lead to increased imatinib plasma concentrations via inhibition of the CYP3A isoenzymes. Seville orange juice is not usually consumed as a juice because of its sour taste, but it is found in marmalade and other jams. Seville orange juice has been reported to be a possible inhibitor of CYP3A enzymes without affecting MDR1 when taken concomitantly with ciclosporin.[76]마취 유도제 Ketamine [ 77 ] 甲状 腺 ホルモン 剤 Levothyroxine ( Eltroxin 、 Levoxyl 、 Synthroid ) : ” Grapefruit juice may slightly delay the absorption of levothyroxine 、 but it seems to have only a minor effect on its bioavailability . ” [ clarification needed ][78]고혈압 약 Losartan(Cozaar)[60]헤로인 중독 치료제 Methadone:Inhibits the metabolism of methadone and raises serum levels.[79]위 궤양 약 Omeprazole(Losec, Prilosec)[80]진통제 Oxycodone:grapefruit juice enhances the exposure to oral oxycodone.And a randomized, controlled trial 12 healthy volunteers ingested 200 mL of either grapefruit juice or water three times daily for five days. On the fourth day 10 mg of oxycodone hydrochloride were administered orally. Analgesic and behavioral effects were reported for 12 hours and plasma samples were analyzed for oxycodone metabolites for 48 hours. Grapefruit juice and increased the mean area under the oxycodone concentration-time curve (AUC(0-∞)by 1.7 fold、the peak plasma concentration by 1.5-fold and the half-life of oxycodone by 1.2-fold as compared to water.The metabolite-to-parent ratios of noroxycodone and noroxymorphone decreased by 44%and 45%respectively.Oxymorphone AUC(0-∞)increased by 1.6-fold but the metabolite-to-parent ratio remained unchanged. 비쵸은효은적 정신병 약물 Quetiapine(Seroquel)당뇨병 약 Repaglinide(Prandin)호르몬제 Tamoxifen(Nolvadex):Tamoxifen is metabolized by CYP2D6 into its active metabolite 4-hydroxytamoxifen.Grapefruit juice may potentially reduce the effectiveness of tamoxifen . 抗うつ 剤 Trazodone ( Desyrel ) : Little or no interaction with grapefruit juice . 、 高 血圧 の 薬 Verapamil ( Calan SR 、 Covera HS 、 Isoptin SR 、 Verelan ) 、 ワファリン Warfarin ( coumadin )
위에 기술된 약은 정확한 성분명에 따른다를 영어로 기술했습니다.
상당히 많은 약이고, 이 목록의 항목이 계속 증가하고 있는 것입니다.
따라서 현재 저는 약의 종류에 관계없이 약을 먹는 기간 중이나 복용이 예상될 때 자몽이나 자몽 주스를 피하고 있습니다.
글. 영상판독사 사진. 픽 서베이
#자몽 #자몽주스 #약 #자몽주스약 #위험한자몽