Pomegranate Juice Drug Interactions

Fresh made Pomegranate juice
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The pomegranate, once considered exotic, is now immensely popular. Pomegranate juice is found in almost every grocery store in North America.

But a case report published in the September 1, 2006, issue of the American Journal of Cardiology suggests that pomegranate may interact with common medications.

A 48-year-old man was taking ezetimibe (Zetia) 10 mg a day and rosuvastatin (Crestor) 5 mg every other day for 17 months. Both medications are used for high cholesterol.

He began drinking pomegranate juice (200 ml twice weekly) and three weeks later, was admitted to emergency with thigh pain and an elevated serum creatine kinase level (138,030 U/L, normal < 200 U/L). Both are symptoms of rhabdomyolysis, a serious condition that causes the breakdown of muscle fibers and may lead to kidney failure.

Rosuvastatin belongs to a group of medicines called HMG-CoA reductase inhibitors, or ‘statins’. Grapefruit juice is known to increase the risk of statin-induced myopathy, but up until now, there was little information about whether pomegranate juice might also increase the risk.

Pomegranate juice and grapefruit juice, are both known to block the cytochrome P450 3A4 enzyme systems in the intestines. By inhibiting these enzymes, the juices may increase blood levels of many medications.

Potential Pomegranate-Drug Interactions

  • Antiarrhythmics - Amiodarone (Cordarone), disopyramide (Norpace), quinidine
  • Calcium channel blockers - Felodipine (Plendil), nicardipine (Cardene), nifedipine (Procardia), nimodipine (Nimotop), nisoldipine (Sular)
  • Statins - Atorvastatin (Lipitor), lovastatin (Mevacor), simvastatin (Zocor)
  • Immunosuppressants - Cyclosporine (Sandimmune, Neoral), tacrolimus (Prograf)
  • Protease inhibitors - Saquinavir (Fortovase)

However, pomegranate juice may also interact with medications not on this list.

The drugs ezetimibe and rosuvastatin are not thought to be broken down by cytochrome P450 3A4.

Based on the limited evidence about the potential drug interactions, it is essential that you talk with your doctor if you are taking medication and are considering drinking pomegranate juice.

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Article Sources

  • Hidaka M, Okumura M, Fujita K, Ogikubo T, Yamasaki K, Iwakiri T, Setoguchi N, Arimori K. Effects of pomegranate juice on human cytochrome p450 3A (CYP3A) and carbamazepine pharmacokinetics in rats. Drug Metabolism and Disposition. 33.5 (2005):644-8.
  • Kim H, Yoon YJ, Shon JH, Cha IJ, Shin JG, Liu KH. Inhibitory effects of fruit juices on CYP3A activity. Drug Metabolism and Disposition. 34.4 (2006):521-3.
  • Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis associated with pomegranate juice consumption. American Journal of Cardiology. 98.5 (2006):705-6.