![]() activated by the enzyme to an active metabolite.metabolized by the enzyme to an inactive metabolite, or.Inhibition of enzymes can have two different effects, depending on whether the drug is either ![]() CYP3A4 is a metabolizing enzyme for almost 50% of drugs, and is found in the liver and small intestinal epithelial cells. These chemicals inhibit key drug metabolizing enzymes, such as cytochrome P450 3A4 (CYP3A4). The effects are caused by furanocoumarins (and, to a lesser extent, flavonoids). People are also advised to ask their physician or pharmacist about drug interactions. Affected drugs typically have an auxiliary label saying "Do not take with grapefruit" on the container, and the interaction is elaborated upon in the package insert. The relative risks of different types of citrus fruit have not been systematically studied. Fruit consumed three days before the medicine can still have an effect. One whole grapefruit, or a small glass (200 mL, 6.8 US fl oz) of grapefruit juice, can cause drug overdose toxicity. It was reported in 2008 that similar effects had been observed with apple juice. A 2005 medical review advised patients to avoid all citrus juices until further research clarifies the risks. The effect was first discovered accidentally in 1991, when a test of drug interactions with alcohol used grapefruit juice to hide the taste of the ethanol. The effect is most studied with grapefruit and grapefruit juice, but similar effects have been observed with certain other citrus fruits. Some fruit juices and fruits can interact with numerous drugs, in many cases causing adverse effects. ![]()
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