A1 Refereed original research article in a scientific journal
Repeated Intake of Grapefruit Juice Inhibits CYP2B6, CYP2C9, CYP2C19, and CYP3A4 while Lingonberry Powder Does Not Induce Major CYP Enzymes in Humans
Authors: Aurinsalo, Laura; Lapatto‐Reiniluoto, Outi; Kurkela, Mika; Neuvonen, Mikko; Moilanen, Eeva; Niemi, Mikko; Tornio, Aleksi; Backman, Janne T.
Publisher: Wiley
Publication year: 2025
Journal: Clinical Pharmacology and Therapeutics
Article number: cpt.70165
ISSN: 0009-9236
eISSN: 1532-6535
DOI: https://doi.org/10.1002/cpt.70165
Publication's open availability at the time of reporting: Open Access
Publication channel's open availability : Partially Open Access publication channel
Web address : https://doi.org/10.1002/cpt.70165
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/506011425
Grapefruit juice is a well-established inhibitor of cytochrome P450 (CYP) 3A4, but its effects on other CYP enzymes or organic anion transporting polypeptides (OATPs) are not fully characterized in humans. Recently, lingonberry powder was shown to induce murine CYP enzymes. We investigated the effects of lingonberry powder and grapefruit juice on seven CYP enzymes and two OATPs. Eleven healthy volunteers received three pretreatments three times per day: water for 1 day (control), lingonberry powder for 9 days, and grapefruit juice for 3 days. CYP index drugs (caffeine/CYP1A2, bupropion/CYP2B6, repaglinide/CYP2C8, flurbiprofen/CYP2C9, omeprazole/CYP2C19, dextromethorphan/CYP2D6, midazolam/CYP3A4, and simvastatin/CYP3A4) were administered orally on the study day of each pretreatment (day 1, 10, and 3, respectively). Venous blood samples were collected until 23 hours postdose. The concentrations of index drugs, their metabolites and endogenous OATP1B1 and OATP1B3 biomarkers glycochenodeoxycholate 3-O-glucuronide (GCDCA-3G) and glycochenodeoxycholate 3-sulfate (GCDCA-3S), respectively, were quantified. Grapefruit juice expectedly increased the AUC0–23h values of the CYP3A4 index drugs midazolam and simvastatin (P < 0.01). Additionally, grapefruit juice decreased the hydroxybupropion/bupropion (CYP2B6), 4′-hydroxyflurbiprofen/flurbiprofen (CYP2C9), 5′-hydroxyomeprazole/omeprazole (CYP2C19), and 1′-hydroxymidazolam/midazolam AUC0–23h ratios to 0.57-fold (90% confidence interval: 0.45–0.74), 0.78-fold (0.69–0.87), 0.43-fold (0.36–0.52), and 0.72-fold (0.63–0.84) of control, respectively (P < 0.01). Lingonberry pretreatment did not change any CYP indices. GCDCA-3G and GCDCA-3S concentrations were unaffected by grapefruit juice or lingonberry pretreatment. Collectively, our findings indicate that in addition to inhibiting CYP3A4, repeated grapefruit juice intake causes clinically relevant inhibition of CYP2B6, CYP2C9, and CYP2C19, revealing previously underappreciated interaction risks. Conversely, lingonberry powder is unlikely to induce CYP enzymes in humans.
Downloadable publication This is an electronic reprint of the original article. |
Funding information in the publication:
This study was supported by grants from the Academy of Finland [Grant decision 325667, 2019], the Sigrid Jusélius Foundation (Grant numbers 8037 and 250162; Helsinki, Finland), and by State funding for university-
level health research (TYH2021304, TYH2022301, TYH2023412, and TYH2024301; Hospital District of Helsinki and Uusimaa, Finland). In addition, Aurinsalo L received personal grants from the Finnish Medical Foundation (Grant numbers: 4697, 2021, and 7649, 2024; Helsinki, Finland) and Orion Research Foundation (Grant decision in 2024;
Espoo, Finland).