In America, for as long as I remember grapefruit juice interactions are both listed on the bottle and on the pamphlet you receive every single time you get a prescription (renewed or new).

We can't put billboards up for everything. It is your health, and therefore your responsibility, to read the provided literature and raise any questions to your doctor. It's not obscured or hidden knowledge. In fact, it's usually one of the first things mentioned in big, bold text. In addition every pharmacy I've been to offers consulting on medications for free and in general doctors will always go over major interactions with medication (though I've had less luck with this).

There are plenty of medications I've seen where they specifically call out interactions with grapefruit. And pharmacists will warn you about that, if this is the first time you're taking these meds.

Pharmacists will generally warn you about known major drug interactions, when you should take the medication, etc... when you're getting a new medication that you've not had before. Now, if you've had this medication before, they may not warn you. But they will ask if this is the first time you're taking this medication.

At least, that's always been my experience.

> We can't put billboards up for everything. It is your health, and therefore your responsibility, to read the provided literature and raise any questions to your doctor

I eat thousands of different things every week and I don't ask questions about any of them weekly. Do you? And would you think it's realistic to question everything all the time?

We recently adopted a dog. The first thing we did was find a list of the ~20 common foods that are poisonous for the dog. We now have that list in mind and are careful about him when we are eating those foods. I didn't ask people to add a dog warning label to each food that contains garlic.

I see no reason why prescription drugs shouldn't work the same way (which is, in fact, the way they work now). If you start taking a new prescription drug, find out what foods you can't eat and avoid them. There's no need to add a specific warning to every food that might interact with any given drug.

Agreed. A "read your drug information pamphlet for patients" campaign would be much more helpful than having a bunch of "don't take x,y,z,a,b,c,p,q,r with this food." Because x,y,z,a,b,c,p,q,r already have warnings against the foods that are incompatible.

> I didn't ask people to add a dog warning label to each food that contains garlic.

Dogs can eat garlic. You'd have to be feeding them multiple powdered garlic packets to cause harm, if its even possible.

So you've failed at risk management. This is why we have to have these dumbed down labels.

> "Dogs can eat garlic. You'd have to be feeding them multiple powdered garlic packets to cause harm, if its even possible."

The American Kennel Club [1] and [2] the Pet Poison Help Line (among others) would disagree with your certainty, sir. In this case it is you who have "failed at risk management". You did not bother to consider the risks of posting false / incorrect information on a public forum. This is why we have to have these dumbed down labels. Because people cannot bother to do (literally) ten seconds of research on their favorite search engine before "speaking with authority" on public forums / social media about a topic which they are clearly not nearly as sure of as they believe themselves to be. That's how misinformation spreads so readily these days.

[1] https://www.akc.org/expert-advice/nutrition/can-dogs-eat-gar...

[2] https://www.petpoisonhelpline.com/poison/garlic/

Your first link ( https://www.akc.org/expert-advice/nutrition/can-dogs-eat-gar... ) basically states exactly what the GP said about dosage:

Studies have found it takes approximately 15 to 30 grams of garlic per kilograms of body weight to produce harmful changes in a dog’s blood. To put that into perspective, the average clove of supermarket garlic weighs between 3 and 7 grams, so your dog would have to eat a lot to get really sick. However, some dogs are more sensitive to garlic toxicity than others, and consumption of a toxic dose spread out over a few days could also cause problems.

This means that if your dog accidentally eats something containing a little garlic, they will probably be okay, but intentionally feeding it to your dog is a bad idea.

> "However, some dogs are more sensitive to garlic toxicity than others, and consumption of a toxic dose spread out over a few days could also cause problems."

You wanna risk it with your dog, that's on you… Also, "Dogs can eat garlic." and then ridiculing the person who actually did research about what's safe for their dog, when this person couldn't be bothered to even do a ten second web search to determine if their harshness was even justifiable? And it's worth taking into account that dogs come in a pretty wide variety of sizes and body mass. Larger or more massive dog can obviously tolerate more of a toxic substance before it's a serious issue. Still shouldn't just take this person at their word and start feeding your dog garlic just because some Internet rando says "dogs can eat garlic".

> this person couldn't be bothered to even do a ten second web search

Do you know that it is true? Pretty sure they read the same/similar info from a web search and determined that foods that contain a bit of garlic aren't a big danger to dogs. The context is important (although it's fair to point out that the quote can be taken out of context) -- the discussion was about food that incidentally contained garlic as ingredient (which realistically wouldn't contain a whole lot of it), not feeding whole cloves of garlic to dogs.

I'm aware of that, and you're being needlessly pedantic. There's a sliding scale of toxicity and garlic is on the low end.

If you'd prefer, feel free to insert "grapes" instead. The point remains.

If I am on a medication I always read the pamphlet. If it's a particularly dangerous med when used incorrectly I consult with the pharmacist. As I indicated it is free. If I still don't have answers I call my doctor, or find a doctor I can call. I'm not some super star. I'm not even what I would consider "health conscious". I just know that I don't know something about a drug I am taking and should figure out more.

My burden taking a medication is on a percentage basis an edge case for the general "eating stuff" problem. So the onus is on me to resolve this edge case.

If you really desire some sort of campaign to stop this there are ways that don't impede on businesses and other's lives. You could run commercials about pharmaceutical pamphlets, you could fund a website where people could find their drug and learn quickly about interactions, you could make it a legal obligation of doctors and pharmacists to both tell you the necessary precautions with your medication. All of these would be better solutions than some safety theater like a warning label on an unambiguously safe product except to people taking certain medications. To exemplify this most diet soda contains a required notice "caution phenylketonurics: contains phenylalanine." Did you know this? Do you think the average person finds utility in this? If you are a phenylketonuric you most likely already know about the risks and what to avoid with your condition. Not only that it's incredibly rare on a population basis (~1/15,000). It's not the onus of a business to put this theater on their foods unless the chemical is dangerous to a majority (such as tar in tobacco).

You're missing his point.

Sure, you eat thousands of things. But surely you're consuming less prescribed medicine. The onus is on you to read the material given to you when prescribed potentially life threatening medication. It's prescribed and not over-the-counter for a reason. There's extra precaution placed on the medicine itself, and so you should pay attention to that and read up.

God forbid someone should come at you with a lingonberry before you've acquired a PhD in botany or properly armed yourself.

More seriously, it is easy to overlook the extreme spectrum of knowledge and ignorance in our society. There are other factors too, such as cognitive impairment, state of mind, etc. Ignorance may be a poor defence under law, but in a more ideal world, ignorance of grapefruits shouldn't result in capital punishment.

With the extreme liberalness we accept advertisements everywhere, it doesn't seem unreasonable to dedicate an extra amount of space here and there for friendly warnings.

Edit: I see several comments stating that such warnings are printed on labels. If so, discard my comment. Other than verbal warning, that's probably adequate for our imperfect world.

> Sure, you eat thousands of things. But surely you're consuming less prescribed medicine.

Maybe you eat thousands of things and some interact with each other. You don't know, you're just hoping it will be fine, because learning everything about everything is not feasible, which was my point.

My secondary point is that everyone on this thread is blaming the victim for not doing enough research, while at the same time everyone on this thread is only marginally better - maybe you do enough research in this specific topic, but surely not for everything in life.

It's hardly "research" if it's printed on the information you're given and the pharmacist is legally required to offer to tell you what you should know when you pick up the medicine. In America (or at least in every state I've lived in) you need to explicitly decline counseling by the pharmacist about new medications.

Exactly! If you cannot be bothered to read the actual warnings that come with any medication you're about to eat, then you're kinda askin' for trouble. They give you those instructions and warnings for good reason.

Actually, yea. Many people do. It's relatively common. This is an element of personal responsibility. Granted, I know how to cook and I'm not a big fan of boxed, processed foods. This makes the gamut of foods I care about easier to track.

Plus, knowing that grapefruit helps metabolize different things helpful and cheapens your bartab. You'll get drunk faster after eating a grapefruit or two. Animal derived fats help slow down the inebriation process, like butter and a really greasy beef patty.

I'm not sure what you're getting at. The analysis isn't on each thing you eat. It's merely a blacklist of a couple things for the specific medication you're on.

This feels like the responsibility of the pharmacy more than that of the grocer who sold you juice. Pharmacies typically put stickers on medication bottles that say, “Do not take with grapefruit juice,” “Avoid sun exposure,” “Take with food,” etc.

Would you want grocery stores to label grapefruits in the produce section?

Do you take thousands of different medications weekly? It's pretty realistic to ask about medications you take and what interactions to avoid with that medicine.

You're assuming that only medications interact with food. Maybe you eat thousands of things and some interact with each other. You don't know, you're just hoping it will be fine, because leaving everything about everything is not feasible, which was my point.

>You're assuming that only medications interact with food.

Where did I say that? We're in a topic about medicine interacting with grapefruit. I suggest putting the warning on the medicine is a reasonable approach for this issue.

>Maybe you eat thousands of things and some interact with each other.

Whats your point here? Should every food list every possible interaction with every other existing food and medicine? Will I need to a read a 1400 page book before I can buy an orange?

Because what are you going to put on the grapefruit juice label, a list of thousands of drugs that can have interactions with it? If people don't read the leaflets to their medication that's really on them.

It's surprising that people would take any medication without reading the leaflet anyway, given that grapefruit is not the only thing that can interact with them, and it's usually pretty clearly written.

Something similar to cigarette package warnings, like "this food interacts with many medications, please read the leaflets carefully".

I, for one, look forward to GMO grapefruit trees that produce fruit with the warnings already printed on the peel so that the millions of people globally that get their morning grapefruit fresh can know that there are a few dozen medications the fruit might interact with.

It's weird how many people are seemingly against this. It's simple, cheap and will probably save lives.

It is also enirely and completely useless. You would get desensitized to the warning the second or third time you buy grapefruit, and have 0% chance to remember the ubiquitous warning when you actually get some medication that does interact.

The important thing is for your doctor to be aware, and notify you.

Also, grapefruit is nowhere near the only food that can have terrible interactions with certain drugs.

Desensitization doesnt matter. Grapefruit isnt an addictive drug. I learned about grapefruit's crazy drug interactions about 2 years ago once from an online article. Ever since then Ive been careful.

I was entirely ignorant about them while buying grapefruits and juice for decades.

Well, ours is the profession from which "RTFM" arose as jargon (admittedly not without justification) so it doesn't seem that strange.

This was literally the argument for Prop 65 warnings

Most foods don't have so many interactions with drugs. It wouldn't hurt to put a reminder on the grapefruit juice to check that stack of paper that came with your prescription to see if it's on the list.

No one reads warnings more than a handful of times in their entire life.

Someone prescribed a medicine is given given direction by the doctor, a consult from their pharmacist, and printed material explaining how to take their medication and what to be careful of while taking it. More information is available to them online and in popular home reference books for drugs.

Perhaps because of a life too inundated by data, or because they’re busy, or for whatever reason, they ignore all of these opportunities to understand the medicine they’ve been asked to take.

I can’t judge a person for doing that, as I’m sure I’ve done the same thing, but I certainly wouldn’t expect a new label on a jug of grapefruit juice that they barely glance at to finally make it across the finish line!

There are problems in the world that are just going to exist, and efforts to eradicate them can become costly and fruitless nuisances rather than further solutions. This feels like one of those to me.

> Someone prescribed a medicine is given given direction by the doctor, a consult from their pharmacist, and printed material explaining how to take their medication and what to be careful of while taking it.

I don’t know what the healthcare system is like where you live but based on my experience in the UK, the only reliable one of these three sources that I’ve experienced is the printed material. Doctors and pharmacists, for whatever reason, have not proved to be a good source for anything but the most basic of information (if any) about prescribed medicine.

And that printed material is so broad that they list every possible side effect and contraindication under the sun. Presumably for sufficient legal cover for the pharmaceutical company.

And you think a warning on a grapefruit juice bottle that you buy everyday would do better? Especially one that, by force of space, says "ask your pharmacist if any medicine you take may interact with this"?

I don’t have an opinion on that. I was replying to the parent (about sources of information) with my specific experience.

I take a medication for which grapefruit juice is contraindicated.

I got no shortage of warning about from the medication side (doctor and pharmacist directly and verbally, plus in written form in the paperwork and labeling).

It seems far more reasonable and feasible to put the warnings on the medicine than on the food.

Counter point. Both I and my daughter are on unrelated medications that interact with grapefruit according to https://www.fda.gov/consumers/consumer-updates/grapefruit-ju....

I remember no such warning for either of us.

If you take medications regularly, I'd recommend checking out https://www.fda.gov/consumers/consumer-updates/grapefruit-ju....

It’s not on the initial prescription filling paperwork AND not on the labeling on the container? My container has 5 warning/notice labels:

Warning about interactions with pregnancy, grapefruit/grapefruit juice, alcohol, all other medications, and a description of the physical appearance of the pills.

That’s not a counterpoint. It’s an anecdote, and an indication you need a better doctor.

Anecdotes like this, indicate that the current method of information isn't secure enough.

You mean reliable, not secure, but there are two checks you got and if you didn’t read the warnings it’s on you. This whole thing is so nanny-state I can’t believe I’m having this discussion here.

As the old saying goes, you can't fix stupid.

By the time someone has killed themselves by eating grapefruit, it means they've already plunged through two safety barriers:

    1) The medical professional that prescribed failed in their duty to inform of interactions (which then begs the question as to whether they also failed to screen for interactions before prescribing).

    2) You know, those little bits of magically folded paper that come in every single packet of pills. They're not just there for decoration. And if you can't read, then there's always the Pharmacist (or friends or family).

Its a bit like that stupid warning the Californians put on wine bottles that it may cause issues with pregnancies. Well, that warning is a bit short, because they should have also told you about cirrhosis of the liver, drink driving, the dangers of broken glass, the fact you might stain your carpet ....

> You can't fix stupid

True, but you can fix bad design.

I have a chronic ailment and take medication for it. Every single box comes with that strip of paper with important information.

The problem? It's tiny, extremely dry and technical, and is barely readable even by someone who wants to understand it (me).

There's absolutely a need for making more readable pamphlets. Until anybody cares the manufacturers will just put in the bare legal effort, and patients may suffer.

I agree, it would be nice to have boxes of medication come with obvious large prints in style "grapefruit + this medicine = DEATH, tomato juice + this medicine = VOMIT FOR DAYS, YAY".

It seems that the most deadly things should be pointed out in bold and in as simple language as possible. Like in (human friendly) UX design, what is important should look important.

I suspect that the reason they don't want to put it on the boxes is largely because brands don't want medication to look dangerous in any way. The excuse that might be made about is that "pamphlet must be read too, and if we print something on the box people won't read pamphlets", but it does not seem very convincing.

There are people at the FDA who do this day in and day out.

Packaging is all approved by the FDA. Grapefruit interactions are a concern but so are a dozen other pieces of info.

When I’ve gotten a prescription with a grapefruit interaction the medicine had a colorful sticker with a picture of grapefruit on it.

That certainly caught my attention.

https://shop.gohcl.com/default.aspx?page=item+detail&itemcod...

This looks great, exactly what I meant. I'm not in US, and I've never seen any similar warnings on any medication unfortunately.

Manga for prescription interactions makes a lot more sense than warnings on everything with grapefruit.

You can always ask your doctor or pharmacist. Or even look up WebMD etc.

The problem is that it's not just "stupid" that creates problems. A warning would reduce the lethality of neglect and forgetfulness.

The risks that come with grapefruit juice is much less obvious than the example with broken glass from the wine bottle.

> A warning would reduce the lethality of neglect and forgetfulness.

There's so many warnings and small print already. Just like terms of services and cookie banners on websites, nobody is reading them any more because we have warning fatigue.

"The risks that come with grapefruit juice is much less obvious than the example with broken glass from the wine bottle."

Whoa there. Do you know about how impact to glass can create a crater on the inside of the bottle without shattering? Then you can end up eating or drinking the glass fragments that are in the food/drink. That's something that's not very obvious.

Great, now I have a new worry.

I've known many people who flippantly pop medications without regard for the dosage and interaction warnings. I've even been ridiculed myself for doing so, as if taking 2 minutes to read the label makes me some kind of schmuck or sheeple. I don't really care what other people say, I'm paranoid about everything I put in my body and understand not everyone lives that way, but there are a lot of people that just don't care to think about it.

Sure, but do you think any of the people that doesn't even stop to check if their new prescription medication interacts with the acetaminophen (paracetamol/Tylenol) they take whenever they have a headache is going to be moved by a grapefruit juice generic warning?

defensive and uncharitable comments..

Not common sense that grapefruit interacts with many meds. Signal to noise is important, but grapefruit interacts with enough to be notable. Someone would become aware that would've otherwise been ignorant:

https://en.wikipedia.org/wiki/Defence_in_depth_(disambiguati...

Even this thread itself raised some awareness, so thanks

If the prescribing physician is not informing you of important interactions and you are relying on random internet threads or food labeling (especially for food you normally consume) to notify you, then you are already doomed.

Medicine, especially prescription medicine, often has terrible interactions with many commonly used substances.

On the other hand, warning are useless when they are unspecific and appear on something you regularly consume. You will at best notice a warning label on a package 2-3 times in your entire life, assuming you use that regularly, and even then you will immediately forget unless it is very specific to you (such as a peanut warning for someone with a peanut allergy).

The real question is if this thread (or proposal) raised awareness that wouldn't otherwise occur for the target population via existing consultation and literature.

Would large leaflets attached to grapefruits be somehow read much more than large leaflets attached to drug packaging?

The evil little bastards could be branded, with hot irons, right on their tender, conniving zests. It would serve them right.

Or, when we soon switch to a CBDC with programmable credits, people who purchase prescription products could be prohibited from purchasing grapefruit products.

Edit: I'm in favor of advancing awareness of the dangers of fresh and pasteurized fruit, not as proposed above, but in some effective way.

Well, I need to be on statins forever. No doctor ever told me about interaction between statins and grapefruit. I totally googled at random one day about grapefruit and cholesterol and tangentially it was mentioned (the dreadful interactions with statins).

What statin? Grapefruit does not react adversely with all statins. Atorvastatin (Lipitor) and simvastatin (Zocor) have warnings about interactions with grapefruit. Rosuvastatin (Crestor) does not. Not all statins are the same. Talk to your doctor and pharmacist, read the information given yo you with your prescription, and look up the information yourself.

I take atorvastatin + ezetimibe

There’s no warning label on the pill bottle itself? I suppose that varies by pharmacy, but mine has a yellow, red, and black label that includes the grapefruit as #2.

Do you think a warning on a bottle of juice that you buy everyday saying "this may interact with certain medications" would have changed anything? I am 100% sure it wouldn't.

I honestly don't know. And how could you be 100% sure? But knowing myself and how curious I am with these topics, if I read it on a bottle, I'd look around for sure. And since I'm daily taking these medications, until I die, would be wise to search for more information ofc.

I am 100% sure because I have seen how many warnings there are on the packages of many everyday items, and have never remembered a single one more than a day of two.

And because I know I have never read the packaging of an item I buy more than once, with the exception of medication.

I also know that this fact doesn't change when I do take medication.

I don't suddenly start re-reading packaging on my milk to see if they have any warning about interacting with medications. Especially given how many different food items I buy every month that could have a generic warning.

I genuinely would love to see data in that regard. I'm not a doctor or pharmacologist, but I'm very curious to know what exactly I'm taking into my body and what might happen and I'm sure I'm not alone.

Grapefruit is a food that alone or with other foods poses basically no risk.

Medications have all kinds of complex interactions.

The vitamin K from any number of leafy greens in conjunction with prescription meds can kill you too.

If you are tuned within an inch of your life on prescription meds maybe you should read the leaflets.

Warnings on citrus fruit. What.

PSA: don't stop drinking grapefruit juice abruptly, if you are on meds. your effective dosage of medication will swing wildly as your liver enzymes adjust.

this has killed people before - someone will be on a carefully titrated dose of heart meds, stop consuming grapefruit, and die from their body suddenly having 3x more/less of their med.

Or just ask a doctor. There shouldn't be guesswork involved.

If we start such warnings. What else should be covered? Alcohol by my understanding has interactions with those drugs that are broken down by liver at least. What should be threshold for warning to be present?

We already have warning text for phenylalanine (for example in sweeteners, tonic, etc) and a list of allergens that must be stated.

I think a more interesting question would be: should food that contains grapefruit have a warning? Any food with high levels of phenylalanine says “phenylketonurics: contains phenylalanine”. Perhaps food containing substantial amounts of grapefruit should carry a similar warning.

This is complicated by the fact that other citrus fruits may have similar interactions and, at least according to Wikipedia, the full set of problematic citrus fruits is not well characterized.

I've run into a variant of this: Beer. Citrus is a popular adjunct flavoring for IPAs and other hopped beers. Sometimes it's obvious, a grapefruit shandy is going to have grapefruit in it; but I've also had beers labeled something like Orange Citra Juice Bomb where down in the ingredients it notes that the citrus flavor is boosted by grapefruit, but I didn't catch that.

Now, that's partially on me for not scrutinizing the ingredients, but also *beer doesn't have to list ingredients*. So it's entirely possible to have a beer containing a significant amount of grapefruit without any indication of it on the label. And that can be life-threatening, depending on the medication in question.

So that's something where I'd definitely appreciate a standard of noting grapefruit if it's in a food. Activated charcoal similarly.

Yes, of course there should be warnings for other citrus hybrids that produce the same chemical.

But there is a limitation for HN thread titles, I had to keep the question simple.

I don’t mean other fruit. I mean prepared foods that contain citrus.

IMO, it would be perfectly reasonable to include a warning saying that grapefruit is known to interact with many medicines and should be taken with caution by medicated individuals.

That's more likely to prompt someone who's medicated into looking up if their drugs are affected by the fruit.

At worst, it causes a few companies to have to print an extra line of text and it gets disregarded by users.

Why is it the grapefruit juice company's responsibility to let you know about your drug interactions? The cost to reprint labels is non-negligible and a tiny warning on the back is only going to be read by someone who ALSO reads their pamphlets with their medication. You're attempting to fix end user carelessness with bureaucracy which never works.

Eventually this argument will move on to putting big bold warnings on the front of food, and then giant warning stickers like we do for cigarettes. At some point we have to allow people to have responsibility over their condition. Not only is the number of people affected by this small its also asinine. If it is a problem, make it a legal requirement to get drug counseling at the pharmacy before you can pick up your prescription. Otherwise it's a solution looking for a problem.

Do you really think anyone would notice that warning after the third time they buy grapefruit their entire lives?

Especially if the same warning appears on every common food that interacts with some common medication (for example, tea has potential bad interactions with SSRIs and other anti-depressants).

This is 100% on your doctor, pharmacist, medicine producer, and yourself to check. Vague warnings on common foods would have 0 effect.

So on a grapefruit, rather than the standard PLU sticker, there's a jumbo one with a cigarette-style warning?

For whole grapefruits sold by the kilogram or pound, there could be a sign next to the price.

The question is what is the level of risk you are trying to prevent. For me a far more underappreciated risk is the level of liver toxicity in acetaminophen (Tylenol) especially with even moderate amounts of alcohol--taking Tylenol for a hangover is a very bad idea.

You can be in liver failure (See https://www.mayoclinic.org/diseases-conditions/acute-liver-f... ) after one very large dose of acetaminophen, or after higher than recommended doses every day for several days.

From https://www.ucihealth.org/blog/2018/03/acetaminophen-liver-f... About 1,600 U.S. cases of acute liver failure occur each year due to acetaminophen overuse. And some 500 people die each year from overdosing on the drug.

Estimates are that half of those deaths are suicide. (That doesn’t mean the drug’s side-effect-free, but does mean labeling likely wouldn’t be effective.)

If labeling efforts cut the death rate in half that's 249 more people a year who are saved vs. "grapefruit deaths." The trick is to aim for improvement not perfection. We could limit deaths more by banning Tylenol but that would lead to other problems that might be equally serious (e.g. more opioid use for pain relief).

What level of additional labeling will eliminate non-intentional ODs? There’s clear dosage instructions already, including “do not exceed” levels.

I used acetaminophen as an example of drug that is killing many more people than grapefruit juice. It's possible we could take a more holistic look and see where else we could minimize unintentional overdoses and dangerous interactions.

The question is what additional measures would reduce--for example, cut in half--the current level of unintentional overdoses and drug interactions that cause liver failure.

What the doctors call polypharmacy and regular people call "grandma has a big bag of pills to take each day" is a serious problem for folks over 65 to pick a different aspect of the same challenge.

In my experience you will get nowhere if you will only explore interventions that "eliminate problems." Reduction in harm for effort and money invested is a better standard.

I think you were the one to introduce a target that functionally represents eliminating unintentional OD deaths. It seems we agree on that being folly.

You are making an inference, it was not my implication.

Why stop at grapefruit juice? I've heard citrus juice can have unpredictable effects on any drug.

Imagine you have a peanut allergy and have to check the labels on everything to see if it contains peanut or processed in a plant with peanuts.

Then you walk into the drinks aisle and see grapefruit juice box with a big red banner WARNING THIS PRODUCT CONTAINS GRAPEFRUIT JUICE.

Grapefruit will be mentioned in the ingredient list if it's present in significant amounts. Many allergens, such as peanuts, which can cause severe anaphylactic reactions and can affect many people, are prominently mentioned, including if the facility that produces a product also deals with them.

Beyond that, it's really on the consumer of food to make sure they are not ingesting anything that can cause harm to them. Ascertaining grapefruit presence in the food falls squarely in this category. If you can not be sure that grapefruit is absent in a juice, do not drink it. It's that simple. And if something says grapefruit prominently on the packaging (I imagine grapefruit juice in its original packaging would certainly fit the bill), then it's really the individual's responsibility.

CBD does the same as grapefruit. I don't know if it affects all the same medicines but I'm on a med affected by grapefruit and found out CBD has the same effect and my pharmacist confirmed what I found.

NO

You can of course, but you obviously need to print it on grapefruit too, no ?

Too much noise is bad even today. Try to about solutions which provide clarity and personalization.

Medical professional should be responsible for your care, so he should provide you with link/printed brochure with comprehensive list of interactions for YOUR exact condition. it is more efficient and if something happens to you have piece of paper near you in your house with all interactions. You need personalization of everything.

There are numerous interactions and precautions for most medications. The riskier ones are prescribed, and doctors (and pharmacists) should be going over the risks and interactions. The less risky (or grandfathered, or politically motivated) are available over the counter, and it's important to read the literature that comes with it. If people can't reasonably read or understand the risks and interactions, then that medication should be prescription.

Grapefruit juice has been thought to increase the effects of some drugs for some time. You can find many "recipes" of certain drugs taken with grapefruit juice on trip reports on Erowid.

Known to.

No.

The medicine comes with a warning label.

A more relevant move would be to add warnings about monoamine oxidase inhibitors to various items that contain them, from coffee to tobacco.

You can’t avoid what isn’t on the packaging.

No: it’s in the documentation of your medicine. Stop the shroud warning labels on everything that keep increasing consumer product prices

Leafy greens have drug interactions too, just to give another example. Ask your pharmacist about interactions with foods and supplements!

The Medicines should be labeled

Maybe the warning should be on the medicine?

YES!!!!

They should.

-

My grandmother was an ER nurse her whole life (a candy-striper, etc, malpractice insurance investigations etc...)

she was on some medications and grapefruit was a staple morning breakfast for my grandmother and grandfather... Grapefruit, a small sprinkle of either sugar or salt and a glass of O.J. - every morning for like 40 years....

Nearly killed her after she was on some medication that had a poor interaction with grapefruit.

and these were medical experts!

So, _YES_

EDIT: The point is: that even if youre a medical expert, you're still susceptible to this problem, and SHE WAS AWARE but the thing was that a medication she took at like 75 years old, was NOT properly warned about...

Jeasus folks, even brilliant people miss shit like this at times.

Is it not the responsibility of the doctor prescribing or the very least the person who is taking the medication to be aware? They put warnings on all medication that has interactions with grapefruit, because they don't want to check a piece of paper on their prescription or mention to their doctor of their diet.

It's your body, your health ultimately, in hand with the doctors support.

How would you even mark fresh fruit? Force supermarkets, farmers, why stop there?

So every day for 40 years she would have read and thought carefully about that warning label, so that finally when it became relevant it would save her? Unfortunately not: we humans cope with the enormous stream of information pouring relentlessly through our senses by ignoring almost any unchanging signal. In industries requiring constant awareness for rare events, such as piloting highly automated aircraft or scanning luggage for bombs, we've learnt to present constant challenges (fake alerts, etc) to keep the operators paying attention. See also: safely driving a Tesla on autopilot...

Are you sure she would have even see it? After eating grapefruit for 40 years, she'd become accustomed to ignoring the warning. She wouldn't have thought this warning suddenly applied to her.

Yes, and she would have seen the same warning on the grapefruit juice that she had been seeing for 40 years - which would have helped her not at all.

Or do you think the warning would be kept up to date with the brand names (since many people don't know the substance names, of course) of the hundreds or thousands of medications that interact with grapefruit, and that people would periodically read that list?

This is 100% on the doctor that prescribed the medication, a label on the juice or the fruit would do less than nothing, especially for people who consume it regularly.

How would this new medication appear on the interaction label on all grapefruits/juice containers if your claim is that a medication itself made it all the way to market without the proper labeling on that very medication?

If you think ER nurses are medical experts I don’t know what to say. They are medical assistants and specialists who do not prescribe medications — they do what the doctor says.

Maybe that's true in your part of the world but at least in Australia nurses play a crucial role in double checking whether medication directives/dosages actually make sense, and knowing what to do when patients have allergic reactions or appear to have been mis-prescribed certain drugs. Doctors make at most high level decisions about courses of treatment (even for chemotherapy) and rely on the experience and responsibility of nurses to ensure they're delivered safely and effectively.

(Source: watching my partner do online professional competency tests. Definitely expert level knowledge required.)

Yes your partner is a medical specialist. I have also had partners who were nurses. My statement is still correct.

There is no such thing as a “medical expert” as the term is over broad and eg ER nurses are not required to advise patients on interactions of prescription medications.

That falls to the doctor and likely pharmacist.

It does not surprise me at all that a former ER nurse doesn’t know that some medication she got prescribed interacts with grapefruit juice.

She's a registered nurse shrug. And yes she's worked ER.

Hi. My grandmother knows more about medicine than you will ever know, my brother was the Commander of the tenth medical wing for USAF and had over 10,000 service members and their families under his care - director of the VA and currently runs the largest hospital group in a particular state... (Timothy Dean Ballard, MD Col. USAF - if you care to fact check my bullshit) and the personal flight surgeon to the joint chiefs at the pentagon (general Shelton)... Ive built more hospitals than you have stepped in....

My aunt is the head NICU nurse at El Camino Hospital in Mountain View Ca, (the hospital of the future) one of the many hospitals I built... (el Camino, UCSF, SFGH, Sequoia, Nome, Methodist) yeah im a little closer to this subject than you may have assumed.

And if you think an ER nurse "just does what a doctor says"

You know absolutely nothing of top nurses. They wear the pants.

I'm comfortable with my statement. So, thankfully you don't know what to say.

I am close with several ICU and cardiac nurses. They are experts at what they do, so in a sense you could call them medical experts.

However they are medical experts in the same way that a plumber is a construction expert. I would not be surprised if a plumber was caught off guard by lighting codes.

The term is so broad as to be meaningless in practical application.

>>"_cardiac nurses_"

-

Please share this joke with them, this is from Dr. Francis Stutzman, Cardiologist and mayor of Saratoga Ca..

--

>"I've got good news!!! and bad news"

>>You're _heart_ is going to last you the rest of your life!!

>>>"Sadly, thats going to be about a week."

Cool. I dont have a medical degree - but I can design hospitals (and have) so your approximation of knowledge/ability to the problem at hand is meaningless.