Effect of Fruit/Vegetable-Drug Interactions on CYP450, OATP and p-Glycoprotein: A Systematic Review

Purpose: To review the concomitant use of certain drugs with fruit/vegetable juices that may lead to drug-juice interactions resulting in medication-related problems. Method: In this systematic review, online databases (PubMed, Google Scholar and Science Direct) were searched for information on juices derived from fruits and vegetables that are reported to have inhibitory effects on cytochrome P450, p-glycoprotein and organic anion transporting polypeptides (OATPs). Results: Fruits can inhibit CYP1A1, CYP1A2, CYP1A4, CYP3A1, CYP3A4, CYP2C6, CYP2C9, CYP2E1 and drug transporters (P-glycoprotein, OATP). On the other hand CYP1A1, CYP1A2, CYP2A2, CYP3A1, CYP1B1, CYP2B1, CYP2B2, CYP2C1, CYP2C6, CYP2E1 can be inhibited by some vegetables. Antihypertensives, antidiabetics, statins, analgesics and antipsychotics were the most common drugs interacting with fruits and vegetables. The inhibition of their metabolism by fruits and vegetables can cause serious toxic effects, e.g., hypertension, poor glycemic control, rhabdomyolosis and drug overdose-related toxic effects. Overall, active components of fruits and vegetables can interact with many drugs leading to adverse effects. Conclusion: Screening of fruits/vegetables for possible risk of interaction, and patient counseling are some effective strategies for preventing such interactions for optimal patient care.