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I have not been able to eat grapefruit for more than a dozen years due to its annoying chemistry that interferes with the metabolism of multiple medications.

It has been called the forbidden fruit due to its potent inhibition of cytochrome P450 3A4 (CYP3A4) that can lead to toxic levels of many medications including two that saved by life, cyclosporin for my immune platelet problem and ibrutinib for my chronic lymphocytic leukemia. Its effects on drug levels are not always predictable but can be extreme and last for up to 3 days, so best to play it safe. In some cases, it can even decrease a medication’s activity.

I remember having dinner with our CLL pharmacy expert, Tom Henry and his worried frown when I ordered a scoop of grapefruit sorbet. I survived, but I haven’t really wanted to tempt fate again, so I have avoided the juicy fruit, and its savory cousin, Seville oranges used to make marmalade. Other citrus may have similar but milder effects.

This is serious business, but now that I am off ibrutinib (I stopped my cyclosporin years ago), I was able to have some grapefruit for breakfast this morning. I had forgotten how sour it tasted. I loved it.

Now I need to buy some of those cool serrated spoons that I remember so well from childhood.

One more of the benefit of being in a deep remission and coming off all my meds.

Stay strong. We are all in this together.


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