High Blood Pressure, Some Meds I Take, and Grapefruit Juice

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I am in my mid-fourties, male, 5' 8", currently weight about 170 lbs. For many, many years my blood
pressure has always been good -- typically 120/70. For the past year, my blood pressure readings
have been edging up, most recently 140/90. I will be seeing my doctor about this in about a month.
However, there are a few facts of note:

1. I've been on various antidepressants for years. Just over a year ago, my doctor took me off
Serzone, and put me on Remeron and a low dosage of Desipramine. (I also continued to take
other medicines I've been on for years: Depakote, a very low dose of Zyprexa, and Zantac.
I'm just starting on Flomax for another condition.) I first started getting higher blood
pressure readings sometime after starting on the Remeron and Desipramine, though exactly
when I can't recall.

2. Probably as a result of the Remeron, I've put on about 15 or 20 pounds over the past year. I
know that may contribute to higher blood pressure, but my weight seems to have stabilized, and
I'm not a blimp.

3. I love Grapefruits and Grapefruit juice. However, I recently came across some information that
something in Grapefruit juice can interact poorly with some medicines.

So, I'd rather not get on yet another medicine, i.e., one for high blood pressure. But I don't want
to get off the Remeron and Desipramine, because they are really helping my mood. So if by any chance
the Grapefruit juice is causing the high blood pressure, then -- as much as I love the stuff -- I'll
give it up.

Does anyone know if that could actually be the cause?

Thanks in advance for all replies. CharlesJones123@yahoo.com

Charles wrote:
>
> I am in my mid-fourties, male, 5' 8", currently weight about 170 lbs. For many, many years my
> blood pressure has always been good -- typically 120/70. For the past year, my blood pressure
> readings have been edging up, most recently 140/90. I will be seeing my doctor about this in about
> a month. However, there are a few facts of note:

That reading is "borderline hypertensive". It should be monitor, not treated at this stage.

> 1. I've been on various antidepressants for years. Just over a year ago, my doctor took me off
> Serzone, and put me on Remeron and a low dosage of Desipramine. (I also continued to take
> other medicines I've been on for years: Depakote, a very low dose of Zyprexa, and Zantac. I'm
> just starting on Flomax for another condition.) I first started getting higher blood pressure
> readings sometime after starting on the Remeron and Desipramine, though exactly when I can't
> recall.

Four psych meds! That should increase your risk of drug interactions! Sorry, irrational polypharmacy
is a hobby-horse of mine.

>
> 2. Probably as a result of the Remeron, I've put on about 15 or 20 pounds over the past year. I
> know that may contribute to higher blood pressure, but my weight seems to have stabilized, and
> I'm not a blimp.

Yes, Remeron is the most likely culprit, but Zyprexa and Depakote are both associated with some
weight gain.

> 3. I love Grapefruits and Grapefruit juice. However, I recently came across some information that
> something in Grapefruit juice can interact poorly with some medicines.

Yes, grape fruit juice inhibits two of the liver's cytochrome P450 isoenzymes and, as a result,
slows the metabolism of certain drugs.

Specifically, it inhibits the 3A4 iso-enzymes which metabolises dihydropyridines (Ca channel
blockers), terfenadine, saquinavir, cyclosporine, midazolam, triazolam, verapamil, diazepam;
possibly lovastatin, cisapride and astemizole [Br J Clin Pharmacol 1998 Aug;46(2):101-10]

http://www.anaesthetist.com/physiol/basics/metabol/cyp/g.htm

None of your culprit drugs there.

However, it also inhibits the 1A2 iso-enzyme, which metabolises tricyclic antidepressants, like
desipramine. Hence greater desipramine effect, which can raise (or lower) your BP.

http://www.mentalhealth.com/drug/p30-n03.html

>
> So, I'd rather not get on yet another medicine, i.e., one for high blood pressure. But I don't
> want to get off the Remeron and Desipramine, because they are really helping my mood. So if by any
> chance the Grapefruit juice is causing the high blood pressure, then -- as much as I love the
> stuff -- I'll give it up.

Consider dropping desipramine. Two antidepressants is overkill.

> Does anyone know if that could actually be the cause?

See above

--
Larry Brash

"Charles" <CharlesJones123@yahoo.com> wrote in message
news:4cbd6372.0308091858.3514d2fe@posting.google.com...
> I am in my mid-fourties, male, 5' 8", currently weight about 170 lbs. For many, many years my
> blood pressure has always been good -- typically 120/70. For the past year, my blood pressure
> readings have been edging up, most recently 140/90. I will be seeing my doctor about this in about
> a month. However, there are a few facts of note:
>
> 1. I've been on various antidepressants for years. Just over a year ago, my doctor took me off
> Serzone, and put me on Remeron and a low dosage of Desipramine. (I also continued to take
> other medicines I've been on for years: Depakote, a very low dose of Zyprexa, and Zantac. I'm
> just starting on Flomax for another condition.) I first started getting higher blood pressure
> readings sometime after starting on the Remeron and Desipramine, though exactly when I can't
> recall.
>
> 2. Probably as a result of the Remeron, I've put on about 15 or 20 pounds over the past year. I
> know that may contribute to higher blood pressure, but my weight seems to have stabilized, and
> I'm not a blimp.
>
> 3. I love Grapefruits and Grapefruit juice. However, I recently came across some information that
> something in Grapefruit juice can interact poorly with some medicines.
>
> So, I'd rather not get on yet another medicine, i.e., one for high blood pressure. But I don't
> want to get off the Remeron and Desipramine, because they are really helping my mood. So if by any
> chance the Grapefruit juice is causing the high blood pressure, then -- as much as I love the
> stuff -- I'll give it up.
>
> Does anyone know if that could actually be the cause?
>
> Thanks in advance for all replies. CharlesJones123@yahoo.com

While 15-20 lbs. may not seem to be whole heck of a lot of weight, it can definitely contribute to
hypertension. Maintaining your proper weight (including a good body fat percentage) as well as
moderate exercise can often go a long way to keeping one's BP normal.

Grapefruit juice & grapefruits would not be the cause of high BP.

I hope you see a doctor who is aware of all the meds you are on. They may want to re-evaluate the
overall regimen you are on to see if adjusting it may help or if adding a BP medication is the only
alternative.

High BP can be a killer. Please take care of it.

Michele I ENJOY being a cranky bitch.

In article<4cbd6372.0308091858.3514d2fe@posting.google.com>, Charles
<CharlesJones123@yahoo.com> writes:
>I am in my mid-fourties, male, 5' 8", currently weight about 170 lbs. For many, many years my blood
>pressure has always been good -- typically 120/70. For the past year, my blood pressure readings
>have been edging up, most recently 140/90. I will be seeing my doctor about this in about a month.
>However, there are a few facts of note:
>
>1. I've been on various antidepressants for years. Just over a year ago, my doctor took me off
> Serzone, and put me on Remeron and a low dosage of Desipramine. (I also continued to take other
> medicines I've been on for years: Depakote, a very low dose of Zyprexa, and Zantac. I'm just
> starting on Flomax for another condition.) I first started getting higher blood pressure
> readings sometime after starting on the Remeron and Desipramine, though exactly when I can't
> recall.

Depakote: sodium valproate, anti-manic drug. Zyprexa: olanzpine, anti-psychotic drug. OFTEN A CAUSE
OF WEIGHT GAIN. Zantac: ranitidine, antihistamine drug. (for what purpose? allergy??)
>
>2. Probably as a result of the Remeron, I've put on about 15 or 20 pounds over the past year. I
> know that may contribute to higher blood pressure, but my weight seems to have stabilized, and
> I'm not a blimp.

Sadly it is a truism that depression causes loss of appetite, and recovery boosts appetite/weight.
I would estimate from first principles that Wellbutrin and atypicals like remeron should be the
worst offenders.
>
>3. I love Grapefruits and Grapefruit juice. However, I recently came across some information that
> something in Grapefruit juice can interact poorly with some medicines.

Yes it does -- see Larry's reply.
>
>So, I'd rather not get on yet another medicine, i.e., one for high blood pressure. But I don't want
>to get off the Remeron and Desipramine, because they are really helping my mood. So if by any
>chance the Grapefruit juice is causing the high blood pressure, then -- as much as I love the stuff
>-- I'll give it up.

It is definitely screwing up the metabolism of your meds; it would be safer to give it up, maybe
change to orange juice instead.
>
>Does anyone know if that could actually be the cause?
>
>Thanks in advance for all replies. CharlesJones123@yahoo.com

In<3F35C0C8.27664F4@brash.net>, Larry Brash <larry@brash.net> writes:
>Consider dropping desipramine. Two antidepressants is overkill.

Usually, yes. However I have found that the alpha2 adrenergic block from remeron is worse than
useless in me, in fact counter-productive, but one tab of a pure NARI like amitryptaline (or
desipramine) obviates the problem.

--
Dave Bird, an official ARS HakeMonger ><_'> <_" (licensed to mung pelagic fish and clams of all
kinds upon the Internet) "If turbot be the food of hate, Lay on MacErrel and, by damn, Cry HADDOCK
and let loose the cods of war!" Wm Skatesfin

CharlesJones123@yahoo.com (Charles) wrote:

>I am in my mid-fourties, male, 5' 8", currently weight about 170 lbs. For many, many years my blood
>pressure has always been good -- typically 120/70. For the past year, my blood pressure readings
>have been edging up, most recently 140/90.

Has your exercise been edging down?

>2. Probably as a result of the Remeron, I've put on about 15 or 20 pounds over the past year. I
> know that may contribute to higher blood pressure, but my weight seems to have stabilized, and
> I'm not a blimp.

It has been shown in some recentLARGE studies that a loss of 10-20 pounds can decrease BP
significantly. The converse might be true.

>3. I love Grapefruits and Grapefruit juice. However, I recently came across some information that
> something in Grapefruit juice can interact poorly with some medicines.

Please post the URL or the publication whare you "came across" that info ... some of it is real,
some of it it hogwash.

>So, I'd rather not get on yet another medicine, i.e., one for high blood pressure. But I don't want
>to get off the Remeron and Desipramine, because they are really helping my mood. So if by any
>chance the Grapefruit juice is causing the high blood pressure, then -- as much as I love the stuff
>-- I'll give it up.
>
>Does anyone know if that could actually be the cause?

Give it up for a couple of months, start exercising more, and see what happens.

Tsu

--
To doubt everything or to believe everything are two equally convenient solutions; both dispense
with the necessity of reflection.
- Jules Henri Poincaré

"Charles" <CharlesJones123@yahoo.com> wrote in message
news:4cbd6372.0308091858.3514d2fe@posting.google.com...
> I am in my mid-fourties, male, 5' 8", currently weight about 170 lbs. For many, many years my
> blood pressure has always been good -- typically 120/70. For the past year, my blood pressure
> readings have been edging up, most recently 140/90. I will be seeing my doctor about this in about
> a month. However, there are a few facts of note:
>
> 1. I've been on various antidepressants for years. Just over a year ago, my doctor took me off
> Serzone, and put me on Remeron and a low dosage of Desipramine. (I also continued to take
> other medicines I've been on for years: Depakote, a very low dose of Zyprexa, and Zantac. I'm
> just starting on Flomax for another condition.) I first started getting higher blood pressure
> readings sometime after starting on the Remeron and Desipramine, though exactly when I can't
> recall.
>
> 2. Probably as a result of the Remeron, I've put on about 15 or 20 pounds over the past year. I
> know that may contribute to higher blood pressure, but my weight seems to have stabilized, and
> I'm not a blimp.
>
> 3. I love Grapefruits and Grapefruit juice. However, I recently came across some information that
> something in Grapefruit juice can interact poorly with some medicines.

You don't want to take time released blood pressure meds with grapefriut juice of any kind. It
causes the med to dissolve all at once thus no time release with the med hitting you all at once and
nothing or very little at the end of the day.
>
> So, I'd rather not get on yet another medicine, i.e., one for high blood pressure. But I don't
> want to get off the Remeron and Desipramine, because they are really helping my mood. So if by any
> chance the Grapefruit juice is causing the high blood pressure, then -- as much as I love the
> stuff -- I'll give it up.
>
> Does anyone know if that could actually be the cause?
>
> Thanks in advance for all replies. CharlesJones123@yahoo.com

Larry Brash wrote:
> Consider dropping desipramine. Two antidepressants is overkill.

Do you mean by this that there are no people who get benefit from a second antidepressant? Do you
have data to support this contention?

--
David Rind drind@caregroup.harvard.edu

On Sun, 10 Aug 2003 11:57:27 -0700, "Robert" <Robert@hotmail.com> posted:

>> 3. I love Grapefruits and Grapefruit juice. However, I recently came across some information
>> that something in Grapefruit juice can interact poorly with some medicines.
>
>You don't want to take time released blood pressure meds with grapefriut juice of any kind. It
>causes the med to dissolve all at once thus no time release with the med hitting you all at once
>and nothing or very little at the end of the day.

What time release blood pressure meds are there?

Perhaps grapefruit interfers with the action of calcium channel blockers, like it says on the label?

On Sun, 10 Aug 2003 09:47:37 -0700, Tsu Dho Nimh <tsudhonimh@lumbercartel.com> posted:

>>3. I love Grapefruits and Grapefruit juice. However, I recently came across some information that
>> something in Grapefruit juice can interact poorly with some medicines.
>
>Please post the URL or the publication whare you "came across" that info ... some of it is real,
>some of it it hogwash.

Which bit is hogwash?

David Rind wrote:
>
> Larry Brash wrote:
> > Consider dropping desipramine. Two antidepressants is overkill.
>
> Do you mean by this that there are no people who get benefit from a second antidepressant?

No, I didn't say that. Many people do respond to combinations of antidepressants.

What I am saying, is that you increase your risk of drug interactions but combining two meds. Many
of the combinations used are not done a logical rational basis. For example, it make better clinical
sense to combine an antidepressant with a mood stabiliser, rather than another antidepressant.

> Do you have data to support this contention?

Only 30 years experience of clinical experience and listening to world experts.

--
Larry Brash

"Mooshie peas" <almostnothing@very.little> wrote in message
news:or1hjv4a83k793i0k75uk8d150e7bn9d9u@4ax.com...
> On Sun, 10 Aug 2003 11:57:27 -0700, "Robert" <Robert@hotmail.com> posted:
>
> >> 3. I love Grapefruits and Grapefruit juice. However, I recently came across some information
> >> that something in Grapefruit juice can interact poorly with some medicines.
> >
> >You don't want to take time released blood pressure meds with grapefriut juice of any kind. It
> >causes the med to dissolve all at once thus no
time
> >release with the med hitting you all at once and nothing or very little
at
> >the end of the day.
>
> What time release blood pressure meds are there?
>
> Perhaps grapefruit interfers with the action of calcium channel blockers, like it says on
> the label?
the calcium channel blockers are time released that is to say you do not cut them in half or
anything like that and there is a warning of grapefruit related to that interference.

Larry Brash wrote:
> David Rind wrote:
>
>>Larry Brash wrote:
>>
>>>Consider dropping desipramine. Two antidepressants is overkill.
>>
>>Do you mean by this that there are no people who get benefit from a second antidepressant?
>
>
> No, I didn't say that. Many people do respond to combinations of antidepressants.
>
> What I am saying, is that you increase your risk of drug interactions but combining two meds. Many
> of the combinations used are not done a logical rational basis. For example, it make better
> clinical sense to combine an antidepressant with a mood stabiliser, rather than another
> antidepressant.
>
>
>>Do you have data to support this contention?
>
>
> Only 30 years experience of clinical experience and listening to world experts.

Okay, what does that mean? Do you mean that after 30 years of clinical experience and listening to
experts that you are able to reliably tell someone over the Internet to consider stopping one of the
two antidepressants he has been prescribed because it is "overkill"? You've admitted that
combinations of antidepressants work in some people, yet after a brief post you are willing to make
recommendations about rearranging someone's psychoactive meds over the Web?

--
David Rind drind@caregroup.harvard.edu

David Rind wrote:

> Okay, what does that mean? Do you mean that after 30 years of clinical experience and listening to
> experts that you are able to reliably tell someone over the Internet to consider stopping one of
> the two antidepressants he has been prescribed because it is "overkill"? You've admitted that
> combinations of antidepressants work in some people, yet after a brief post you are willing to
> make recommendations about rearranging someone's psychoactive meds over the Web?

The word I used was that he should "consider" stopping desipramine.

The author, Charles, sounds like an intelligent person who has a
psychiatrist with whom he can discuss various options. I am sure he can make his own mind up about
his treatment.

--
Larry Brash