Save thousands dollar to take medicine with grapefruit

[CLTann]

Many of us probably already knew that grapefruit or its juice has strong interaction with many drugs. Lapatinib is one of them. If you are on that medication, you can save thousands of dollars by combining them. See the article below:

The Value Meal: How to Save $1,700 Per Month or More on Lapatinib -- Ratain and Cohen 25 (23): 3397 -- Journal of Clinical Oncol (http://www.jco.ascopubs.org/cgi/content/full/25/23/3397)

Make sure to check with your doctor on correct dosage.

[Lolly]

I participated in a teleconference with GSK when this article was first published, and basically their admonition was in the clinical trials conducted on Tykerb, the only reliable way to mitigate side effects was to give the drug on an empty stomach. Their trials looked at side effects with food (or drinks like grapefruit juice) and without, and with food the side effects were all over the map. So a person might be inclined to experiment on themselves, but at the risk of having some very unpleasant and potentially serious side effects. And definitely not without consulting one's oncologist.


<3 Lolly

[hutchibk]

This is not a new controversy or idea... My doctor and I talked about it last summer (and he was not interested in anything so speculative without any scientific studies behind it) and then I talked to doctors at SABCS who were heavily involved in phase 1 to phase 3 trials of Tykerb (Dr. Skip Burris and Dr. Dan Hayes) as well as one of the scientists who works for GSK and was on the team that "invented" it... and they all strongly agreed with this response from GSK.
_______________________________________________

GSK’s Response to JCO commentary – July 17, 2007
In response to commentary published by Ratain and Cohen in the July 20,2007 issue of the JCO, GlaxoSmithKline issues the following statement:

Speculative statements by Ratain and Cohen in a recent JCO commentary have the potential to be misunderstood and misused by clinicians and patients. TYKERB® (lapatinib) is indicated in combination with capecitabine for the treatment of patients with advanced or metastatic breast cancer whose tumors overexpress HER2 and who have received prior therapy including an anthracycline, a taxane, and trastuzumab. Breast cancer is a serious and potentially life threatening disease. In order for treatments like TYKERB to be used safely and effectively, it is critical that TYKERB is prescribed and taken correctly, as approved by the FDA. The effectiveness of TYKERB depends on the right amount of medicine reaching the cancer cells. TYKERB should be taken at least one hour before or at least one hour after food. The current FDA-approved labeling for TYKERB was established based on the efficacy and safety data from the pivotal Phase III study, in combination with capecitabine. Currently there is no evidence to support that adjusting the dose of TYKERB, in combination with either food or grapefruit juice may be as safe or effective for the patient. While dosing TYKERB with food has been found to increase absorption, food effects are highly variable and hard to predict. Taking TYKERB with food could result in increased side effects and decreased efficacy. Additionally, concurrent medicines that patients may be taking, including capecitabine, must be considered. Each medicine has its own potential for drug and food interactions. Therefore, it is imperative that patients follow the current FDA approved TYKERB dosing and administration recommendations without food so that a consistent amount of the medicine is absorbed by the body. Finally, our clinical experience indicates that dosing with food does not impact the incidence of diarrhea associated with TYKERB. The speculation that this side effect is due to unabsorbed drug in the intestine, and that dosing with food would decrease this toxicity, is not validated by our clinical experience. Identifying cost-savings for the healthcare system and cancer patients is necessary. However, making speculative dosage adjustments for this potential “value meal” does a disservice to patients with this life threatening disease and the healthcare professionals who treat them.

[TSund]

Certainly what you say make sense Lolly. It would be nice if there was a scientific way to caculate this tho. Ruth's surgeon does mission BC work, and there simply is not $ for the drugs. Sure would be great if there was a way of minimizing drug cost and maximizing efficiency. I don't know how they'd ever figure out the optimal dosages tho.

[hutchibk]

Another potential problem is what kind of foods might be effective, and what kinds might create toxicity or effect efficacy? It would require millions for the studies/trials... and then, how do you monitor patient adherence?

[chrisy]

Another take I heard - I believe it was at San Antonio or from my USCF doc, was that the grapefruit juice does change the metabolism of the drug, and that it would affect different individuals differently. Thus, it would be impossible to control the amount of the drug in anybody's system, other than the recommendation to take on an empty stomach.

Agreed, tho, it would be nice to see some studies on this although I doubt GSK (as truly concerned as I believe them to be) would be interested in spending millions to fund research designed to reduce sales of lapatinib!

[StephN]

Don't forget that ANYONE taking medicine to lower BLOOD PRESSURE needs to stay away from grapefruit and its juice.

There may be other drugs that also are rendered ineffective by grapefruit juice or other foods.

Agreed that dietary changes are best done under consultation.

[TSund]

Question (I'm always full of 'em, sorry):

Does the different profile of side effects that people have to the same drug (even on an empty stomach) have to do with different drug metabollizing rates of those individuals? Or is it more to do with an "allergic-type" reactions? I suppose a combination of the above and more...

Seems we already have a large profile scale of reactions (i.e. unpredictable) either way for many of these drugs...?

[hutchibk]

I spoke with the two docs mentioned above after their presentation at SABCS, and both asked my doseage of Tykerb and Xeloda, the length of time I had been on it, the timing of my meds (what time of day I took them/and how close to meals, etc) and side effects. They offered that the fact I have very, very mild side effects and lack of relative toxicity from this combination, is probably due in large part to my own individual high metabolism...