Drug interactions
Everolimus + Grapefruit
Severity: Major
Everolimus and Grapefruit: major interaction.
Last updated Sources: UK SmPC
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Grapefruit and its juice can raise everolimus blood concentrations, increasing the risk of dose-related adverse effects such as stomatitis, infections, hyperglycemia, hyperlipidemia and myelosuppression. The size of the effect varies between patients and products.
What this interaction means in plain words
Everolimus and Grapefruit can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Furanocoumarins in grapefruit inhibit intestinal CYP3A4 (and possibly P-glycoprotein), reducing first-pass metabolism of everolimus.
What to do
Advise patients to avoid grapefruit, grapefruit juice and related citrus such as pomelo and Seville orange while taking everolimus. If exposure is unavoidable, monitor everolimus trough levels and toxicity.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Everolimus and Grapefruit, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Everolimus
- Bcg vaccine live + Everolimus Contraindicated
- Everolimus + Influenza virus vaccine quadrivalent intranasal Contraindicated
- Everolimus + Levoketoconazole Contraindicated
- Everolimus + Measles mumps and rubella vaccine live Contraindicated
- Everolimus + Measles mumps rubella and varicella vaccine live Contraindicated
- Everolimus + Measles vaccine Contraindicated
Frequently asked questions
Can I take Everolimus with Grapefruit?
MediHelp rates the interaction as major. Everolimus and Grapefruit can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Grapefruit and its juice can raise everolimus blood concentrations, increasing the risk of dose-related adverse effects such as stomatitis, infections, hyperglycemia, hyperlipidemia and myelosuppression. The size of the effect varies between patients and products.
How serious is the interaction between Everolimus and Grapefruit?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Advise patients to avoid grapefruit, grapefruit juice and related citrus such as pomelo and Seville orange while taking everolimus. If exposure is unavoidable, monitor everolimus trough levels and toxicity.
What other medicines interact with Everolimus?
MediHelp also lists interactions of Everolimus with, for example, Bcg vaccine live, Influenza virus vaccine quadrivalent intranasal, Levoketoconazole. The full list is on the Everolimus page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
