Feeling Uneasy After Eating Pomelo and Grapefruit: A Medical Inquiry

After consuming pomelo and grapefruit, I felt a sensation of tilting to one side?

Hello Dr.
Yeh,
This evening, a 41-year-old male friend of mine consumed almost an entire pomelo and then ate a whole grapefruit, both of which were quite large, between 9 PM and 11 PM.
Shortly after, he reported feeling unwell and that he felt his body leaning to one side.
While it wasn't very noticeable upon examination, he did indeed lean to the right when standing, which is concerning.
He mentioned that he took an over-the-counter pain relief medication around 5 to 6 PM, and I'm unsure if this is related.
Additionally, his father passed away from a myocardial infarction, and he has personally experienced palpitations or irregular heartbeats in the past.
Should he seek medical attention, and if so, which specialty should he consult? Or could this simply be a side effect of consuming too much grapefruit? Thank you for taking the time to read this inquiry.

Best regards,
Violet

violet, 40~49 year old female. Ask Date: 2016/11/03

Dr. Ye Qianyu reply Family Medicine

Hello! Both pomelos and grapefruits contain high levels of furanocoumarins, which inhibit the enzyme CYP3A4 that the body uses to metabolize certain medications.
When this enzyme is unable to function, the rate at which the body breaks down drugs slows down, leading to an extended duration of the medications in the body or causing abnormally high concentrations of the drugs in the bloodstream, similar to an overdose, which can result in side effects.
The inhibition of drug metabolism can last for several hours or even two to three days, making it difficult to completely avoid interactions even with spaced dosing.
Therefore, it is recommended to avoid consuming pomelos or grapefruits during the period of taking specific medications to prevent unnecessary drug-food interactions.
It is advised not to consume them in large amounts if you are on medication.
Regarding palpitations or arrhythmias, it is recommended to consult a cardiologist for diagnosis and treatment.
Thank you for your question!

Reply Date: 2016/11/03

More Info

It sounds like your friend is experiencing some concerning symptoms after consuming a large quantity of pomelo and grapefruit. Given the context of his medical history, including a family history of myocardial infarction and his own experiences with palpitations, it is essential to approach this situation with caution.

Firstly, pomelo and grapefruit are known to interact with various medications, particularly those metabolized by the liver. Grapefruit contains compounds that can inhibit cytochrome P450 enzymes, particularly CYP3A4, which is responsible for the metabolism of many drugs. If your friend has taken any medications that are metabolized by this pathway, the consumption of grapefruit could lead to increased levels of the drug in the bloodstream, potentially causing side effects or toxicity. This is particularly relevant if he has taken any pain medications or other prescriptions that could interact adversely with grapefruit.

The symptoms your friend is experiencing, such as feeling unsteady and leaning to one side, could be indicative of several issues. While it is possible that these symptoms are related to the consumption of grapefruit, they could also signify a more serious condition, especially considering his history of heart issues. Symptoms like these could be related to neurological issues, vestibular disorders, or cardiovascular problems. Given that he has a history of heart palpitations, it is crucial to rule out any cardiac events, such as arrhythmias or other heart-related issues.

In terms of seeking medical attention, it would be advisable for your friend to visit a healthcare provider as soon as possible. He should consider going to an emergency department or an urgent care facility, especially if he continues to feel unsteady or if his symptoms worsen. A healthcare professional can perform a thorough evaluation, which may include a physical examination, an electrocardiogram (ECG), and possibly blood tests to assess his heart function and rule out any acute issues.

If he is stable and his symptoms are mild, he could also consider visiting a primary care physician or a cardiologist for a more comprehensive evaluation. The cardiologist would be particularly well-suited to assess any potential heart-related concerns, given his family history and personal experiences with heart palpitations.

In summary, while it is possible that the symptoms could be related to the excessive consumption of grapefruit, given your friend's medical history and the nature of his symptoms, it is crucial to seek medical attention promptly. It is always better to err on the side of caution, especially when it comes to potential cardiovascular issues.

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