Grapefruit juice appears to completely inhibit the metabolism of amiodarone to its major active metabolite, increases the AUC of amiodarone by 50% and increases the peak serum level by 84%, which may lead to toxicity. However, the effect of amiodarone on the PR and QTc intervals is apparently decreased, possibly due to reduced levels of the active metabolite.
Further study is needed. In the meantime, it may be prudent to suggest to patients that they avoid grapefruit juice.
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