Massage Therapists Beware: Drug and Citrus Caution

People on certain medications may or may not be aware of the potential danger evoked when they consume grapefruit or any of its derivatives. Because their work can have a dramatic effect on clients taking certain medications, the possibility of grapefruit interfering with a drug is even more complicated for massage therapists. Thus, bodyworkers taking extra precautions for clients who could have a drug and citrus interaction are better equipped to deliver a safe and therapeutic massage.

Grapefruit’s Good Side

Grapefruit and its juice are healthful, providing enough vitamin C, potassium, dietary fiber and other nutrients to earn the American Heart Association’s “heart-check” mark. Aside from the mixture of sweet and sour favored by so many, some of the documented health benefits of grapefruit include:

Inhibition of tumor formation
Supporting the body’s excretion of toxins
Hindering Hepatitis C propagation
Improvement in cholesterol levels
Protection during cold and flu season

While this fruit’s obvious advantages explain its frequent recommendation by nutritionists, grapefruit can dangerously interact with over 50 medications.

Grapefruit’s Not So Good Side

Despite its reputation as one of nature’s perfect creations, grapefruit interferes with the absorption of certain medications. A compound in grapefruit binds to the enzyme CYP3A4 in the intestinal tract – the same enzyme that many drugs fasten to. Because this enzyme is occupied by the grapefruit, the medications that typically bind to it are blocked and pass from the digestive system to the bloodstream. This causes quantities of the drug to rise faster and higher than desired, sometimes dangerously too high.

Although the medications that interact with grapefruit juice always carry clear warnings, many consumers fail to fully read drug labels. Unfortunately, many people are unaware of their drug’s interaction with grapefruit. Since a single glass of grapefruit juice can reduce a drug’s intestinal absorption by nearly 50 percent, only a small amount is needed to dramatically boost blood levels of susceptible drugs.

An abbreviated list of commonly prescribed drugs that interact with grapefruit include:

Anxiety: Xanax, Buspar, Versed, Halcion
Depression: Luvox, Zoloft
Allergies: Allegra
Abnormal heart rhythm: Cordarone, Quinidine
Heart disease/stroke/blood clots: Coumadin
Epilepsy: Tegretol
Cancer: Cyclophosphamide, Etoposide, Ifosfamide, Tamoxifen, Vinblastine, Vincristine
Cough: Dextromethorphan
HIV: Agenerase, Crixivan, Viracept, Norvir, Fortovase
Prostate enlargement: Proscar
Heart disease/High blood pressure: Coreg, Cardizem, Plendil, Cardene, Adalat, Procardia, Nimotop, Sular, Covera, Calan, Verelan
Erectile dysfunction: Viagra, Cialis
Asthma/Emphysema: Theophylline
High cholesterol: Lipitor, Lescol, Mevacor, Zocor
Pain: Alfenta, Duragesic, Actiq, Sufenta

Adding Massage Therapy to the Mix

Similar to any medical treatment capable of dramatic health improvements, massage therapy must be practiced with care. Included in careful bodywork administration is understanding that medications influence massage. Depending on the absorption, distribution and excretion of any particular drug, enhancing circulation through massage therapy can impact the function or side effects of that medication. Making for a larger potential impact, taking a drug that interacts with grapefruit while consuming grapefruit can exaggerate the side effects impacting massage therapy. Therefore, massage therapists can make the best decisions about giving a treatment when they know:

which drugs carry a contraindication or side effect impacting massage
and which drugs interact with grapefruit.

Below are three examples of drugs that fall into both categories and their corresponding massage implications:

Xanax – An anti-anxiety medication known to interact with grapefruit, this drug can cause fatigue, dizziness, drowsiness and hypotension. Thus, clients who are taking this drug and who have also recently consumed grapefruit are at much higher risk for getting dizzy or experiencing hypotension when changing positions or getting off the massage table.
Zoloft – This antidepressant medication also interacts with grapefruit. Its side effects that may impact massage include orthostatic hypotension, sleepiness, anxiety and insomnia. Thus, clients taking this drug who have recently consumed grapefruit are more likely to need stimulating strokes (such as tapotement) for orthostatic hypotension or sleepiness, or slow and rhythmic strokes (such as rocking) for anxiety or insomnia.
Duragesic – An externally applied patch used for pain, this narcotic also interacts with grapefruit. Side effects that can impact massage include dizziness, sedation, euphoria and decreased pain sensation. When working with clients on Duragesic, therapists must be extra careful with their depth and pressure due to decreased pain sensation – especially if the drug level in the blood is elevated from grapefruit consumption.

The problem of abnormally high blood levels of a drug caused by grapefruit consumption would not exist if everyone understood the warnings associated with their medication. However, massage therapists work in the real world, where some people are too hurried to comprehensively read and understand their drug’s labels.

Bodyworkers who recognize a client’s medication as one that interacts with grapefruit should always inquire about their fondness for this citrus fruit. By informing clients on these drugs of the danger of mixing it with grapefruit, advising them to discuss it with their physician and being careful with massage by assuming a possible exaggeration of side effects, massage therapists actively contribute to the safety of their clients and to the elevation of their profession.