Day and Night Pharmacy – Forbidden fruit

I keep getting reminded to write about medicines. Recently a patient asked me if he could take his high blood pressure medicine- amlodipine- two hours apart his daily drink of grape fruit juice as a way of complying with the cautionary label which read, ‘Avoid eating grapefruit and/or drinking grapefruit juice). The answer is no. The interaction between grapefruit juice and drugs is not a direct physical of chemical disagreement in the gut… No.

day and night forbiddenfruitLet’s start from the beginning- when Adam and Eve ate the forbidden fruit and created Abel- the chief organ responsible for the degradation of drugs and toxins was and is still the liver. It uses internal biological machinery (enzymes) to hasten the breakdown of medicines before elimination out of the body. Grapefruit juice contains chemicals which slow down this machinery. It therefore follows that a drug which would otherwise have a 24-hour effect ends up circulating in the blood stream for much longer because the rate of its breakdown is being inhibited. So when the next dose is taken each day there is accumulation of the drug such that one can end up with a two to seven fold drug blood level as has been witnessed with some statins like simvastatin (used to lower cholesterol). Basically one can end up exhibiting signs of over-dose or toxicity that requires admission to hospital. There are many other drugs that are similarly affected by this juice, always read the cautionary label on the pack. An occasional single grapefruit itself may not contain enough juice to cause an adverse drug effect but it is best avoided. Grapefruit juice is the forbidden fruit. It’s not a very nice drink in any case, not to me.

A gentleman was recently prescribed ‘another drug for water-works problems’ (finasteride) by a specialist and wondered whether he was to stop the one (tamsulosin) that he was already taking. This is a common phenomenon which I’ve handled in the pharmacy over the years. It’s either the prescribers do not always explain themselves well or that the patients find it hard to grasp information from doctors. I love these sorts of questions. I know I sometimes get carried away and start delivering a lecture to patients but, time permitting, I’d rather deliver more than less… it increases the chance of the critical message being retained. OK, the prostate surrounds the pipe (urethra) that delivers urine from the bladder; visualise a tomato impaled onto flexible plastic tubing like one for biro ink. With advancing age and via the influence of male hormones the prostate (tomato) overgrows and squeezes the tube giving rise to erratic urinary outflow. Finasteride reduces the effect of male hormones on the prostate reducing further growth. The tamsulosin relaxes the muscles of the prostate reducing the squeeze. That’s it. The two drugs are complimentary; they both have to be taken. In complicated cases specialists may prescribe a further drug to reduce the contractility of an unstable bladder. Medicines are the wages of a long life.

Shall you join me in belatedly congratulating the UK-knighted Comrade Robert Gabriel Mugabe, Sir Bob, on turning 91 this past February? There certainly is a common trait that lends an African politician to greed, a propensity to overstay one’s invitation and a tendency to have it all for oneself and cronies whether there be mega or meagre amounts available. It’s a trait probably derived from nurture under poverty rather than the natural behavioural instinct of a people. This is aptly illustrated by the Friday chicken dinner scene at Day and Night pharmacy. Us, the members of the team who are born and bred Africans eat the skin and the flesh off the bone then proceed to chew off the cartilage and the soft end of the bones before sucking the contents of the core of the bone: A complete massacre of chicken not too dissimilar to the decimation of an economy in Sothern Africa.

We will be recruiting post GCSE or post A Level students who may wish to further their education by way of vocational training ie Apprenticeship in NVQ Level 2 Pharmacy Dispenser course.

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