Influence of grapefruit juice on the pharmacokinetics of a slow release nifedipine formulation

The objective of this study was to investigate in a twoway randomized crossover whether repeated uptake of grapefruit juice (200 ml at 0, 2, 4, 8 and 12 h enhances bioavailability of a nifedipine (1) slow release formulation (20 mg) in ten healthy volunteers. Grapefruit juice increased the AUC and cmax of 1 statistically significantly by 103 (SD 73, range 48 to 265)% and 94 (SD 83, range -23 to 259)%, respectively. AUC of dehydronifedipine (2) was also higher during grapefruit phase, but to a lesser extent (mean increase 66, SD 106, range -30 to 236)%. Half lives of neither 1 nor 2 were altered by grapefruit juice. Because 2/1-ratio was not lowered by grapefruit juice in comparison to control, a selective inhibition of cytochrome P450 3A based on the presented in vivo data is not very likely. In the light of other reports concerning grapefruit juice induced increase in bioavailability our data contradict the assumption of a selective inhibition of only one cytochrome P450 subfamily. The observed effect could be clinically significant, especially if other factors affecting the elimination of 1 occur.