Antioxidant and Antiatherogenic Effects of Pomegranate

Stacy L. Haber, Pharm.D; Jamie K. Joy, Pharm.D; Roxanne Largent, Pharm.D

Disclosures

Am J Health Syst Pharm. 2011;68(14):1302-1305. 

In This Article

Interactions

Based on animal and in vitro studies, pomegranate may inhibit cytochrome P-450 (CYP) isoenzymes 3A4 and 2C9.[1,20] However, in a drug-interaction study involving healthy human volunteers, pomegranate juice did not alter the clearance of oral or intravenous midazolam (a probe for CYP3A4 activity).[21] Pomegranate may increase the risk for rhabdomyolysis during statin therapy, as a result of intestinal CYP3A4 inhibition and increased absorption of active drugs, as commonly reported for grapefruit juice. One case report described a 48-year-old man who developed rhabdomyolysis three weeks after he began drinking pomegranate juice while taking ezetimibe and rosuvastatin for familial hypercholesterolemia.[22] Pomegranate may also interact with war-farin, based on its potential to inhibit CYP2C9, the isoenzyme responsible for metabolizing the more potent S-isomer of warfarin, as commonly reported for cranberry juice. In a recent case report, a 64-year-old woman had lower-than-target International Normalized Ratio values after she stopped drinking pomegranate juice while also taking warfarin for several months.[20] Pomegranate has been shown to reduce ACE activity, so it may lower blood pressure and enhance the effects of ACE inhibitors or other antihypertensive agents.[1]

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