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). 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. 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. 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.
Am J Health Syst Pharm. 2011;68(14):1302-1305. © 2011 American Society of Health-System Pharmacists, Inc.
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Cite this: Antioxidant and Antiatherogenic Effects of Pomegranate - Medscape - Jul 15, 2011.