（来源：南京晨报） 转自：南京晨报 近日，南京市妇幼保健院妇科内分泌科副主任医师孙艳丽在门诊接诊了一位特殊患者。该患者口服黄体 酮胶囊第一盒时无任何不适，服用第二盒期间却突然出现头晕、昏倒症状。经详细问诊，医生发现关键 诱因——患者服药期间食用了柚子。西柚，这一常见水果，为何会与妇科内分泌药物产生如此强烈的反 应？ 孙艳丽介绍，西柚中含有呋喃香豆素类化合物，这类物质会抑制人体内的药物代谢酶CYP3A4的活性。 血液中需要该酶代谢的药物浓度便会异常升高，相当于间接"加量"服药，进而引发一系列不良反应。 在妇科内分泌领域，以下几类常用药物，需与西柚保持明确的"安全距离"： 1.孕激素类药物 如黄体酮、地屈孕酮等，常用于调节月经周期、保胎治疗。与西柚同服时，血药浓度升高易引发头晕、 嗜睡、恶心，严重时可能出现昏厥、心悸，就像上述案例中的患者一样。 2.雌激素类药物 包括雌二醇、戊酸雌二醇等，多用于激素替代治疗、改善围绝经期症状。西柚会增强此类药物的药效， 可能导致体内雌激素水平过高，增加乳房胀痛、不规则阴道出血等风险。 3.短效口服避孕药 西柚与部分短效口服避孕药同服，可干扰药物代谢，加重恶心、头晕、头痛、乳房胀等 ...

Core Viewpoint - The article emphasizes the health risks associated with consuming grapefruit, particularly in relation to certain medications, highlighting the need for caution when combining grapefruit with specific drugs due to potential adverse effects on drug metabolism [4][3]. Group 1: Health Risks of Grapefruit - Grapefruit, especially varieties like grapefruit juice, contains furanocoumarins that inhibit the CYP3A4 enzyme in the liver, which is crucial for metabolizing many medications [4][6]. - The most significant interactions are noted with grapefruit, rather than other types of pomelo or citrus fruits [4][3]. Group 2: Medications to Avoid with Grapefruit - Certain antihypertensive medications (e.g., nifedipine, felodipine, amlodipine) can lead to dangerously low blood pressure when taken with grapefruit [8]. - Statins (e.g., atorvastatin, simvastatin, lovastatin) may increase the risk of muscle pain and liver damage when combined with grapefruit, necessitating discussions with healthcare providers about safer alternatives [9]. - Some antihistamines (e.g., terfenadine, astemizole) can cause increased drowsiness and heart rhythm issues when taken with grapefruit [10]. - Immunosuppressants (e.g., cyclosporine, tacrolimus) can have dangerously fluctuating concentrations in the body when combined with grapefruit, leading to severe health consequences [11]. - Sedatives and anesthetics (e.g., midazolam, diazepam) may have prolonged effects and increased risks of respiratory depression when taken with grapefruit [12]. Group 3: Practical Advice for Consumers - Consumers should carefully read medication labels for warnings about grapefruit interactions and identify if their medications fall into high-risk categories [13]. - If uncertain about the type of grapefruit or its effects on medications, consulting a healthcare professional is advised [13]. - Safer fruit alternatives, such as oranges, tangerines, and apples, are recommended for those on high-risk medications [13].