This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
For anyone finding this later: the short answer on Grapefruit is that it depends on one thing, and the rest of the thread is people identifying which thing.
Practical note on Grapefruit: write down what you expect before you look. The number of times I have found what I went looking for is higher than chance would allow.
Answering the question post #31 raises rather than the one it answers.
Anticoagulant questions come up regularly and are the clearest case for professional advice rather than discussion, because the consequence of being wrong is not gradual.
It is worth stating the boring hypothesis before the interesting one.
The useful distinction on Grapefruit is between what was measured and what was inferred from it. Both end up in the same sentence and only one of them has error bars.
Worth separating two things that post #35 runs together.
A supplement is a drug for interaction purposes, and the fact that it is sold without a prescription tells you nothing about whether it interacts. The paperwork is usually worse rather than better.
This follows post #38 rather than contradicting it.
The most defensible general position in this subcategory: identify the plausible mechanism, check whether it has been studied, and where it has not, say that rather than filling the gap.
A modest claim, modestly supported.
Delayed gastric emptying is the mechanism behind most of the plausible interactions in this class: anything whose absorption depends on how quickly the stomach empties can behave differently.
What I would check first on Grapefruit is whether the thing being measured moved or whether the way of measuring it moved. Those look identical in a graph.
This follows post #40 rather than contradicting it.
Practical experience of Grapefruit, offered as one case with the conditions stated, not as a general finding. Conditions first, because they are what make it interpretable.
Reading rather than answering, but this is the post I would point somebody at.
Two sentences on Grapefruit and then I will stop, because the rest is speculation and the thread is better without mine.
What is documented is narrow. What is inferred from it is broad. The gap between them is where every argument here lives.
An observation about Grapefruit that I cannot explain and am posting anyway, on the principle that unexplained observations are more useful public than private.
On post #46 — agreed on the reasoning, with one qualification.
SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern.
That is the version I would defend. It is not the version I started with.
A pharmacist can answer most questions in this subcategory in a few minutes with access to a proper interaction database, and that access is the thing a forum does not have.
Happy to be the one who is wrong here if it settles the question.
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