Fruit juices inhibit organic anion transporting polypeptide-mediated drug uptake to decrease the oral availability of fexofenadine

Clin Pharmacol Ther. 2002 Jan;71(1):11-20. doi: 10.1067/mcp.2002.121152.


Objectives: Our objective was to examine the effect of different fruits and their constituents on P-glycoprotein and organic anion transporting polypeptide (OATP) activities in vitro and on drug disposition in humans.

Methods: P-glycoprotein-mediated digoxin or vinblastine efflux was determined in polarized epithelial cell monolayers. OATP-mediated fexofenadine uptake was measured in a transfected cell line. The oral pharmacokinetics of 120 mg fexofenadine was assessed with water, 25%-strength grapefruit juice, or normal-strength grapefruit, orange, or apple juices (1.2 L over 3 hours) in a randomized 5-way crossover study in 10 healthy subjects.

Results: Grapefruit juice and segments and apple juice at 5% of normal strength did not alter P-glycoprotein activity. Grapefruit extract reduced transport. 6',7'-Dihydroxybergamottin had modest inhibitory activity (50% inhibitory concentration [IC(50)], 33 micromol/L). In contrast, grapefruit, orange, and apple juices at 5% of normal strength markedly reduced human OATP and rat oatp activity. 6',7'-Dihydroxybergamottin potently inhibited rat oatp3 and oatp1 (IC(50), 0.28 micromol/L). Other furanocoumarins and bioflavonoids also reduced rat oatp3 activity. Grapefruit, orange, and apple juices decreased the fexofenadine area under the plasma concentration-time curve (AUC), the peak plasma drug concentration (C(max)), and the urinary excretion values to 30% to 40% of those with water, with no change in the time to reach C(max), elimination half-life, renal clearance, or urine volume in humans. Change in fexofenadine AUC with juice was variable among individuals and inversely dependent on value with water.

Conclusions: Fruit juices and constituents are more potent inhibitors of OATPs than P-glycoprotein activities, which can reduce oral drug bioavailability. Results support a new model of intestinal drug absorption and mechanism of food-drug interaction.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • ATP Binding Cassette Transporter, Subfamily B / metabolism
  • Administration, Oral
  • Adult
  • Area Under Curve
  • Beverages / adverse effects*
  • Biological Availability
  • Carrier Proteins / metabolism
  • Citrus
  • Double-Blind Method
  • Female
  • Flavonoids / metabolism
  • Food-Drug Interactions / physiology*
  • Fruit*
  • HeLa Cells
  • Histamine H1 Antagonists / pharmacokinetics*
  • Humans
  • Intestinal Absorption
  • Male
  • Malus
  • Membrane Transport Proteins*
  • Organic Anion Transporters / antagonists & inhibitors*
  • Organic Anion Transporters / metabolism*
  • Organic Anion Transporters, Sodium-Dependent
  • Symporters
  • Terfenadine / analogs & derivatives*
  • Terfenadine / pharmacokinetics*


  • ATP Binding Cassette Transporter, Subfamily B
  • Carrier Proteins
  • Flavonoids
  • Histamine H1 Antagonists
  • Membrane Transport Proteins
  • Organic Anion Transporters
  • Organic Anion Transporters, Sodium-Dependent
  • Symporters
  • sodium-bile acid cotransporter
  • Terfenadine
  • fexofenadine