Grapefrugtjuice og lakrids øger kortisol tilgængelighed hos patienter med Addison's sygdom.

KONKLUSION: lakrids og især grapefrugtjuice forøger cortisol-tilgængelighed i alle kroppens væv, i timer efter indtagelse. Både patienter og læger bør være opmærksomme på disse interaktioner (også meget relevant for folk med binyre-problemer - lav cortisol - uanset om de er i behandling med hydrocortison eller ikke/red.).

Grapefruit juice and licorice increase cortisol availability in patients with Addison's disease.
2011: Paal Methlie; Eystein E S Husebye; Steinar Hustad; Ernst A Lien; Kristian Løvås
Institute of Medicine, University of Bergen, 5021 Bergen, Norway. paal.methlie(at)med.uib.no
European Journal of Endocrinology / European Federation of Endocrine Societies 2011;165(5):761-9.

Abstract:
OBJECTIVE: Failure to mirror the diurnal cortisol profile could contribute to the impaired subjective health status in Addison's disease (AD). Some patients report benefit from the use of various nutritional compounds. The objective of this study was to investigate the impact of licorice and grapefruit juice (GFJ) on the absorption and metabolism of cortisone acetate (CA).

DESIGN: Patients (n=17) with AD on stable CA replacement therapy were recruited from the outpatient clinic at Haukeland University Hospital, Norway. They were assessed on their ordinary CA medication and following two 3-day periods of co-administration of licorice or Grapefruit juice.

METHODS: Time series of glucocorticoids (GCs) in serum and saliva were obtained, and GCs in 24 h urine samples were determined. The main outcome measure was the area under the curve (AUC) for serum cortisol in the first 2.6 h after orally administered CA.

RESULTS: Compared with the ordinary treatment, the median AUC for serum cortisol increased with licorice (53 783 vs 50 882, P<0.05) and Grapefruit juice (60 661 vs 50 882, P<0.05). Median cortisol levels in serum were also elevated 2.6 h after tablet ingestion (licorice 223 vs 186 nmol/l, P<0.05; Grapefruit juice 337 vs 186 nmol/l, P<0.01). Licorice increased the median urinary cortisol/cortisone ratio (0.43 vs 0.21, P<0.00001), whereas Grapefruit juice increased the (allo-tetrahydrocortisol+tetrahydrocortisol)/tetrahydrocortisone ratio (0.55 vs 0.43, P<0.05).

CONCLUSION: Licorice and in particular Grapefruit juice increased cortisol available to tissues in the hours following oral CA administration. Both patients and physicians should be aware of these interactions.