We know this one will be familiar to most pharmacists, but seeing it in patient-friendly terms can elevate your counselling.
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1. Counselling Conundrum: a real question from a patient
2. Concise Conclusion: a straight-forward patient-friendly answer
3. Quick Wrap-up
Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.

Counselling Conundrum: "What's the deal with grapefruit anyway? And can't I just take my meds a few hours apart from grapefruit?"
Concise Conclusion: Grapefruit stops the body from properly metabolizing certain drugs, leading to higher levels than intended in the body, which can lead to serious side effects (depending on the medication). Unfortunately, this effect can last up to 3 days, so completely avoiding grapefruit is really the only course of action.
Quick Wrap-up: Grapefruit inhibits CYP3A4 (primarily in the intestine, rather than the liver) and P-Glycoprotein (in the gut), leading to increased levels of the drug in question. We don't try to titrate the amount of grapefruit the patient is taking; it's safer to avoid all grapefruit products altogether. Since intestinal enzymes are the main concern, don't worry too much about IV drugs.
Dive Deeper
We hope you have found this useful. A reply to this email with any feedback or topic suggestion you may have would be greatly appreciated. Your input will be the key to making this newsletter the best it can be.
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