Artemether Grapefruit juice

ARTEMETHER WITH LUMEFANTRINE GRAPEFRUIT JUICE Possibly t efficacy and adverse effects t bioavailability 1 presystemic metabolism. Constituents of grapefruit juice irreversibly inhibit intestinal cytochrome CYP3A4 Monitor more closely. No ECG changes were seen in the study... 

Grapefruit juice doubles the AUC of artemether. Although the clinical relevance of this is uncertain, the manufacturers of co-art-emether advise against concurrent use. 

The clinical relevance of a twofold increase in artemether levels is unclear. The authors suggest that the use of grapefruit juice might improve clinical efficacy in malaria, and might theoretically reduce the recrudescence (the reappearance of a disease after a period of inactivity) rate of artemether monotherapy. However, artemether is used with Iumefantrine to limit recrudescence. Further study is needed. 

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