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Most of the safety concerns regarding citrus aurantium relate to its stimulant constituents.
The drug synephrine is known to produce many unpleasant and possibly dangerous side effects, including headache, agitation, rapid heart rate, and heart palpitations. In some people, it can cause angina pectoris , kidney damage, increased pressure in the eye, and reduced blood circulation to the heart and the extremities. The other stimulant amines in Citrus aurantiummay increase such effects. There is one case report of a heart attack that appears possibly related to use of a citrus aurantium supplement, 1 and another that links the herb to stroke. 2 Citrus aurantiumjuice or concentrated extracts can raise blood pressure and increase heart rate 3 and therefore should not be used by individuals with cardiovascular disease or high blood pressure . The herb should also be avoided by people with glaucoma .
Synephrine can also interact with numerous medications and other drugs, including stimulants (e.g., ephedrine , pseudoephedrine (Sudafed), Ritalin, and even caffeine) and anesthetics. The tyramine constituent of Citrus aurantiumcan cause deadly side effects when combined with drugs in the MAO inhibitor family.
The peel and essential oil of Citrus aurantiummay cause photosensitivity (increased tendency to react to sun exposure). For this reason, combination treatment with drugs that cause the same side effect (such as sulfa antibiotics ) is not recommended.
Finally, Citrus aurantiumjuice can alter the way that the liver processes various medications, potentially raising or lowering their levels. 4 5 6 In particular, the drugs cyclosporine and felodipine (a calcium channel blocker ) are thought to be affected by Citrus aurantiumjuice, but numerous other drugs may interact with it as well. For this reason, we recommend that if you are taking any medication that is critical to your health, you should not take Citrus aurantiumjuice.
Safety in young children, pregnant or nursing women, or people with severe liver or kidney disease has not been established.
Interactions You Should Know About
If you are taking
- Drugs in the MAO inhibitor family: Do not use Citrus aurantiumat all.
- Ephedrine, pseudoephedrine (Sudafed), Ritalin, cyclosporine , calcium channel blockers, drugs that cause photosensitivity (such as sulfa antibiotics ), or any medication that is critical to your health: Do not use Citrus aurantiumwithout consulting a physician.
- Nykamp DL, Fackih MN, Compton AL. Possible association of acute lateral-wall myocardial infarction and bitter orange supplement. Ann Pharmacother. 38(5):812-6.
- Bouchard NC, Howland MA, Greller HA, Hoffman RS, Nelson LS. Ischemic stroke associated with use of an ephedra-free dietary supplement containing synephrine. Mayo Clin Proc. 80(4):541-5.
- Bui LT, Nguyen DT, Ambrose PJ. Blood pressure and heart rate effects following a single dose of bitter orange. Ann Pharmacother. 40(1):53-7.
- Edwards DJ, Fitzsimmons ME, Schuetz EG, Yasuda K, Ducharme MP, Warbasse LH, Woster PM, Schuetz JD, Watkins P. 6',7'-Dihydroxybergamottin in grapefruit juice and Seville orange juice: effects on cyclosporine disposition, enterocyte CYP3A4, and P-glycoprotein. Clin Pharmacol Ther. 65(3):237-44.
- Malhotra S, Bailey DG, Paine MF, Watkins PB. Seville orange juice-felodipine interaction: comparison with dilute grapefruit juice and involvement of furocoumarins. Clin Pharmacol Ther. 69(1):14-23.
- Hou YC, Hsiu SL, Tsao CW, Wang YH, Chao PD. Acute intoxication of cyclosporin caused by coadministration of decoctions of the fruits of Citrus aurantium and the Pericarps of Citrus grandis. Planta Med. 2000;66:653–5.