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doi: 10.1016/j.phrs.2021.105782 80 CantiniGMannucciELuconiM

Data Availability Will individual participant data be available (including data dictionaries)

Combination formulations: Compounded preparations may include vitamin B12 (cyanocobalamin or methylcobalamin) to support energy levels during caloric restriction

In addition, a case report showed cyclosporine concentration to be increased to 600% with grapefruit.44 Taking tacrolimus after ingesting grapefruit juice (250 mL, 4 times/d for 3 d) resulted in a 1000% higher trough blood concentration, causing profound inhibition of calcineurin phosphatase in a recipient of a liver transplant.45 Moreover, taking tacrolimus after consuming a large amount of grapefruit marmalade during the previous week caused a 500% greater blood concentration of the drug and acute renal dysfunction.24 Breast cancer Based on increased oral bioavailability of estrogens (ethinylestradiol and 17--estradiol) with grapefruit juice, 2 large epidemiologic studies assessed the risk of breast cancer.46 , 47 The initial investigation found higher risk (relative risk 1.30, 95% confidence interval 1.061.58) in women postmenopause who were taking estrogens and consuming one-quarter grapefruit or more per day compared with women not eating grapefruit.48 However, a follow-up study involving the same population found no such association.49 Thus, there is controversy over the risk of breast cancer in women postmenopause receiving estrogen therapy and consuming grapefruit