If you kick-start your day with a glass of grapefruit juice, be careful.

Canadian scientists say the number of common prescription drugs that can interact badly with the tart citrus is climbing, with the potential for dangerous, even deadly, results.

Twenty-six new drugs that can cause serious harm when mixed with grapefruit have been introduced in the past four years alone, bringing the total to 43, said Dr. David Bailey, a clinical pharmacologist at the Lawson Health Institute Research Center in London, Ontario. That’s an average of more than six new drugs a year.

“What I’ve seen has been disturbing,” said Bailey, lead author on a study published in the Canadian Medical Association Journal. “It’s hard to avoid putting a drug out on the market that is not affected by grapefruit juice.”

Joerg Beuge / featurepics.com

The number of drugs that interact with grapefruit is climbing, with potentially serious results, scientists say.

More than 85 drugs that interact with whole grapefruit, grapefruit concentrate or fresh grapefruit juice have been identified, though not all have serious consequences. Those that do, however, can cause problems that include acute kidney failure, respiratory failure, gastric bleeding -- and worse.

“When I say sudden death, I’m not being sensational,” said Bailey, who said 13 drugs may be lethal when mixed with grapefruit.

The heart drug dronedarone, or Multaq, for instance, has a very high risk of interaction when taken with grapefruit, which may cause a rare form of ventricular tachycardia or rapid heart rhythm, the researchers found.

Mixing the prescription painkiller oxycodone with grapefruit can cause serious breathing problems, and adding the fruit to a dose of the popular statin simvastatin, or Zocor, can lead to rhabdomyolysis, a breakdown of muscle fibers that can lead to kidney damage.

To see a complete list of drugs that interact with grapefruit, click here.

The trouble with grapefruit has been known for two decades, ever since Bailey and his colleagues first discovered that ingestion of the fruit with certain prescription drugs can concentrate the medication in a patient’s bloodstream.

Drinking less than a cup of grapefruit juice once a day for three days, for instance, can lead to a 330 percent concentration of simvastatin, the researchers reported.

“I’ve seen a 10-fold increase in some patients,” Bailey said.

And it doesn’t matter whether the grapefruit is consumed hours before the pills, the researchers found.

The problem is caused by an active ingredient in some citrus fruits, including grapefruit, limes and pomelos. Even the Seville oranges used in marmalades can trigger it. The fruits produce organic chemical compounds called furanocoumarins, which interfere with a human digestive enzyme.

That enzyme, called CYP3A4, helps metabolize toxic substances to keep them from getting into the bloodstream. Typically, that means the enzyme inactivates the effects of about 50 percent of all medications. Doctors adjust for that when prescribing drugs.

However, when the furanocoumarins in citrus inhibit that enzyme, the drugs can become concentrated in a patient’s system. In some cases, it can be like getting a triple or quadruple dose of medication, Bailey said.

Drugs known to interact with grapefruit do carry warnings, but Bailey said he believes that neither doctors nor patients may take the threat seriously enough.

“Basically, most people are sort of aware of grapefruit juice drug interactions, but I don’t think it’s in the forefront of their mind on a regular basis,” he said.

It’s not clear how many people actually are harmed by grapefruit interactions, mostly because the side effects are often not recognized as being related to the citrus, said Bailey, who included eight case reports in his study.

“For every case report, there are at least 100 that have never been reported,” he said.

Part of the concern lies in the fact that people older than 45 are most likely to consume grapefruit juice -- and to take prescription drugs. Seniors older than 70 have the most trouble tolerating excessively high levels of drugs, Bailey noted.

“These are the individuals with the greatest chance of exposure," he said.

Patients worried about the interaction of grapefruit with their medications should talk with their doctors, Bailey said. And doctors should make sure to ask about grapefruit consumption when prescribing drugs.

Some grapefruit lovers may have cut back already because of the risk of drug interaction. Consumption of grapefruit juice has dropped in the past decade, falling from .44 gallons of juice per person per year in 2000 to .15 gallons per person in 2011, according to figures from the Florida Department of Citrus.

Officials there say that although some drugs do interact with grapefruit, most do not. In most cases, doctors can prescribe drugs in the same class that don’t interact, noted Karen Mathis, a department spokeswoman.

“These medications often can provide the same therapeutic effect with no need to avoid grapefruit juice,” she said in a statement.

And not all citrus poses a problem, Bailey noted. Sweet oranges, such as navel and Valencia varieties, don’t contain the damaging compound.

“You have an alternative there,” he suggested. “If you want to take your medications with orange juice, you’re home free.”

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Fungal meningitis and other infections linked to contaminated injection drugs continued to rise Monday, with 354 cases in 19 states, with Rhode Island reporting its first case. Deaths held steady at 25, the Centers for Disease Control and Prevention reported.

Cases of fungal meningitis, stroke presumed to be caused by the infection or other central-nervous system infections climbed to 347. Another seven infections have been reported in people who received mold-tainted injections in joins such as the hip, knee, elbow or shoulder.

The contaminated drugs were produced by the New England Compounding Center of Framingham, Mass., which has recalled all of its products and been stripped of its pharmacy license.

Food and Drug Administration officials released new documents last week showing that company officials documented mold and bacteria at several sites in the company’s clean rooms dating from January through September.  Massachusetts health officials also documented contamination and problems with the steam sterilization equipment known as an autoclave. In addition, NECC was dispensing vast quantities of sterile drugs without having the individual patient prescriptions required for compounding pharmacies.

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CDC

Health officials have found the black mold Exserohilium in unopened vials of injection drugs made by a Massachusetts pharmacy and implicated in an outbreak of fungal meningitis that has killed more than 20 people.

The toll of a growing outbreak of fungal meningitis continued to rise Friday, with 21 deaths and 271 confirmed infections in 16 states linked to contaminated steroid shots from a Massachusetts pharmacy.

There have been 268 cases of fungal meningitis, stroke believed to be caused by fungal meningitis or central nervous system infections tied to the tainted drugs. Three other patients who received shots in their joints, such as hips, knees, shoulders or elbows, have developed infections as well, according to latest figures from the Centers for Disease Control and Prevention.

Nearly 14,000 patients may have received the fungus-contaminated shots distributed by the New England Compounding Pharmacy in Framingham, Mass., since May. All products from the pharmacy have been recalled. 

On Thursday, federal health officials confirmed that they found the fungus Exserohilum rostratum in unopened medication vials of one of three lots of methylprednisolone, a steroid, implicated in the infections and deaths. That discovery confirmed the link between the type of fungus in the drugs and that found in most of the patients who became sick after the shots.

Officials have also confirmed the mold Aspergillus in one infected patient. Another was found to be infected with the fungus Cladosporium. All of the fungi are present in the environment, but rarely cause meningitis.

A second pharmacy connected to the NECC is also being investigated. Ameridose LLC said on Friday that it has agreed to extend a temporary shutdown while state and federal regulators continue an investigation into the company. Ameridose, based in Westborough, Mass., shares some common ownership with NECC. Investigators launched an investigation on Oct. 10.

Most patients got the shots to help relieve back pain. The time it takes for an infection to show up in people who got the tainted shots may be up to four weeks, officials said. 

Patients should be watching for symptoms including fever, headache, stiff neck, nausea and vomiting, sensitivity to light and altered mental status, the Food and Drug Administration said. Symptoms for other infections might include fever, swelling at the injection site, increasing pain, redness, visual changes, discharge from the eye, chest pain or drainage from a surgical site. Anyone who develops these symptoms should seek medical attention. 

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By Steve Karnowski
AP

Officials have told school lunch programs across the country to check to see whether they have any Smucker's Uncrustables sandwiches that might contain peanut butter made by a New Mexico company that is being recalled because of potential salmonella contamination.

The J.M. Smucker Co. used peanut butter that was produced by Sunland Inc. and supplied by the U.S. Department of Agriculture in "limited production runs" of 72-count bulk packs of the sandwiches that went to schools under the National School Lunch Program, Smucker's spokeswoman Maribeth Badertscher said in an email Thursday.

Related post: Peanut plant closed after feds find more salmonella

Uncrustables are pre-made peanut butter and jelly, pocket-like, circular sandwiches.

The Orrville, Ohio-based company tests all the incoming USDA-supplied peanut butter it gets, and tests finished products before distributing them, and found no problems, she said.

But out of "an abundance of caution," and working with federal agencies, she said, Smucker's recently notified school customers that they should check to see if they still have any of the crustless frozen peanut butter and jelly sandwiches from the recalled lots, which all have either expired or will expire soon. They should not be served to students, the company said.

No other Smucker's products contain peanut butter from Sunland or other outside suppliers, Badertscher said. She said she did not immediately know how many sandwiches were involved.

Related post: Peanut butter plant tests positive for salmonella; recall widens

Sunland shut down its plant in Portales, N.M., last month and recalled more than 200 products made under a variety of brand names after salmonella was found in Trader Joe's Creamy Salted Valencia Peanut Butter. Thirty-five illnesses in 19 states have been linked to Sunland, but no illnesses have been linked to the Uncrustable sandwiches.

"When USDA learned of the FDA recall of certain products manufactured by Sunland, Inc., we coordinated with state agencies to immediately notify individual school districts and ensure that recalled products were identified and destroyed," USDA spokeswoman Alyn Kiel said in an email.

By MyHealthNewsDaily Staff

More young and middle-aged adults are having strokes, a new study suggests.

In 1994, 12.9 percent of strokes occurred in adults between ages 20 and 55, whereas in 2005, 18.6 percent of strokes occurred in this age group, according to the study of stroke rates in a four-county region of Ohio and Kentucky.

Additionally, the data showed that the average age of people who experienced a stroke fell from 71 in 1994 to 69 in 2005.

"The reasons for this trend could be a rise in risk factors such as diabetes, obesity and high cholesterol," said study author Dr. Brett Kissela, of the University of Cincinnati College of Medicine in Ohio. However, factors such as improved diagnosis may also have contributed to the increase, he said.

"Regardless, the rising trend found in our study is of great concern for public health, because strokes in younger people translate to greater lifetime disability," Kissela said.

In the study, researchers looked at data on all stroke patients between ages 20 and 54 seen at hospitals, clinics and nursing homes during three separate, yearlong periods: July 1993 through June 1994, and the calendar years of 1999 and 2005. Only a patient's first stroke was included in the analysis.

The stroke rate among people over age 75 decreased between 1994 and 2005, according to the study, and other studies have shown a general decrease in stroke rates over recent decades. For example, the Framingham Heart Study reported a decline in stroke rates between 1950 and 2004.

"Any decline in stroke incidence is positive from a public health prospective, but reduced incidence in older ages is counterbalanced by the worrisome trend of younger strokes," Kissela and colleagues wrote in their study. Strokes at younger ages can mean a greater loss of productive life years, and greater health care expenses over time.

The new findings show that the trend toward younger stroke patients was seen in both African-Americans and Caucasians. The yearly stroke rate among African-Americans increased between 1994 and 2005 from 83 strokes to 128 strokes per 100,000 people, according to the study. Among Caucasians, the yearly stroke rate increased from 26 strokes to 48 strokes per 100,000 people over the same period.

Most of these increases were seen in a type of stroke called an ischemic stroke, which occurs when an artery bringing blood to the brain is blocked. (Another type — called a hemorrhagic stroke, which occurs when a blood vessel leaks or bursts — was less common.)

While the reasons for the increased stroke rate among younger people are not entirely clear, the researchers pointed to the findings of a separate survey of people in the region, which showed an increasing percentage had high cholesterol. Data from national surveys also show that rates of diabetes, high cholesterol, and obesity increased over the study period, they said.

"The good news is that some of the possible contributing factors to these strokes can be modified with lifestyle changes, such as diet and exercise," Kissela said.

One question raised by the study is whether the increase is partly due to better diagnoses of stroke, according to two researchers who wrote an editorial accompanying the new study in the journal. 

"The progressive adoption of MRI as a diagnostic tool during the study period challenges the validity," of comparing the stroke rates between the early 1990s and 2005, wrote Drs. Sally Sultan and Mitchell S. V. Elkind, both neurologists at Columbia University Medical Center in New York City.

While the researchers tried to account for the increased use of MRI in their study, it likely still had an effect, Sultan and Elkind said.

However, if strokes are affecting more young people, there are public health implications, they said. "If strokes occur at earlier ages, as life expectancy increases, stroke-related disability will increase even more," they wrote.

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A new look at child abuse reports suggests there may have been a small but worrying rise in injuries to babies over the past decade or so. While most research suggests child abuse is down overall, the report published on Monday in the journal Pediatrics shows infants are far from safe.

The study contradicts government data collected over the same time, and it shows that health officials need to take a better look at whether child abuse is getting better, worse or staying the same, experts said.

“I think it’s premature to make any conclusions about whether it is going up or down,” says Dr. James Anderst, chief of the section on child abuse and neglect at Children's Mercy Hospitals and Clinics in Kansas City, Mo., who was not involved in the study. “Medical providers may be getting better at identifying abuse over time.”

Either way, it’s still happening and that’s a concern, says Dr. John Leventhal of Yale University, who led the study. “Maybe parents are doing better and hurting their children less in general, but there is a small group where there continue to be substantial injuries that end in hospitalization,” Leventhal said.

Leventhal and colleague Julie Gaither looked at statistics on children admitted to hospitals for serious injuries. Writing in the journal Pediatrics, they said they found a nearly 11 percent increase over 12 years in serious injuries to babies a year old and younger.

This is at the same time that two major national surveys of child abuse found decreases of between 55 percent and 23 percent in child abuse injuries overall, for all ages, between 1997 and 2009. It's important to point out that each study goes to different sources for data -- this week's study looks at hospital admissions, while the government studies examined reports of abuse filed to Child Protective Services and other agencies by doctors and other sources.

Child abuse is a serious problem in the United States. The Centers for Disease Control and Prevention says more than 740,000 children and youth are treated in hospital emergency departments for injuries resulting from violence every year.

“Child abuse, neglect or violence can actually affect the development of a child’s brain – impacting the child now and for years to come. Our Adverse Childhood Experiences (ACE) studyshows a connection between child maltreatment and some of the nation’s worst health problems, including depression and heart disease,” CDC child abuse expert Linda Degutis says in a blog on the agency’s website. 

CDC declined comment on Monday’s study in Pediatrics.

“I would say that the experts in this area are still trying to make sense of the various trends in physical abuse and explain why there are divergences,” said David Finkelhor of the University of New Hampshire, who led one of the studies showing a decrease in child abuse injuries between 1997 and 2009. “This new report is helpful but does not resolve any of the outstanding questions.”

Leventhal said it’s important to get better data, but says it’s difficult. “It is probably harder to substantiate a physical abuse case now than it was 15-20 years ago,” he says -- mostly because agencies have tightened the rules for classifying cases as child abuse. “My colleagues in child protective services say it is much harder.” Many, he says, classify abuse cases as neglect instead. But it would be important to get data to back this up.

Anderst and Leventhal both said education is an important way to help prevent child abuse. “Over 50 percent of the kids on my study were infants. Thirty to 40 percent of those infants had abusive head trauma, often known as shaken baby syndrome,” Leventhal said. That suggests parents are caretakers who are frustrated and don’t know how to cope with a wailing baby, he said.

“I think, regardless of the cause, the message is too many children, particularly very young children are  getting hurt,” he said. “And pediatricians and others who look after children need to craft clear messages so that children are not hurt by abuse.

Yale’s hospital has an approach called “Take Five.” “If you feel like you are going to lose it, put the baby in a safe place, namely a crib, step back and take five,” Leventhal says. Some states are also giving new parents information about not shaking their babies – even seemingly gentle shakes can cause traumatic brain injury. “There are now systematic efforts funded in part by the CDC to see whether education about crying infants, about stepping away, about not shaking a baby, change the likelihood that children end up in the hospital with those injuries,” Leventhal added.

Sometimes people were themselves beaten as children, and pass this behavior along, Anderst said. “Some people are just ill-prepared to be parents and don’t know how to handle children. Some people come from violent backgrounds and that is how they handle their problems.”

So how to change this behavior? “It’s the same way we get people to quit smoking. It is the same way we get people to wear seat belts. It is a combination of laws and enforcement of those laws and also supporting people so they can be better parents,” Anderst said.

He said government officials should think about those consequences when they cut programs to save money in state budgets.

Sometimes it's not the parents who are doing the harm but someone outside the family.

Dr. Suzanne Starling, a pediatrician at Eastern Virginia Medical School, has made intensive studies of who’s hurting kids, and found a consistent pattern: men are far more likely to hit, shake or batter young children. One study she published in the Southern Medical Journal found fathers committed 45 percent of attacks, and boyfriends of the mothers another 25 percent.

“Parents need to believe that the people close to them might have the potential to lose it with a frustrating circumstance such as a crying baby,” Leventhal advised. “They need to say each of the people who looks after their child, ‘my baby cries sometimes and it gets frustrating. If you feel that way, call me. I will come home from work. But don’t hurt my baby’.”

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Whooping cough is causing the worst epidemic seen in the United States in more than 50 years, health officials said Thursday, and they’re calling for mass vaccination of adults.

The epidemic has killed nine babies so far and babies are by far the most vulnerable to the disease, also known as pertussis, the U.S. Centers for Disease Control and Prevention says. The best way to protect them is to vaccinate the adults around them, and to vaccinate pregnant women so their babies are born with some immunity.

“As of today, nationwide nearly 18,000 cases have been reported to the CDC,” the CDC’s Dr. Anne Schuchat told reporters in a conference call. “That is nearly twice as many as reported last year. We may be on track for a record high pertussis rate this year,” she added.

“We may need to go back to 1959 to find as many cases. I think there may be more coming to a place near you.”

The last record year was 2010, when 27,000 cases were reported and 27 people died. In 1959, 40,000 cases were reported.

In 2008, whooping cough killed 195,000 people globally, according to the World Health Organization.

Whooping cough is caused by a bacterial infection. It gets its name from the nagging cough it causes that can make children breathless. They often gasp for air, making a distinctive whooping sound. But it’s not so serious in adults and they may not realize that a persistent cough is being caused by pertussis.

Related: Obesity may increase adults' whooping cough risk

Washington state is having an especially bad time with whooping cough this year, with 3,000 cases so far, compared to 20 at the same time last year, said Mary Selecky, secretary of the Washington State Department of Health.  “For every case that we know about, we suspect that there are many people out there who have pertussis and don’t know it,’ Selecky said.

“In many cases, babies get this illness from their mothers or others close to them. It’s absolutely tragic.”

The state has distributed 27,000 doses of a booster vaccine for uninsured adults and has ordered more.  “This disease is very easy to catch,” Selecky said. “It has certainly gotten hold of our population in Washington state.”

The CDC is trying to figure out what's going on, but Schuchat said a couple of factors are clearly at work. The formulation for the whooping cough vaccine was changed in 1997, and kids hitting age 13 and 14 now are the first to have been fully vaccinated with five doses of the new vaccine. The new formulation causes less of a reaction, but it may also wear off sooner, Schuchat said.

The older vaccine was made using a whole pertussis bacterium. It was very effective, but it did cause swelling in some kids who got it, and sometimes caused a fever -- something that scared parents. It also was widely blamed for causing rare but serious neurological reactions, although Schuchat said studies have not confirmed this.

“Vaccines have done a good job of reducing the incidence of pertussis but our vaccines aren’t perfect,” Schuchat said. “We wish we had better ways of controlling pertussis. Given how dangerous pertussis is for babies, preventing infection in babies is our priority.”

Schuchat says people who are not vaccinated have eight times the risk of infection compared to people who are fully vaccinated against whooping cough. And if someone who’s been vaccinated does get whooping cough, the disease is usually less serious and they are far less likely to infect someone else.

The CDC says 95 percent of toddlers aged up to three years have received at least three doses of the vaccine and 84 percent have four doses. And in 2010 69 percent of 13- to 17-year-olds got a fifth booster dose. Kids should get five doses to be fully protected.

And while adults are supposed to have at least one dose of whooping cough vaccine, only 8.2 percent of U.S. adults have done so.

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