Vaccinium macrocarpon
Cranberry/Drug Interactions:
GeneralGeneral: A review was published on the potential risks resulting from fruit (including cranberry)/vegetable-drug interactions (100). Further information is lacking. AcidifiersAcidifiers: In humans, consumption of cranberry juice decreased urinary pH levels (101; 102); however, another study found a lack of an effect (92). Alzheimer's agentsAlzheimer's agents: In vitro, cranberry fruit extract had some protective effects against Alzheimer's disease (24). AmoxicillinAmoxicillin: In humans, cranberry juice used with omeprazole, amoxicillin, and clarithromycin reduced H. pylori infections, particularly in females (103). AntacidsAntacids: Theoretically, cranberry juice may counteract antacids due to its acidic pH.AntihelminticsAntihelmintics: Based on traditional use, cranberry may have anthelmintic properties.AntibioticsAntibiotics: In adult humans, cranberry juice reduced the frequency of bladder infections or H. pylori infections (81; 76; 82; 83; 64; 74; 54; 75; 77; 78; 79; 84; 103; 69). However, in children, there are conflicting results as to whether cranberry affects the frequency of urinary tract infections (51; 91; 6; 8; 104). In another clinical study, ingesting cranberry had a lack of an effect on nasal and fecal bacterial populations in children (105). Based on a study investigating dipsticks and diagnostic algorithms in urinary tract infection, in patients on antibiotics for urinary tract infections, effects of cranberry were lacking (106), and based on a review, cranberry juice had a lack of an effect on the pharmacokinetics of oral antibiotics (47). Anticoagulants and antiplateletsAnticoagulants and antiplatelets: In humans, ingestion of cranberry increased bleeding and INR in patients taking warfarin (Coumadin?) (15; 16; 17; 18; 19; 20; 21; 22; 107; 108; 109; 110). However, studies in healthy volunteers, patients taking warfarin, and laboratory animals indicated that moderate consumption of cranberry had a lack of an effect on the anticoagulation effects of warfarin or INR (52; 93; 53; 94; 95), and based on a randomized controlled trial in patients on stable warfarin, and a systematic review, a clinically relevant interaction was lacking (111; 112). AntidiabeticsAntidiabetics: In humans, consumption of a low-calorie cranberry juice rich in proanthocyanidins were associated with a favorable glycemic response (55). Some commercially available cranberry juice products contain large amounts of sugar. Sugar-free cranberry juice products are also available. AntifungalsAntifungals: In vitro, cranberry juice at 40% concentration inhibited the growth of some fungi (113). The antifungal activity of urine after ingestion of cranberry products was investigated (114). Details are lacking at this time. AntilipemicsAntilipemics: In humans, ingestion of a low-calorie cranberry juice cocktail daily increased plasma HDL-cholesterol concentrations, but had a lack of an effect on LDL and VLDL levels (48; 35). On the other hand, in human study, HDL-cholesterol was decreased following consumption of double-strength cranberry juice (61; 63) or with a lack of an effect in another (68). Another study reported that cranberry juice supplementation significantly reduced circulating oxidized LDL concentrations, but lack of an effect on plasma lipoprotein-lipid concentrations (36). These results are supported by in vitro study as well (37). Antineoplastics treat cancer, as a stAntineoplastics: In vitro, cranberry may have antineoplastic activity (115; 116). However, cranberry should be used cautiously to treat cancer, as a study has shown that cranberry pills have a strong positive association with bladder cancer (117). AntiprotozoalsAntiprotozoals: Based on traditional use, cranberry may have antiprotozoal properties.Antiulcer agentsAntiulcer agents: Based on laboratory evidence, cranberry phenolics may possess antibacterial activity against Helicobacter pylori (118). AntiviralsAntivirals: In vitro, cranberry juice may inactivate polio virus (119). AspirinAspirin: Based on secondary sources, cranberries contain significant amounts of salicylic acid. People who are taking aspirin or are allergic to aspirin should avoid drinking large quantities of cranberry juice (23). ClarithromycinClarithromycin: In humans, cranberry juice used with omeprazole, amoxicillin, and clarithromycin may reduce H. pylori infections, particularly in females (103). Cytochrome P450 metabolized agentsCytochrome P450 metabolized agents: In humans, cranberry juice did not inhibit cytochrome CYP2C9, CYP1A2, or CYP3A (52; 53). However, laboratory studies indicate that cranberry juice may inhibit the function of enteric CYP3A (21) and CYP3A inhibitors (the triterpenes maslinic acid, corosolic acid, and ursolic acid) have been isolated from cranberry (120). Diuretics, thiazideDiuretics, thiazide: Based on preliminary study, cranberry may reduce the formation of renal stones (98; 121; 122; 73). Patients with a history of calcium oxalate nephrolithiasis, however, developed recurrent stones following self-administration of cranberry concentrate tablets (98). Disulfiram (Antabuse?)Disulfiram (Antabuse?): Alcoholic cranberry tinctures may lead to vomiting if used with disulfiram.Gastrointestinal agentsGastrointestinal agents: Based on secondary sources, doses greater than 3L daily will likely cause gastrointestinal distress and diarrhea. Gastrointestinal upset has also been reported in patients consuming cranberry juice daily (54; 80). Metronidazole (Flagyl?)Metronidazole (Flagyl?): Alcoholic cranberry tinctures may lead to vomiting if used with metronidazole.OmeprazoleOmeprazole: In humans, cranberry juice used with omeprazole, amoxicillin, and clarithromycin may reduce H. pylori infections, particularly in females (103). Additionally, cranberry juice has been noted to increase absorption of vitamin B12 in patients using proton pump inhibitors (123). Proton pump inhibitors (PPIs)Proton pump inhibitors (PPIs): Cranberry juice has been noted to increase absorption of vitamin B12 in patients using proton pump inhibitors (123). Renally-eliminated agentsRenally-eliminated agents: Theoretically, cranberry juice could enhance the elimination of drugs excreted in the urine.SalicylatesSalicylates: In humans, consumption of cranberry juice may be associated with an increase of salicyluric acid in urine and salicylic acids in plasma (23). WarfarinWarfarin: In humans, ingestion of cranberry may increase bleeding and increase INR in patients taking warfarin (Coumadin?) (15; 16; 17; 18; 19; 20; 21; 22; 107; 108; 109; 110). However, some studies in healthy volunteers, patients taking warfarin, and laboratory animals indicate that moderate consumption of cranberry (up to 250mL for up to 10 days) had a lack of an effect on the anticoagulation effects of warfarin or INR (52; 93; 53; 94; 95). Based on a randomized controlled trial in patients on stable warfarin, and a systematic review of clinical trials, a clinically relevant interaction was lacking (111; 112). Cranberry/Herb/Supplement Interactions:
GeneralGeneral: A review was published on the potential risks resulting from fruit (including cranberry)/vegetable-drug interactions (100). Further information is lacking. AcidifiersAcidifiers: In humans, consumption of cranberry juice decreased urinary pH levels (101; 102); however, another study found a lack of an effect (92). Alzheimer's agentsAlzheimer's agents: In vitro, cranberry fruit extract may have some protective effects against Alzheimer's disease (24). AntacidsAntacids: Theoretically, cranberry juice may counteract antacids due to its acidic pH.AntihelminthicsAntihelminthics: Based on traditional use, cranberry may have anthelmintic properties.AntibacterialsAntibacterials: In adult humans, cranberry juice reduced the frequency of bladder infections or H. pylori infections in adults (81; 76; 82; 83; 64; 74; 54; 75; 77; 78; 79; 84; 103; 69). However, in children, there are conflicting results as to whether cranberry affects the frequency of urinary tract infections (UTIs) (51; 91; 6; 8; 104). In another clinical study, ingesting cranberry had a lack of an effect on nasal and fecal bacterial populations in children (105). Anticoagulants and antiplateletsAnticoagulants and antiplatelets: In humans, ingestion of cranberry may increase bleeding and increase INR in patients taking warfarin (Coumadin?) (15; 16; 17; 18; 19; 20; 21; 22; 107; 108; 109; 110). However, some studies in healthy volunteers, patients taking warfarin, and laboratory animals indicate that moderate consumption of cranberry (up to 250mL for up to 10 days) had a lack of an effect on the anticoagulation effects of warfarin or INR (52; 93; 53; 94; 95). Based on a randomized controlled trial in patients on stable warfarin, and a systematic review of clinical trials, a clinically relevant interaction was lacking (111; 112). AntifungalsAntifungals: In vitro, cranberry juice at 40% concentration may inhibit the growth of some fungi (113). The antifungal activity of urine after ingestion of cranberry products was investigated (114). Details are lacking at this time. AntilipemicsAntilipemics: In humans, ingestion of a low-calorie cranberry juice cocktail daily increased plasma HDL-cholesterol concentrations, but had a lack of an effect on LDL and VLDL levels (48; 35). On the other hand, in human study, HDL-cholesterol was decreased following consumption of double-strength cranberry juice (61; 63) or not changed in another (68). Another study reported that cranberry juice supplementation significantly reduced circulating oxidized LDL concentrations, but had a lack of an effect on plasma lipoprotein-lipid concentrations (36). These results are supported by in vitro study as well (37). AntineoplasticsAntineoplastics: In vitro, cranberry may have antineoplastic activity (115; 116). However, cranberry should be used cautiously to treat cancer, as a study has shown that cranberry pills had a strong positive association with bladder cancer (117). AntioxidantsAntioxidants: In vitro and in humans, cranberry had antioxidant properties (124; 125; 67; 66). AntiparasiticsAntiparasitics: Based on traditional use, cranberry may have antiparasitic properties.Antiulcer agentsAntiulcer agents: In vitro, cranberry phenolics may possess antibacterial activity against Helicobacter pylori (118). AntiviralsAntivirals: In vitro, cranberry juice may inactivate polio virus (119). Cytochrome P450 metabolized herbs and supplementsCytochrome P450 metabolized herbs and supplements: In humans, cranberry juice did not inhibit cytochrome CYP2C9, CYP1A2, or CYP3A (52; 53). However, laboratory studies indicate that cranberry juice may inhibit the function of enteric CYP3A (21) and CYP3A inhibitors (the triterpenes maslinic acid, corosolic acid, and ursolic acid) have been isolated from cranberry (120). DiureticsDiuretics: Based on preliminary study, cranberry may reduce the formation of renal stones (98; 121; 122; 73). Patients with a history of calcium oxalate nephrolithiasis, however, developed recurrent stones following self-administration of cranberry concentrate tablets (98). LingonberryLingonberry: In humans, cranberry-lingonberry juice may prevent urinary tract infections (126; 127). Gastrointestinal agentsGastrointestinal agents: Based on secondary sources, doses greater than 3L daily will likely cause gastrointestinal distress and diarrhea. Gastrointestinal upset has also been reported in patients consuming cranberry juice daily (54; 80). HypoglycemicsHypoglycemics: In humans, a low-calorie cranberry juice rich in proanthocyanidins may be associated with a favorable glycemic response (55). Some commercially available cranberry juice products contain large amounts of sugar. Sugar-free cranberry juice products are also available. Renally-eliminated agentsRenally-eliminated agents: Theoretically, cranberry juice could enhance the elimination of drugs excreted in the urine.Salicylate-containing herbsSalicylate-containing herbs: In humans, consumption of cranberry juice may be associated with an increase of salicyluric acid in urine and salicylic acids in plasma (23). Vitamin B12Vitamin B12: In humans, ingestion of cranberry juice may double absorption of protein-bound vitamin B12 in patients taking proton pump inhibitors (123). Cranberry/Food Interactions:
LingonberryLingonberry: In humans, cranberry-lingonberry juice may prevent urinary tract infections (126; 127). Cranberry/Lab Interactions:
Calcium levelsCalcium levels: Based on preliminary study, cranberry may reduce the formation of renal stones (98; 121; 122; 73). Coagulation panelCoagulation panel: In humans, ingestion of cranberry may increase bleeding and increase INR in patients taking warfarin (Coumadin?) (15; 16; 17; 18; 19; 20; 21). However, studies in healthy volunteers, patients taking warfarin, and laboratory animals indicate that moderate consumption of cranberry (up to 250mL for up to 10 days) had a lack of an effect on the anticoagulation effects of warfarin or INR (52; 93; 53; 94; 95). Glucose metabolismGlucose metabolism: In humans, following consumption of various food products, plasma glucose peaked at 60 minutes following white bread consumption vs. 30 minutes following consumption of raw cranberries, sweetened dried cranberries, and sweetened dried cranberries containing less sugar (128). The plasma levels of glucose were 9.6?0.4, 7.0?0.4, 9.6?0.5, and 8.7?0.5mmol/L, respectively, and were elevated following white bread consumption over the cranberry products at 120 minutes. The plasma levels of insulin peaked at 60 minutes for white bread and sweetened dried cranberries, and 30 minutes for raw cranberries and sweetened dried cranberries with less sugar with lower plasma insulin at 60 minutes for the low sugar dried cranberries vs. white bread or sweetened dried cranberries, and a decreased area under the curve for insulin for both the raw cranberries and the low sugar sweetened dried cranberries vs. the other two food products. H. pyloriH. pylori: In vitro and in clinical trials, cranberry juice reduced H. pylori infections (129; 103; 69; 104). LipidsLipids: In humans, ingestion of a low-calorie cranberry juice cocktail daily increased plasma HDL-cholesterol concentrations, but had a lack of an effect on LDL and VLDL levels (48; 35). On the other hand, in human study, HDL-cholesterol was decreased following consumption of double-strength cranberry juice (61; 63) or not changed in another (68). Another study reported that cranberry juice supplementation significantly reduced circulating oxidized LDL concentrations, but had a lack of an effect on plasma lipoprotein-lipid concentrations (36). These results are supported by in vitro study as well (37). Liver enzymesLiver enzymes: In humans, dried cranberry juice extract both decreased and increased aspartate aminotransferase (AST) depending on dose, and decreased alanine aminotransferase (ALT) (63). Salicylate levelsSalicylate levels: In humans, consumption of cranberry juice may be associated with an increase of salicyluric acid in urine and salicylic acids in plasma (23). Serum levels of cytochrome P450 metabolized agentsSerum levels of cytochrome P450 metabolized agents: In humans, cranberry juice does not inhibit cytochrome CYP2C9, CYP1A2, or CYP3A (52; 53). However, laboratory studies indicate that cranberry juice may inhibit the function of enteric CYP3A (21). Stool ova and parasite examStool ova and parasite exam: Based on traditional use, cranberry may have anthelmintic properties.UrinalysisUrinalysis: In adult humans, cranberry juice may reduce the frequency of bladder infections or H. pylori infections (81; 76; 82; 83; 64; 74; 54; 75; 77; 78; 79; 84; 103; 69; 130). However, in children with neurogenic bladder, cranberry had a lack of an effect on the frequency of urinary tract infections (51; 91; 6; 8). In another clinical study, ingesting cranberry had a lack of an effect on nasal and fecal bacterial populations in children (105). Theoretically, cranberry juice could enhance the elimination of drugs excreted in the urine. In humans, consumption of cranberry juice may decrease urinary pH levels (101; 102; 73); however, other studies found a lack of an effect (92; 131), or known effects are lacking (132). In a human study, a cranberry drink resulted in a slight, but non-significant reduction, in urinary calcium and magnesium (131). In humans, consumption of a cranberry juice cocktail resulted in decreased urinary interleukin-6 levels (133). Effects on urinary white blood cells have been investigated (130). Further details are lacking at this time. Vaginal bacteriaVaginal bacteria: In humans, effects of cranberry drink on the vaginal microbiota were lacking, but pathogenic bacteria were decreased (131). Vitamin B12 and folateVitamin B12 and folate: Cranberry juice has been noted to increase absorption of vitamin B12 in patients using proton pump inhibitors (123).