Grapefruit juice and licorice increase cortisol in Addison's disease

Patients with Addison’s disease (AD) have impaired subjective health and increased all-cause mortality. Treatment involves a lifelong replacement of glucocorticoid (GC) and mineralocorticoid hormones. However, there is speculation that the pharmacokinetics of GCs could depend on various environmental factors such as diet and gut microflora. There have been reports that some patients report benefit from the use of various nutritional compounds such as licorice and grapefruit juice. However, their influence on the absorption and metabolism of cortisone acetate (CA) or hydrocortisone is not clear.

Methlie et al. conducted a study to investigate the impact of licorice and grapefruit juice on the absorption and metabolism of cortisone acetate (CA). They investigated whether 3-days of co-administration of each of these compounds with CA altered the pharmacokinetics of cortisol and cortisone in serum, saliva, and urine in 17 patients with AD on stable CA replacement therapy. They found that licorice and in particular grapefruit juice increased cortisol available to tissues in the hours following oral CA administration. Their findings point to the possibility of pharmacological modification of 11β-HSD activity to attenuate the fluctuations of GC levels throughout the day in patients with AD on replacement therapy. Methlie et al (2011) European Journal of Endocrinology 165 761-769.

Read the full article at: DOI: 10.1530/EJE-11-0518.