The short answer
Grapefruit can potentially increase oral hydrocortisone exposure according to its current oral product information. Ask the prescriber or pharmacist about your usual intake; no universal dose cut or spacing interval is established.
What this answer covers
Oral hydrocortisone tablets with grapefruit (Citrus paradisi) fruit/juice. Other plant parts, extracts, injected steroids and topical hydrocortisone are not equivalent.
- Supplement or preparation
- Citrus paradisi
- Medication ingredient
- hydrocortisone
Which treatment this applies to
This review concerns oral hydrocortisone tablets such as CORTEF. Hormone replacement and higher-dose anti-inflammatory treatment have different exposure and monitoring needs. Findings are not automatically applicable to skin creams, injections or the different medicine cortisone acetate.
What the exact product monograph says
The current oral CORTEF product information names grapefruit juice as a CYP3A4 inhibitor that may increase hydrocortisone concentrations; its patient interaction list includes grapefruit and juice. Any dose adjustment belongs with the prescriber and depends on the treatment and clinical response.
Do not confuse cortisol measurements with the administered drug
A study in Addison’s disease used cortisone acetate and measured subsequent cortisol exposure. Another measured endogenous cortisol metabolites in healthy men after juice. Neither is a direct trial of hydrocortisone tablets with grapefruit flesh, nor a measurement of clinical toxicity with this exact pair.
Agree on a practical plan
Describe the fruit, juice or extract and how often you use it. A few hours of separation is not a validated way to prevent the metabolic concern. Continue the prescribed hydrocortisone regimen, including any supplied illness plan, while obtaining individualized advice; replacement treatment should not be stopped independently.
Evidence and practical considerations
Absorption & effectiveness
The exact oral product monograph supports a conditional grapefruit exposure precaution, separate from indirect cortisone acetate and endogenous cortisol studies.
- Exact scope
- Oral hydrocortisone tablets with grapefruit (Citrus paradisi) fruit/juice. Other plant parts, extracts, injected steroids and topical hydrocortisone are not equivalent. with Exact RxNorm 5492 IN hydrocortisone, also called cortisol; CORTEF plain oral tablets. Cortisone acetate is a different administered drug, and injectable esters or topical products are not equivalent exposure.
- Medication form and route
- Oral
What remains uncertain
- Exact oral label precaution without a quantified flesh dose-response or exact-pair clinical outcome study. Cortisone acetate administration and endogenous biomarkers remain indirect; botanical extracts and other routes are not interchangeable.
Factors that may matter: Exact oral preparation and dose; Treatment duration and indication; Blood pressure and electrolyte status; Other medicines.
Read the supporting source summaries
Source 1: Current prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Patients prescribed CORTEF hydrocortisone oral tablets.
Describes dose-related salt/water retention, potassium loss, calcium excretion and systemic corticosteroid precautions; replacement requirements and tapering depend on indication.
How this applies: Exact ingredient and specified formulation. Exact RxNorm 5492 IN hydrocortisone, also called cortisol; CORTEF plain oral tablets. Cortisone acetate is a different administered drug, and injectable esters or topical products are not equivalent exposure.
Physiologic replacement is not equated with higher anti-inflammatory doses. Cortisone acetate studies and endogenous cortisol measurements are not direct tablet PK trials.
Source 2: Current original product monograph
webfiles.pfizer.com · Source check Sep 10, 2026
Population: Patients prescribed oral hydrocortisone tablets.
Names grapefruit juice as a CYP3A4 inhibitor that may raise concentrations and require clinician dose adjustment; patient interaction list includes grapefruit fruit and juice.
How this applies: Exact oral hydrocortisone fruit/juice precaution, distinct from cortisone acetate studies.
Label precaution, not an exact flesh dose-effect trial. No mandatory reduction or validated spacing interval.
Source 3: Original clinical research
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: 17 patients with Addison’s disease on stable cortisone acetate.
Early serum cortisol exposure increased under both conditions.
How this applies: Applicable only to the stated preparation, route and endpoints; other-drug evidence is indirect.
Abstract-only; administered drug was cortisone acetate, not hydrocortisone. Cortisol endpoint does not establish exact tablet or flesh equivalence; no direct toxicity incidence.
Source 4: Original clinical research
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Healthy Chinese men.
Urinary cortisol and metabolite ratios changed, consistent with altered metabolism.
How this applies: Applicable only to the stated preparation, route and endpoints; other-drug evidence is indirect.
Abstract-only endogenous cortisol biomarkers, not prescribed hydrocortisone absorption or clinical toxicity. Juice is not flesh.
Source 5: Medication terminology
rxnav.nlm.nih.gov · Source check Sep 10, 2026
Population: Terminology.
hydrocortisone is IN.
How this applies: Exact ingredient.
Not clinical evidence.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Sources checked and article drafted. | |
| Research summary published |
Article revision: 1ccebc984c37eca2
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.