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Stereoselective interaction of manidipine and grapefruit juice: a new twist on an old tale.

The paper by Uno et al. [1] in this issue of the Journal shows that another calcium channel blocker, manidipine, interacts with grapefruit juice and that the interaction is stereoselective. As most of the 1,4-dihydropyridine calcium channel blockers are metabolized by cytochrome P450 (CYP) 3A4, it is not surprising that grapefruit juice should inhibit the intestinal metabolism of manidipine. The important scientific implication of this report is the novel finding that the degree of interaction varies for the two enantiomers of manidipine.