Bitter orange, or Citrus aurantium, an ingredient in herbal weight-loss products, is also commonly known as Seville orange or sour orange. Powdered extracts of the dried immature fruit or peel are used as an alternative to ephedra, which the U.S. Food and Drug Administration banned in 2004 due to risk of heart attack and stroke. Synephrine, a stimulant in bitter orange, has a structural similarity to ephedra; it may cause increased heart rate, high blood pressure and cardiovascular toxicity. Some people have experienced heart attack or stroke after taking bitter orange, and scientific evidence does not support its use for health purposes.
Dietary Supplement Regulation
Supplement manufacturers hold the legal responsibility for ensuring the safety of their dietary supplements prior to sale, and the FDA has no legal provision to approve supplements for safety or effectiveness before they reach consumers. Supplement dosages printed on package labels are decisions made by the manufacturer and do not require FDA approval. Dietary supplement recalls have been issued due to heavy-metal or pesticide contamination; recalls have also been issued because products did not contain the dietary ingredients that the manufacturers claimed they contained, or the ingredients were present in quantities much less or much more than the amounts printed on the label.
Herb and Supplement Interactions
Increased risk of hypertension and adverse cardiovascular effects may occur if bitter orange is combined with herbs and supplements that have stimulant properties, such as guarana and yerba mate -- ingredients commonly found in weight-loss products and energy drinks. When Panax ginseng, an ingredient in energy drinks and some sodas, is combined with bitter orange, it could increase the risk of irregular heartbeats. Bitter orange may interfere with the liver's cytochrome P450 enzyme system that processes herbs and supplements; as a result, blood levels of supplements can become too high, with the potential for toxicity.
Weight-Loss Products
Over-the-counter weight-loss products may contain bitter orange combined with caffeine from multiple ingredients, despite research that warns not to mix the two. Bitter orange contains chemicals that increase heart rate and elevate blood pressure; fainting, heart attacks and strokes have occurred in healthy people after they took bitter-orange supplements alone or with caffeine. Less well-known sources of caffeine in weight-loss products include extracts of guarana, yerba mate, kola nut and green tea.
Medication Interactions
Bitter orange may produce dangerous drug interactions with weight-loss formulas, cough and cold medicines, antidepressants and other medications. For example, bitter orange combined with pseudoephedrine, an ingredient in the brand decongestant Sudafed, may increase the risk of hypertension and adverse cardiovascular effects. Never mix monoamine oxidase inhibitor antidepressants with bitter orange, because dangerously high blood pressure may occur. If you have a medical condition or take medications, always consult your doctor before starting any new supplement regimen.
References
- Drugs.com; Bitter Orange
- National Center for Complementary and Alternative Medicine; Bitter Orange
- U.S. Food and Drug Administration: Dietary Supplements
- U.S. Food and Drug Administration: Overview of Dietary Supplements
- U.S. Food and Drug Administration; Backgrounder: Final Rule for Current Good Manufacturing Practices (CGMPs) for Dietary Supplements
- Wellness.com; Bitter Orange (Citrus aurantium)
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