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Decoding The Warnings About Statins And Grapefruit

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Q. I have gotten conflicting information from my doctor, a couple of pharmacists and patient information inserts about how to avoid interactions between statins and grapefruit:

Don't take the medication with grapefruit juice.

Don't have grapefruit products at the same time of day as a statin.

It’s OK to have grapefruit products after, but not before, a statin.

Don't have more than 1 quart (though one said 8 oz.) of grapefruit products a day.

Don't have any grapefruit products at all while taking statins.

This warning applies to other citrus products beside grapefruit.

I hope you can clarify this. I have been avoiding grapefruit (though not other citrus) completely, and would like to be able to eat it again if it is safe to do so.

A. Certain cholesterol-lowering drugs such as atorvastatin (Lipitor), lovastatin (Mevacor) and simvastatin (Zocor) interact with compounds in grapefruit and its juice. These natural chemicals can slow the rate at which the drugs are processed by the body. This may result in a higher blood level of the drug and consequently a greater risk of side effects.

Only grapefruit and bitter orange (not regular oranges) contain the active compounds. The enzymes that are affected may show changed activity for more than 24 hours after a person drinks a glass of juice, so the idea that one could have grapefruit for breakfast and take a pill before bedtime is mistaken.

Some people are far more susceptible to this effect than others. We are sending you our Guides to Grapefruit Interactions and Cholesterol-Lowering Drugs for lots more information on the interaction and on statin drugs that are not affected by grapefruit.

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20 Comments

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I don't have any experience related to this article, but just a question and comment. If taking grapefruit with a drug may result in a higher blood level of the drug, why don't doctors prescribe LESS DRUG and MORE GRAPEFRUIT until the desired effects are reached with no side effects? It seems to me it's the drug, not the grapefuit, creating the dangerous side effects. Am I naive or dumb, but I have had this thought for a while...

In a different article in the newspaper--so many people write to you re: restless legs at nite. I have found that grapefruit juice prevents them and takes them away. If I happen to forget to take it and I get up at nite to drink it.

As a structural bodyworker I hear lots of reports from clients about pharmaceuticals, etc. Last week I had a client who related a detailed experiment he did (with his doctor's participation) in which he diligently took 8 oz of grapefruit juice daily. His doctor was amazed, but because of the positive result, ended up reducing my client's statin prescription to 10% of his pre-experiment dosage. My client says that this approach absolutely requires that he take his grapefruit juice as diligently as he takes his "other medications." He's quite happy to not have to take nearly so much of his pharmaceuticals.

By the way, I understand that the "grapefruit effect" is not limited to statins, but applies to many other pharmaceuticals as well... It bears repeating, however, to never change medications without your physician's agreement.

I also am against some of these statins. Have had reactions in the muscle weakness category with Lipitor, Zocor. I haven't found the one that works yet, if there is one. Hopefully I won't get the stroke before I find the right one. Trying to be healthy--but difficult to do.

I will receive a box of Honeybells in January. These are a cross between a grapefruit and an orange. Should these be treated the same as all grapefruit as far as how they affect statins?

I love the dried Pomelo (a large citrus fruit) product that Trader Joe sells. Does Pomelo, fresh or dried, interact with Statin drugs such as Simvastatin similar to grapefruit?

In my experience this is the kind of grey area where the typical G.P. will have no response other than what the drug company recommends. Obviously the drug companies are not going to provide any information (to your doctor) of the kind which says if you swing your diet to more fruits and vegetables including more grapefruit then you may not need to take Statins at all.

Certainly the possible consequent occurrence of rhabdomyolysis (the notable side-effect of statins) worries me because muscle aches are such vague symptoms. So what benefit taking a drug to prevent cardiovascular disease if one dies instead of kidney failure?

Likewise we will not see too much research done on the tradeoff between grapefruit consumption and statin use for the same commercial reasons. All in all, isn't it amazing how the medical profession is not interested in issues of prevention of disease, unless it comes in the form of a pill. Let's not switch your diet, but find another drug to offset the muscle damage so you can have your statins and grapefruit too.

Question:
"If taking grapefruit with a drug may result in a higher blood level of the drug, why don't doctors prescribe LESS DRUG and MORE GRAPEFRUIT until the desired effects are reached with no side effects? It seems to me it's the drug, not the grapefruit, creating the dangerous side effects."

Answer:
Grapefruit contains the bergamottin, which interacts with cytochrome P-450 and P-glycoprotein enzymes that break down statins. Since the amount of bergamottin varies with each piece of fruit it makes it impossible to standardize a combined dose of a statin and bergamottin.

Question:
"ended up reducing my client's statin prescription to 10% of his pre-experiment dosage."

Answer:
This is impossible since no statins come in doses that are 10% less than the next highest dose. They only come in 50% lower doses. If he was on Lipitor 20mg (Most common dose), to reduce the does by 10% (2mg) he would need to take 18mg a day and there is no dose available in that strength.

Lipitor - 10,20,40,80mg
Zocor - 5,10,20,40mg
Crestor - 5,10,20,40mg
Mevacor - 10,20,40mg

I am sooooooo happy to learn that there are still some people out there who "think".
I wonder why the drug companies don t have some "thinkers" on their team. Oh, I forgot, they do. I ll bet they sell more drugs this way? :))

Great comment Stephanie!!!

@HL: You misunderstood KP. He said the dose was cut to 10% not BY 10%.

I think you meant his prescription was reduced to 10mg, not by 10%????

I take 40mg of Simvastatin daily. I also have a habit of drinking grapefruit juice daily and think this is just as important as the medicine to keep my levels in check, so I asked my doctor about the statement in the medication about interactions and she told me having 1 glass of 8 ounces will not harm anyone when taking it. Over a period of 6 months, I did in fact combine the two and nothing happened, other than my cholesterol levels went to a healthy level.

During that time I did not realize there was a need to be concerned. Then it came to mind that it is a perfectly good drug which works well that should not be sold short to paranoia, nor is there need to bad mouth a perfectly good fruit, so why not really put it to the test. I drank 2 quarts of unsweetened grapefruit juice a day with my medication for 3 months and nothing happened.

I happen to think that this problem only affects a very small percentage of the population who would happen to combine the two in extreme measures. I think taking Tylenol or aspirin with alcohol would have a worse affect for a greater majority of the general population than this particular combination. Since this first article here was placed, how many documented medical cases have come forth on actual medical emergencies due to this combination?

PEOPLE'S PHARMACY RESPONSE: PEOPLE DIFFER IN SUSCEPTIBILITY TO THIS INTERACTION. WE DON'T RECOMMEND ANYONE ELSE REPEAT YOUR EXPERIMENT.

We ask a question, is it okay to have grapefruit and Statin? Guess what the answer is. One of each, yes, no, kind of, sort of, not helpful guys. Here's the honest answer as I read you, we don't know. There you go, honest, straight forward; just read this stuff, moderate okay, moderate not okay, at the time you take the drug, okay in the morning, not okay any time. The only other answer you can honestly give is "it depends."

In order to give that silly answer, you have to indicate what "it depends" upon, and since no one is sure, well, pick the answer that suits you; I like grape fruit, so I'll go with yes, but go easy, don't push it, don't for God's sake take it with Grape Fruit; maybe you'll be one of the lucky ones. I tell you, I don't know is a great answer. No, it's not fun nor popular and someone will always give an answer, but my reading of this and other websites, plus talking with my Dr. leads me to lean toward not having grape fruit, though I'd sure like to.

I take no statins, but red rice in capsules. Is there any interaction between grape fruit and red rice?

I have to agree. If I have a choice between a clean, delicious, nature-provided foodstuff and a man-made drug - I'm going to choose the clean, delicious, nature-provided foodstuff every time. It just seems to me to be common sense. Further, I don't believe that anyone has ever definitively proven that high cholesterol levels lead to anything. Perhaps they do. But where is the definitive proof of this?

I develop muscle soreness on prescription statins, so my cardiologist recommended working up to 2400 mg Red Yeast Rice daily, taken 1200 mg in the morning and 1200 mg in the evening. He said that amount is approximate to 10 mg Lovastatin daily and advised me to avoid grapefruit.

I take 10 mg of Lipitor per day. I propose I can break the pill in half to 5 mg when I eat grapefruit a couple of days a week.

Hypothesize (probably a safe bet) that grapefruit decreases metabilization of Lipitor by up to a factor of 8.

• My body would still be within the maximum safe daily dose of 40 mg per day.
• If the effect is greater than a factor of 8, then it would only be once in a while.
• For the case of much less effect, I took 5 mg per day for a long time and had about 70% of the cholesterol decrease as the 10 mg now gives. I can take that for a couple days a week.

PEOPLE'S PHARMACY RESPONSE: We don't have an exact factor of impact, because it depends to some extent upon your genetic make-up. Some people are extremely susceptible to this interaction, while others are more resistant. Ask your doctor to help you with this experiment.

I'm still confused. I take 20mg Simvastastin at night and enjoy half a grapefruit most days generally in the morning though sometimes around tea time. I have resisted the recommendation to up the dose to 40mg as my cholesterol level is well under control and I'd rather give up statins than grapefruit. I haven't noticed any side effects to any of my medications.

I have stopped taking simvastatin/10 mg, 3 days ago and have gotten different advice from my doctor & pharmacist as to how long I need to abstain from grapefruit. How long?, is my first question.

Question #2: fresh grapefruit vs. juice. I much prefer fresh, especially as I now live in California. Which is actually best, and also which grapefruits: pink or white?

I am on simvistatan and have been eating cava cava oranges unaware if they have the same effect as grapefruit. After about a week I got severe constipation and muscle aches, the bag say ingredients oranges so I thought I was safe. Could I have damaged my liver from these oranges?

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