pitcher of grapefruit juice

Iteractions between food and medicines don’t usually get a lot of attention. The exception is grapefruit. People didn’t take grapefruit interactions seriously when they were first discovered, but decades of research have shown that they must not be ignored.

What Are the Grapefruit Interactions with Statins?

Q. I love grapefruit. I am taking simvastatin for high cholesterol, and I am not supposed to eat grapefruit or drink grapefruit juice while I am on this drug. Is there any way to control my cholesterol that won’t interfere with enjoying grapefruit?

A. If your doctor thinks you need a statin-type drug, ask her to consider fluvastatin, pravastatin or rosuvastatin (Crestor). According to the world’s expert on grapefruit interactions, David Bailey, MD, these statins are safe alternatives to atorvastatin, lovastatin or simvastatin (CMAJ, March 5, 2013). [Dr. Bailey was part of the Canadian research team that discovered grapefruit interactions with the blood pressure medicine felodipine (Lancet, Feb. 2, 1991). That study gave this field of research its start.]

The doctor might also consider pitavastatin (Livalo). This cholesterol-lowering drug does not interact with grapefruit (American Journal of Cardiovascular Drugs, 2011).

Are Grapefruit Interactions Always a Problem?

A recent study shows that drinking grapefruit juice at the same time as taking certain other statins increases their blood levels significantly (American Journal of Medicine, Jan. 2016). Levels of simvastatin and lovastatin are 260 percent higher if taken with grapefruit juice, while the level of atorvastatin is 80 percent higher. Higher levels mean greater effectiveness: LDL cholesterol levels drop by 48 percent, and so the estimated risk of heart disease plummets by 70 percent. The authors suggest that these benefits outweigh the risk of serious side effects such as muscle breakdown (rhabdomyolysis).

Understanding Grapefruit Interactions with Statin Drugs:

There is a lot of confusion around grapefruit interactions. A few years ago we received this question:

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 juice) 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.

Readers Experienced Grapefruit Interactions:

Here are two stories of what can happen when a drug like atorvastatin is affected by grapefruit:

“A few weeks ago I could not get out of my chair to go to bed. I was telling my body “stand up” but my back and legs just wouldn’t respond.

“I eventually managed to lever myself up with my arms but I had considerable difficulty getting to bed. This was odd because I am in pretty good physical shape.

“About a week before this event I had bought two gallons of grapefruit juice because it was on sale and had been consuming quite a large quantity daily. I have been on atorvastatin for about 18 months.”


“I slid to the floor of my bathroom and was unable to get up. My arms and legs did not function and I lay there for eight hours until my son picked me up. I went to the hospital but no one could find an explanation. I was taking Lipitor and eating grapefruit daily.”


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 Guide to Grapefruit Interactions for lots more information on the interaction. Other drugs that are affected by grapefruit include some anti-seizure medicines, estrogen hormones, heart and blood pressure pills and sleeping pills. Anyone who would like a copy may download an electronic PDF version from the Health Guide section of The People’s Pharmacy.

Revised 1/30/2017

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  1. Shawn
    Minnesota
    Reply

    I have always loved grapefruit. I take 40mg of Lovastatin every night. Every couple of weeks I enjoy an 8oz glass of grapefruit juice or eat a whole grapefruit with no side-effects.

  2. bob
    princeton,in
    Reply

    i am a 68 year old male who walks 7,5 miles every day , two years ago i weighed 50 lbs more. my doctor put me on a statin drug and lisinopril for high blood pressure, i also love grapefruit,sometimes eating three or four of them a day. just today a friend noticed my love of grapefruit and asked if i took a statin drug. i told him yes and then read the warning label on my medicine bottle.there it was clear as day not to eat grapefruit. huh, im still alive. lucky i guess feel great but will i feel even better if i quit eating grapefruit? gonna keep up my walking

  3. Pat
    Reply

    I was taking simvastatin for several years and completely forgot about the “no grapefruit” warning – and have not read the accompanying paperwork with the medication for some time.
    I had been enjoying 1 grapefruit per day on average – they were delicious
    I recently went through a rough patch personally and a bitter long divorce that has left me somewhat financially broke – but free!
    I had to take a generic for Xanax for what I though was anxiety – during this most recent time.
    Lo and behold after nearly collapsing last Fir. night, and being beset with flu like symptoms for weeks, along with my hair looking ghastly and my skin being very pale – unusually so, I finaly started to research my prescriptions.
    I was very bewildered. I am overall in good shape – never been overweight, 55 years old, non smoker, not much of a drinker healthy eating habits – clean eater and exercise daily – elipticla and walking my 3 dogs,

    GRAPEFRUIT – the mix witht my meds was the culprit all along. Caused my heart to race, my bones to ache, headache and weakness.
    I have not had a grapefruit (and will miss the taste) for 3 days and feel so so so much better
    I only pray I have not done any permanent damage.
    Now my next goal is to totally detox my body. I am taking a couple days off work to get sleep, fresh air, and cleanse. Less meds is the goal.
    I am so happy

  4. Ann
    Plano, Texas
    Reply

    My mother loved grapefruit, and we had it daily during grapefruit season. However, after she was put on blood pressure medication, her doctor told her, “No more grapefruit.” I asked our pharmacist about this, and he explained that she could have the grapefruit flesh, but no grapefruit juice, as juice is pressed from the whole grapefruit. He said that something in the grapefruit skin, which is expressed while pressing the fruit for juice, was the culprit. I don’t remember what that was, but maybe you know or could find this out. Have there been an experiments to back up this “fact”?

  5. Martha
    Reply

    Why has there been no consideration to allowing grapefruit, 1 eight ounce serving of juice or 1/2 grapefruit per day and reducing the drug dosage? That would seem like common sense to me. Also, take the medication at another time of grapefruit intake/

  6. Fred
    Phoenix
    Reply

    This is perhaps a cavalier response but it works for me: I am prescribed simvistatin 40 mg/day. I weaned down to 20 mg/day along with lifestyle improvements (diet & exercise) and achieved equivalent lipid readings. I now take 10 mg/day and eat 1/2 grapefruit 3 or 4 times a week. Lipids remain right where they should be, no apparent side effects. There may be some consequence lurking in the background but I haven’t encountered it yet.
    I think doctors are reluctant to suggest this because it could come back on them if anything went wrong. (First rule of modern medicine: protect yourself from lawyers, then treat the patient…).

  7. Deloris
    Reply

    While I took simvastatin, I dutifully stopped eating grapefruit, something I really loved. Now, that I stopped taking the drug years ago and am suffering from statin side effects that never went away, I think I should have not taken the drug at all and kept on enjoying the grapefruit. It’s far more beneficial in the long run IMHO.

  8. sean
    ny
    Reply

    Lower your cholesterol naturally, one way eat grapefruit!

  9. Ronald Krieger
    Reply

    I have been taking Simvastatin for several years just before I go to bed. I eat a half pink grapefruit every morning and I have never had a any bad reactions.

  10. Ronald Krieger
    Missouri
    Reply

    I have been taking Simvastatin for several years and I take it before bedtime. I eat a half pink grapefruit every morning and I have had no bad reactions.

  11. Julie
    Port Townsend, WA
    Reply

    After starting this drug I asked both my pharmacist and my doctor if I could continue my usual glass of grapefruit juice in the morning. They both asked how much I was drinking and I informed them it was between 5 and 6 ounces. They both responded that this small amount would have no effect. I am happily continuing my morning ritual without any side effects.

  12. Mary
    WA
    Reply

    What if I eat some grapefruit in the morning and Atorvastatin 12 hours later before bed?

    • sean
      Reply

      Eat turmeric and cayenne say bye bye to heart and cholesterol problem.

  13. Barbara
    TX
    Reply

    I am on a low dose of simvasatin (10mg). My doctor told me specifically it’s okay to have grapefruit or grapefruit juice when I take the medicine, as it will amplify the effects of the medicine. He told me to take my thyroid medicine at bedtime, because of interactions with the grapefruit juice. Sounds as though there is no simple answer and the patient has to discuss this with his/her doctor to see what is the safest course of action.

  14. Art
    Seattle, WA
    Reply

    I want to eat grapefruit and take simvatatin

    • Yosako
      Spain
      Reply

      If you want to eat grapefruit while on a statin, talk your doctor into switching to Pravastatin or Pitavastatin, they are barely affected by CYP3A4 inhibitors such as grapefruit juice.

  15. Kate
    Princeton, NC
    Reply

    I take Zocor but not daily as I have liver problems. But I wanted to know if I could drink Springtime Ice Pink Grapefruit its sparkling and as only 3% juice. I’d like to know what you think since most of it really isn’t pure grapefruit? Thank you

  16. Mary
    Reply

    I would hope that when prescribed any statin drug, that the side effects are checked out first.

    Grapefruit is just one of many possible problems.

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