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Could Pomegranate Juice React Badly with Crestor?

You might worry about whether pomegranate juice will react badly with your medication, but it should not create problems with rosuvastatin (Crestor).
Could Pomegranate Juice React Badly with Crestor?
Fresh half of pomegranate juice on an isolated background

Do you know which foods might react badly with your medications? You might not, especially if your pharmacist didn’t give you specific information. When you look online, you can find conflicting information, especially with regard to beverages like cranberry or pomegranate juice. What’s the straight and skinny on how these drinks interact with the cholesterol-lowering drug rosuvastatin?

Are There Foods That React Badly with Crestor?

Q. I took Crestor for three years. All was well until I started taking my daily meds with pomegranate juice.

Then I developed cramps and muscle pain. It was awful until I discovered pomegranate acts like grapefruit with a statin. I stopped the Crestor and slowly my aches reduced.

A. Rosuvastatin (Crestor) is a statin-type cholesterol-lowering medication. Other statins (atorvastatin and simvastatin) are metabolized by the CYP3A4 enzyme. Grapefruit juice inhibits this enzyme and can raise blood levels of these drugs (American Journal of Cardiovascular Drugs, vol. 4, no. 5, 2004).  However, it should have no effect on the blood level of rosuvastatin.

Grapefruit Juice Doesn’t Affect Crestor:

Rosuvastatin is metabolized by a different intestinal enzyme, CYP2C9. Although pomegranate juice inhibits 2C9 activity in the laboratory, it doesn’t seem to have much effect on blood levels of the drugs that have been studied (Journal of Clinical Psychiatry, April 2014; European Journal of Drug Metabolism and Pharmacokinetics, June 2017). We don’t think you should worry that it will react badly with Crestor.

Consequently, it isn’t clear that pomegranate juice was the factor that triggered your symptoms. This interaction has not been well studied. Rosuvastatin alone can result in muscle pain for some people, and perhaps that is what you experienced (Pharmacology Research & Perspectives, Nov. 7, 2018). You should let your doctor know about this experience, as you may need to continue with a strategy to reduce your risk of heart disease.

We discuss statin drugs and other ways to lower blood lipids in our eGuide to Cholesterol Control and Heart Health. You may also be interested in our free eGuide to Drug & Food Interactions

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
  • Bailey DG and Dresser GK, "Interactions between grapefruit juice and cardiovascular drugs." American Journal of Cardiovascular Drugs, vol. 4, no. 5, 2004. DOI: 10.2165/00129784-200404050-00002
  • Andrade C, "Potentially significant versus clinically significant drug interactions: pomegranate juice as a case in point." Journal of Clinical Psychiatry, April 2014. DOI: 10.4088/JCP.14f09112
  • Abdlekawy AS et al, "Effects of grapefruit and pomegranate juices on the pharmacokinetic properties of dapoxetine and midazolam in healthy subjects." European Journal of Drug Metabolism and Pharmacokinetics, June 2017. DOI: 10.1007/s13318-016-0352-3
  • Akimoto H et al, "Onset timing of statin-induced musculoskeletal adverse events and concomitant drug-associated shift in onset timing of MAEs." Pharmacology Research & Perspectives, Nov. 7, 2018. DOI: 10.1002/prp2.439
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