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Ask Tufts Experts January 2019 Issue

Q. Is it safe for me to eat grapefruit and drink grapefruit juice when I’m taking statins?

grapefruit

A compound in grapefruit can interfere with enzymes that break down some medications.

A. David J. Greenblatt, MD, answers: “With the exception of simvastatin (Zocor), it is safe to take statin medications with customary amounts of grapefruit products – such as one glass of typical commercially-available grapefruit juice, or one-half of a whole grapefruit.

A number of medications, including some statins, are metabolized (broken down) by an enzyme in the wall of the intestines, termed Cytochrome P450-3A, often abbreviated CYP3A. The grapefruit itself, and juice made from the fruit, contain natural substances called furanocoumarins, which have the effect of inactivating CYP3A in the intestinal wall. The result is that medications ordinarily metabolized by intestinal CYP3A may end up with greater absorption and higher levels in blood, as if a higher dose were taken.

The only statin medication that is meaningfully affected by an interaction with customary amounts of grapefruit juice (GFJ) is simvastatin. The GFJ-simvastatin combination is best avoided, and another statin used in its place. All other statin derivatives are not meaningfully affected by typical quantities of grapefruit or GFJ. These include: atorvastatin (Lipitor), lovastatin (Mevacor), fluvastatin (Lescol), pitavastatin (Livalo), pravastatin (Pravachol), and rosuvastatin (Crestor). An important point is that some of the research studies involving GFJ and statins used unrealistically large quantities of GFJ, or ‘super-strength’ forms of GFJ. You may see printed warnings and precautions based on these kinds of studies, but the warnings do not apply to typical or customary amounts of grapefruit of GFJ.”

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