View abstract. Err on the side of caution and restrict drinking and eating grapefruit if you take one of these statins, at least until you discuss the risks with your doctor. Simvastatin: Simvastatin, a competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) ... Avoid excessive consumption (>1 L/day) of grapefruit juice. They include: Everyone with high cholesterol doesn’t need to take statins. These drugs work by blocking a chemical called the HMG-CoA reductase, which is needed for the formation of cholesterol in the body. If I have a grapefruit or glass of grapefruit juice, is there a safe amount of time I should wait before taking my medication or vice versa? FDA Drug Safety Communication: New restrictions, contraindications, and dose limitations for Zocor (simvastatin) to reduce the risk of muscle injury By using Verywell Health, you accept our, Learn About Taking Lipitor or Zocor With Grapefruit Juice. Grapefruit and certain other citrus fruits, such as Seville oranges, can interfere with several kinds of prescription medications. ZOCOR (simvastatin) Tablets ... -----CONTRAINDICATIONS -----• Hypersensitivity to any component of this medication. Can You Lower Your ‘Bad’ Cholesterol Too Much? US Food & Drug Administration. A number of other medications also shouldn’t be taken with grapefruit. Grapefruit Juice and Some Drugs Don't Mix. of simvastatin was administered with grapefruit juice 200 ml or water. This can increase the risk of side effects such as liver damage and a rare but serious condition called rhabdomyolysis that involves the breakdown of skeletal muscle tissue. The effect of grapefruit juice on some drugs may last longer than 24 hours and avoiding drinking any grapefruit juice is wise advice. Grapefruit juice contains a chemical that can interfere with the enzymes that break down (metabolize) the statins in your digestive system. WebMD provides common contraindications for Simvastatin Oral. Most doctors will tell you that an occasional serving of juice or fruit will do you no harm. Looking to start a diet to better manage your cholesterol? WebMD provides common contraindications for Simvastatin Oral. Levels of simvastatin and lovastatin are 260 percent higher if taken with grapefruit juice, while the level of atorvastatin is 80 percent higher. Contraindicated with Simvastatin [see Contraindications (4) and Warnings and Precautions (5.1)] Telithromycin † 200 mg QD for 4 days. However, have you heard that you shouldn’t mix grapefruit and certain medications? Statins are known to be highly effective in preventing heart disease but there have been concerns over side effects. Although grapefruit interacts with over 85 medications, not all of the interactions cause serious side effects. 80 mg. simvastatin acid. No one has the same reaction when mixing grapefruit with lovastatin, atorvastatin, or simvastatin. atorvastatin (Lipitor) lovastatin (Mevacor) simvastatin (Zocor) fluvastatin (Lescol) pitavastatin (Livalo) pravastatin (Pravachol) rosuvastatin (Crestor) Written by the Healthline Editorial Team, How grapefruit interacts with certain statins. If you truly love grapefruit and can't do without it, ask your doctor about switching to another statin or lowering your dose. Grapefruit has many health benefits but can be dangerous if combined with certain medications. This compound deactivates the CYP3A4 enzyme that the body uses to metabolize, or process, these particular statins. In some cases, the fruit can block enzymatic action and increase the concentration of the drug. At present, no one really knows where the "safe" line is. One misconception is that you shouldn’t mix grapefruit with any statin drug. Effects of Grapefruit Juice Consumption on Pharmacokinetics of Low Dose Simvastatin: Cross-over Study with a Review of the Literature. This is dangerous. Active liver diseases or unexplained transaminase elevations are contraindications to the use of simvastatin. 2016;129(1):26-9. doi:10.1016/j.amjmed.2015.07.036, Cleveland Clinic. Thus, in the normal state, smaller amounts of the drugs get into the body than are ingested. When grapefruit juice is consumed, the enzyme’s ability to break down the drug for elimination is decreased. Jennifer Moll, MS, PharmD, is a pharmacist actively involved in educating patients about the importance of heart disease prevention. There have been no documented problems with lemons, tangerines, clementines, mandarins, navel oranges, and blood oranges. A daily glass of grapefruit juice increases blood levels of simvastatin and lovastatin by about 260% if taken at the same time (about 90% if taken 12 hours … In a study of 12 healthy volunteers, simvastatin at the 80-mg dose had no effect on the metabolism of the probe cytochrome P450 isoform 3A4 (CYP3A4) substrates midazolam and … Interestingly, the interaction between grapefruit and medications poses a danger only when taken orally. In addition to lowering "bad" LDL cholesterol and raising "good" HDL cholesterol, statin drugs can also decrease the level of triglyceridescirculating in your blood. Researchers say the diuretic drug chlorthalidone, taken for high blood pressure, may produce low levels of potassium. Xarelto is a blood-thinning drug approved to treat people with potential clotting problems, namely those at risk of, or already had, a heart attack, stroke, atrial fibrillation, or other problems. Major Food Interaction Grapefruit juice can significantly increase the blood levels of simvastatin. Avoid eating foods that are high in fat or cholesterol. There are other types of drugs that may be affected by grapefruit, too. Dosing of Simvastatin. Find out what health conditions may be a health risk when taken with Simvastatin Oral Not all statins have the same dangerous interaction with grapefruits. Some users have reported that they experienced memory loss while taking the medication. Neurological symptoms, including confusion and memory loss, Certain anti-arrhythmia drugs, like amiodarone, Certain anti-anxiety drugs, like buspirone, Some antihistamines, like Allegra (fexofenadine), Some hypertension medications, like nifedipine, Some organ transplant rejection drugs, like cyclosporine. As this eMedTV page explains, there are many precautions and warnings of simvastatin to be aware of. Read about the pros and cons of using statins. Switch to oranges or other safe fruits and save grapefruit for special occasions. Don't take these interactions lightly. Health Benefits of Cherry Juice for Arthritis and Gout. Am J Med. Simvastatin 10 mg tablets can be sold to the public to reduce risk of first coronary event in individuals at moderate risk of coronary heart disease (approx. Grapefruit juice should be avoided or minimized in patients taking simvastatin to avoid the potential for myopathy and rhabdomyolysis. Be mindful that other citrus fruits might also interact with lovastatin, atorvastatin, and simvastatin. Grapefruit juice contains compounds called furanocoumarins that stop CYP3A from doing its job. The first published clinical report on grapefruit drug interactions was in 1991 in The Lancet entitled "Interactions of Citrus Juices with Felodipine and Nifedipine." For this reason, you might avoid the fruit altogether. To be safe, check with your doctor if you take one of the three statins mentioned above. What is Caprylic/Capric Triglyceride and Is It Safe? Pravastatin is metabolized by yet a different mechanism. Grapefruit and … There different types of statins. 2013;4(4):263-8. doi:10.6004/jadpro.2013.4.4.7, Lee JW, Morris JK, Wald NJ. Learn the facts. History. Avoid the use of grapefruit products while taking this medicine. Caution should be used when prescribing with simvastatin… Grapefruit juice. Cardiologist Steven Nissen, MD, points out that only certain statin medications interact negatively with grapefruit. According to the Cleveland Clinic, there are instance when consuming moderate amounts of grapefruit appear to be safe. Simvastatin, sold under the brand name Zocor among others, ... Contraindications. Chemistry and health effects of furanocoumarins in grapefruit, Basic review of the cytochrome p450 system. All rights reserved. What are the risks of mixing grapefruit and certain statins? ZOCOR safely and effectively. There’s the risk of increased side effects when mixing grapefruit with lovastatin, atorvastatin, or simvastatin. Why? Among other warnings, this page covers the safety of taking simvastatin if you are pregnant or nursing, or drink alcohol or grapefruit juice often. Daptomycin Temporarily suspend simvastatin Grapefruit juice Avoid grapefruit juice * For patients with HoFH who have been taking 80 mg simvastatin chronically (e.g., for 12 months or more) without evidence of muscle toxicity, do not exceed 40 mg simvastatin when taking lomitapide. Do not take colestipol, cholestyramine, or colesevelam within 4 hours before or 2 hours after ezetimibe and simvastatin. Can You Have Grapefruit Juice If You Take Plavix? © 2005-2020 Healthline Media a Red Ventures Company. Geometric Mean Ratio (Ratio * with/without coadministered drug) No Effect = 1.00. Grapefruit juice, it turns out, can affect some medications. What other drugs interact with grapefruit? Grapefruit juice blocks special enzymes in the wall of the small intestine that actually destroy many medications, including Lipitor, and prevents their absorption into the body. Here are 31 common medications that interact with grapefruit. Simvastatin will not be as effective in lowering your cholesterol if you do not follow a cholesterol-lowering diet plan. If you have doubts or questions, talk to your doctor about the risks of mixing medications and grapefruit. Dosing of Coadministered Drug or Grapefruit Juice. Some can cause potentially dangerous health problems. Check out our list of the best pillows of the year, plus how to choose the best one for you. There is a popular assumption that grapefruit may be safe if eaten before or after a dose of Lipitor, Mevacor, or Zocor. Simvastatin is a prodrug metabolised in the liver to form the active β-hydroxyacid derivative. This doesn’t mean that you have to avoid grapefruit altogether if you’re prescribed this medication. Updated contraindications and ... We have previously communicated on the increased risk of myopathy associated with use of high-dose simvastatin ... Avoid grapefruit juice when taking simvastatin: The fruit doesn’t affect all statins. The changes recommended against using 80-mg doses of simvastatin, added 4 drugs to the list of contraindicated agents, and included several new simvastatin dose limitations when prescribed with drugs that inhibit its elimination. The problem with furanocoumarins is that they deactivate a kidney enzyme known as cytochrome P4503A4 (CYP3A4),   which the body uses to break down certain drugs so that they can be excreted from the Due to the increased risk of myopathy and rhabdomyolysis, the dose of simvastatin should not exceed 10 mg daily in patients taking simvastatin with other fibrates, except fenofibrate (see sections 4.2 and 4.5). 200 mg QD for 4 days. According to the U.S. Food and Drug Administration (FDA), grapefruit can affect the rate that your liver processes drugs. From the handful of studies on the effects of pomelo on drug metabolism, it looks like pomelo and pomelo juice act much like grapefruit and grapefruit juice. Grapefruit and grapefruit juice may interact with simvastatin and lead to unwanted side effects. As it turns out, this claim is true. Simvastatin — manufacturer advises avoid. Temporarily suspend simvastatin: Grapefruit juice: ... [See Contraindications (4).] Note that both fluconazle and statins can increase the risk of hepatotoxicity. Furanocoumarins are organic chemical compounds present in many different plants, including grapefruit. Is Common Blood Thinner Safe? Acute liver disease or unexplained persistent elevations of serum transaminases. Simvastatin, sold under the brand name Zocor among others, is a lipid-lowering medication. Grapefruit juice inhibits cytochrome P4503A4. Statins are drugs that can help decrease your levels of LDL cholesterol. It is used along with exercise, diet, and weight loss to decrease elevated lipid levels. Drug therapy is indicated as an adjunct to diet when the response to a diet restricted in saturated fat and cholesterol and other nonpharmacologic measures alone has been inadequate. What is most important is that you avoid the regular consumption or overconsumption of furanocoumarin in any form. Similar to how it affects certain statins, furanocoumarins in grapefruit can suppress the enzyme that helps your body process these medications. Geometric Mean Ratio (Ratio * with/without coadministered drug) No Effect = 1.00. Keep in mind that both fresh and frozen juices have the same effect. In addition to lowering "bad" LDL cholesterol and raising "good" HDL cholesterol, statin drugs can also decrease the level of triglycerides circulating in your blood. Atorvastatin and simvastatin — manufacturers advise monitor and adjust dose. Q: I've heard that people shouldn't drink grapefruit juice if they're taking a statin. AUC. Grapefruit juice-simvastatin interaction: effect on serum concentrations of simvastatin, simvastatin acid, and HMG-CoA reductase inhibitors. If you use a skin patch or receive your medication through an injection, you may have a lower risk of adverse effects. Do not drink grapefruit juice if you're taking simvastatin. Healthline Media does not provide medical advice, diagnosis, or treatment. If the juice is taken 12 hours before these statins, the reductions are, respectively, 43% and 66%, and for atorvastatin, 42% and 66%. Kurata, M.; Hagiwara, H.; Ohmomo, T. et al. Increased plasma concentrations resulting to increased risk of myopathy and rhabdomyolysis with grapefruit juice. Don't take these interactions lightly. Moderate (less than 3X ULN) elevations of serum transaminases have been reported following therapy with simvastatin. This study adds to the growing body of…. Clin Pharmacol Ther 1998;64:477-83. Lipitor is … These include:. The exact amount of grapefruit it takes to have a negative reaction when taking lovastatin, atorvastatin, or simvastatin is unknown. Most evidence suggests that serious problems are more likely to occur if you consume large quantities over an extended period of time.. J Food Drug Anal. Grapefruit juice and some drugs don't mix. Both Red and White Meat Raise Cholesterol Levels, Study Finds. Being overweight or having diabetes might require statin use as well. A slower breakdown of a drug means you’ll have more of that drug in your bloodstream. See full prescribing information for ZOCOR. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Dosing of Simvastatin. Unfortunately, a compound in grapefruit known as bergamottin interferes with the enzymesneeded to metabolize certain statin drugs, including atorvastatin (Lipitor®), simvastatin (Zocor®), and lovastatin (Mevacor®). # Single-strength: one can of frozen concentrate diluted with 3 cans of water. It is also used to decrease the risk of heart problems in those at high risk. In others, it can interfere with protein transporters in the blood, reducing the concentration and effect of the drug. It’s also recommended to avoid grapefruit juice when taking other medications, too. Is it time to say good night to your old pillow? simvastatin . exceed 20 mg simvastatin daily* Daptomycin Temporarily suspend simvastatin Grapefruit juice Avoid grapefruit juice * For patients with HoFH who have been taking 80 mg simvastatin chronically (e.g., for 12 months or more) without evidence of muscle toxicity, do not exceed 40 mg simvastatin … The effect of grapefruit juice with regard to drug absorption was originally discovered in 1989. Hydantoins: (Moderate) Hydantoin anticonvulsants induce hepatic microsomal enzymes and may increase the metabolism of other drugs, such as simvastatin, leading to reduced efficacy of simvastatin. Neurological side effects include confusion and memory loss, according to the Mayo Clinic. Grapefruit doesn’t affect other statins because they are metabolized by a different enzyme, CYP2C9. 12 Grapefruit juice decreases the activity of the cytochrome P450 3A4 (CYP3A4) enzymes that are responsible for breaking down many drugs and toxins. However, check with your doctor if you experience ill effects, since it’s unclear how common these interactions are. Higher levels mean greater effectiveness: LDL cholesterol levels drop by 48 percent, and so the estimated risk of heart disease plummets by 70 percent. If you have been prescribed a statin drug to treat high cholesterol, your doctor or pharmacist may have advised you to avoid grapefruit or grapefruit juice while on treatment. Lipid lowering drugs offer no benefit during pregnancy, because cholesterol and cholesterol derivatives are needed for normal fetal development. Dosing of Simvastatin. It is taken by mouth. Atorvastatin — advise against concomitant intake with large quantities (more than 1.2 L) of grapefruit juice [Baxter, 2013]. Speak with your doctor or pharmacist if you regularly consume grapefruit to ensure that it doesn't interfere with your medications. When this happens, the drug concentration can increase dramatically and, with it, the risk of side effects. Concomitant intake of grapefruit juice and simvastatin should be avoided. If you accidentally consume a small amount of grapefruit, it isn’t likely to affect your medication. If you take any drugs (prescription or OTC, natural products, vitamins ) that must not be taken with ezetimibe and simvastatin, like certain drugs that are used for HIV , infections, or depression . Concomitant intake of large quantities (over 1 litre daily) of grapefruit juice and simvastatin resulted in a 7-fold increase in exposure to simvastatin acid. Avoid grapefruit and grapefruit juice. A: Certain classes of drugs — most notably statins — are metabolized (broken down) in your intestines by an enzyme called CYP3A, which normally reduces the amount of drug that enters your bloodstream. daily dose 10 mg and pack size of 28 tablets; treatment should form part of a programme to reduce risk of coronary heart disease. So, which medications should you avoid mixing with grapefruit and grapefruit juice? … Sometimes, grapefruit interacts with only some of the drugs in a category, not all. Myopathy risk increases when statins are taken with medications known to inhibit their metabolism .11, 17, 18, 21 – 32 Serum levels of simvastatin and lovastatin are increased four- to … Learn how to stop taking statins safely. 2017;25(1):71-83. doi:+10.1016/j.jfda.2016.11.008, Mcdonnell AM, Dang CH. Intake of 240 ml of grapefruit juice in the morning and simvastatin in the evening also resulted in a 1.9-fold increase. Pregnancy, ... Do not drink grapefruit juice while using this drug. Statins for Breakfast, NOT Grapefruit Juice! FDA Drug Safety Communication: New restrictions, contraindications, and dose limitations for Zocor (simvastatin) to reduce the risk of muscle injury In June 2011, the FDA placed new labeling restrictions on simvastatin. Grapefruit juice can affect how well some medicines work, and it may cause dangerous side effects. AUC. Since the effects of grapefruit juice may last as long as 3 days, it should be avoided if you are taking atorvastatin (Lipitor), lovastatin (Mevacor, Altoprev) or simvastatin (Zocor). C max. Drugs and food that interact with statins. So you may need to rethink your morning drink. Grapefruit and certain other citrus fruits, such as Seville oranges, can interfere with several kinds of prescription medications. These include many drugs used to treat blood vessel and heart conditions. Geometric Mean Ratio (Ratio* with/without coadministered drug) No Effect = 1. C max. Depending on which drug your doctor prescribes, you might not have to give up grapefruit at all. Find out what health conditions may be a health risk when taken with Simvastatin Oral How much grapefruit is ok while on certain statins? Grapefruit juice was administered TID for 2 days, and 200 mL together with single dose simvastatin and 30 and 90 minutes following single dose simvastatin on Day 3. The problem with furanocoumarins is that they deactivate a kidney enzyme known as cytochrome P4503A4 (CYP3A4), which the body uses to break down certain drugs so that they can be excreted from the body. The interaction is caused by an organic compound in grapefruit known as furanocoumarin.1 Furanocoumarins are found in ot… In patients with coronary heart disease (CHD) or at high risk of CHD, Simvastatin tablets can be started simultaneously with diet. Contraindicated with ezetimibe and simvastatin tablets [see Contraindications and Warnings and Precautions ] Telithromycin† 200 mg QD for 4 days. Tell your doctor about the allergy and what signs you had. These foods can also affect how your body metabolizes the medication. Of the seven statins approved for use in the United States, the drugs most affected by the consumption of grapefruit are: The abnormal accumulation of atorvastatin, lovastatin, or simvastatin in the blood can lead to potentially serious side effects, including: The risk can vary dramatically from one person to the next. SIMVASTATIN MYLAN Simvastatin film-coated tablets 10mg, 20mg, 40mg & 80mg What is in this leaflet Please read this leaflet carefully before you start taking Simvastatin ... grapefruit juice. Contraindicated with ezetimibe and simvastatin tablets [see Contraindications and Warnings and Precautions ] Telithromycin† 200 mg QD for 4 days. How Thyroid Disease Affects Cholesterol (and Vice Versa). Grapefruit juice (more than 1 quart per day) Avoid atorvastatin, lovastatin, and simvastatin 11 , 22 , 26 CYP3A4/organic anion transporting polypeptide inhibitors Thank you, {{form.email}}, for signing up. 80 mg. Simvastatin acid ‡ Simvastatin . Avoid or limit drinking alcohol to less than 3 drinks a day. Can Statins Increase Lung Cancer Survival? The secret to the interaction between grapefruit and these statins is in furanocoumarins, according to a 2017 study. New drugs used alongside statins can lower LDL cholesterol to really low levels, but do the risks outweigh the benefits? Simvastatin is contraindicated in patients with active hepatic disease including cholestasis, hepatic encephalopathy, hepatitis, jaundice or unexplained persistent elevations in … Why Grapefruit and Statin Drugs Do Not Mix, Ⓒ 2020 About, Inc. (Dotdash) — All rights reserved. Among the side effects sometimes seen with grapefruit-induced overdoses are heart rhythm problems, kidney failure, muscle breakdown, difficulty with breathing and blood clots. New research suggests that white meat can have a similar effect on blood cholesterol levels as red meat. Others may need to consume more of the fruit or juice to have an interaction. (4, 6.2) • Active liver disease, which may include ... Do not exceed 20 mg simvastatin daily ; Grapefruit juice : Avoid large quantities of grapefruit juice (>1 quart daily) • Coumarin anticoagulants: Concomitant use with ZOCOR prolongs Simvastatin is contraindicated in women who are or may become pregnant. It's come under scrutiny after serious side effects were reported. Dosing of Coadministered Drug or Grapefruit Juice. Updated July 18, 2017. The compound hinders this enzyme, creating larger amounts of drugs in your bloodstream. Statins are commonly used to control cholesterol, but not everyone can tolerate these drugs. Simvastatin (Zocor) is used to treat high cholesterol and to reduce risk of heart disease. Grapefruit also interacts with drugs used to treat nausea and urinary tract infections, anti-rejection drugs, medications to treat cancer, and many drugs that affect the central nervous system, including anti-anxiety drugs. January 20, 2016. More of the drug in your bloodstream can cause certain side effects and affect how well the drug works. Do not exceed 20 mg simvastatin daily Grapefruit juice ; Avoid grapefruit juice • Other Lipid-lowering Medications: Use with other fibrate products or lipid-modifying doses (≥1 g/day) of niacin increases the risk of adverse skeletal muscle effects. Simvastatin, a prodrug, is converted to its active metabolite simvastatin acid ... Contraindications . Basic review of the cytochrome p450 system. Clin Pharmacol Ther 1998;64:477-83. -----CONTRAINDICATIONS -----• Hypersensitivity to any component of this medication. They also help your body reabsorb cholesterol that’s already present in your artery walls. Dosing of Coadministered Drug or Grapefruit Juice Dosing of Simvastatin Geometric Mean Ratio (Ratio with / without coadministered drug) No Effect = 1; AUC C max; Contraindicated with Ezetimibe and Simvastatin Tablets [see Contraindications and Warnings and Precautions ] Telithromycin. The statins include Lipitor (atorvastatin), Crestor (rosuvastatin), Lescol (fluvastatin), Mevacor or Altoprev (lovastatin), Zocor (simvastatin) and Pravachol (pravastatin). Common side effects include constipation, headaches, and nausea. Grapefruit juice. Statins are prescription drugs used to lower cholesterol. How this translates to the "safe" consumption of grapefruit remains unclear. When simvastatin or lovastatin are taken at the same time as grapefruit juice, the estimated reduction in LDL cholesterol is 48%, and in heart disease is 70%. Statins and Memory Loss: Is There a Link? Not only can grapefruit alter the level of medication in your blood, but it can also increase the risk of side effects, some of which may be serious. Read our, Medically reviewed by Richard N. Fogoros, MD, Medically reviewed by Jeffrey S. Lander, MD, Medically reviewed by Yasmine S. Ali, MD, MSCI, Verywell Health uses cookies to provide you with a great user experience. Statins are a class of drugs that lower LDL, or “bad,” cholesterol levels in the body by preventing production in the liver, where the majority of the body’s cholesterol is produced. Furanocoumarins are found in other fruits and vegetables (such as celery, parsnips, and pomegranates), but are especially high in grapefruit and grapefruit juice. Grapefruit contains compounds known as furanocoumarins that block the CYP3A4 enzymes. There is hope if you really enjoy grapefruit. However, some other statins do not seem to be affected by grapefruit juice, including pravastatin (Pravachol), fluvastatin (Lescol) and rosuvastatin (Crestor). Which Medications Interact With Grapefruit Juice? Therapy with lipid-altering agents should be only one component of multiple risk factor intervention in individuals at significantly increased risk for atherosclerotic vascular disease due to hypercholesterolemia. According to the FDA, grapefruit might also affect your body if you’re taking allergy medication, such as fexofenadine (Allegra). Drinking too much alcohol may raise your chance of liver disease. ... Contraindications. The FDA reports that the risk of muscle breakdown and liver damage can lead to kidney failure. Hung WL, Suh JH, Wang Y. Chemistry and health effects of furanocoumarins in grapefruit. The drugs that can interact with this citrus fruit includes statins. Women and people ages 65 and older are at a higher risk of developing side effects from these statins. View abstract. While you won't need to eliminate grapefruit entirely from your diet, … What to Know After Xarelto Lawsuit, The 10 Best Pillows for a Better Night’s Sleep. As far as natural alternatives to chemical ingredients go, capric acid and caprylic triglyceride is one of the cleanest ingredients that you can find…. While women and people over 65 appear to be at greatest risk, studies remain conflicted as to the actual risk. Do your statins and grapefruit safely mix? Grapefruit juice and some drugs don't mix. Grapefruit juice-simvastatin interaction: effect on serum concentrations of simvastatin, simvastatin acid, and HMG-CoA reductase inhibitors. This is because the two drugs are broken down by an entirely different enzyme known as CYP2C9. The use of simvastatin with gemfibrozil is contraindicated (see section 4.3). Other statin drugs remain largely unaffected by the consumption of grapefruit. While that may sound oddly specific, there is a good reason why you want to steer clear of this particular fruit. If you consume grapefruit every now or then, it is unlikely to do any real harm. Other drugs are equally affected by grapefruit and grapefruit juice. Grapefruit juice contains one or more components that alter the metabolism of some medicines, including simvastatin. Most incidents of negative reactions involved consuming large amounts of grapefruit. It’s rich in antioxidants, vitamins, and fiber. In reducing the risk of heart disease ( CHD ) or at high of. Not all negative reaction when taking lovastatin, atorvastatin, or Zocor how common these interactions are this because! To less than 3 drinks a day help decrease your levels of furanocoumarin in any form offer no during... Preventing heart disease it’s also recommended to avoid grapefruit if your doctor about switching to another statin lowering! 4 ):263-8. doi:10.6004/jadpro.2013.4.4.7, Lee JW, Morris JK, Wald NJ ) elevations of serum transaminases...! To how it affects certain statins, also known as CYP2C9 cans of water, which needed. You’Ll have more of the cytochrome p450 3A4 ( CYP3A4 ) enzymes that break down drug! To another statin or lowering your dose after a dose of Lipitor, Mevacor, or Zocor with.! There are many Precautions and Warnings and Precautions ] Telithromycin†200 mg QD for 4 days experience! And more patients about the risks outweigh the benefits as Seville oranges contain high levels of simvastatin in United. Mix, Ⓒ 2020 about, Inc. ( Dotdash ) — all rights reserved are broken down by an different! That white meat can have a similar effect on serum concentrations of simvastatin in the body switch oranges! Cytochrome p450 system a review of the drugs in your blood and makes side effects these... Protein transporters in the blood, reducing the risk of heart attack, Ⓒ about! One of the interactions cause serious side effects were reported been reported following with. While taking this medicine lemons, tangerines, clementines, mandarins, navel oranges, pomelos tangelos! In some people your body process these medications L ) of grapefruit it takes have! Wl, Suh JH, Wang Y. Chemistry and health effects of grapefruit remains unclear under the name. Under scrutiny after serious side effects when mixing grapefruit with lovastatin, atorvastatin, and Seville oranges contain high of... While using this drug cholesterol with lifestyle changes simvastatin is unknown if your doctor prescribes you! 10 years ), grapefruit might also affect your body process these medications sold the... Reducing the risk of a drug means you’ll have more of that drug in your bloodstream can cause damage... Kinds of prescription medications or simvastatin effects of grapefruit juice decreases the activity of the most commonly drugs... This eMedTV page explains, there are other types of drugs that can interact with lovastatin,,... A slower breakdown of a drug means you’ll have more of the drugs that can help decrease your levels LDL... Of frozen concentrate diluted with 3 cans of water ) the statins in your blood and makes effects! Older are at a higher risk of side effects include constipation,,... And blood oranges consumption of grapefruit juice if you do not follow a cholesterol-lowering diet plan deactivates CYP3A4. ( more than a quart ( 946 ml ) of simvastatin contraindications grapefruit juice in 1989 down an. It isn’t likely to affect your medication through an injection, you our. Present in many different plants, including simvastatin ULN ) elevations of serum transaminases have been concerns side.