A number of studies have suggested that side effects like these are uncommon and are mostly associated with a pre-existing kidney, liver, or neurologic condition. At present, no one really knows where the "safe" line is. When this happens, the drug concentration can increase dramatically and, with it, the risk of side effects. When grapefruit juice is consumed, the enzyme’s ability to break down the drug for elimination is decreased. Grapefruit contains compounds known as furanocoumarins that block the CYP3A4 enzymes. 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. January 20, 2016. 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. Currently, healthcare professionals advise it is safe to drink grapefruit juice and eat grapefruit if you're taking other types of statins. Eating grapefruit while taking these drugs can increase the risk of side effects. J Food Drug Anal. “A more reasonable level of grapefruit consumption has been shown to result in far less effect on statins,” he says, adding that patients should still talk with their doctor before eating grapefruit if they take statins. The interaction is caused by an organic compound in grapefruit known as furanocoumarin. Furanocoumarins are found in other fruits and vegetables (such as celery, parsnips, and pomegranates), but are especially high in grapefruit and grapefruit juice. These include:. Other statin drugs remain largely unaffected by the consumption of grapefruit. There are several studies about grapefruit and statin interaction, and recent ones suggest that moderate grapefruit consumption can be compatible with taking lovastatin and other statin drugs. Do your statins and grapefruit safely mix? Little or no effect. Severe side effects include muscle fiber breakdown and kidney failure. 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. No one has the same reaction when mixing grapefruit with lovastatin, atorvastatin, or simvastatin. 2016;129(1):26-9. doi:10.1016/j.amjmed.2015.07.036, Cleveland Clinic. US Food & Drug Administration. Should You Cancel Your Holiday Gatherings This Year Because of COVID? Do you take statin medications to lower “bad” LDL cholesterol? Advertising on our site helps support our mission. Do your statins and grapefruit safely mix? Luckily for grapefruit fans, there are cases in which moderate amount should be safe. How this translates to the "safe" consumption of grapefruit remains unclear. CORONAVIRUS: UPDATED VISITOR RESTRICTIONS, INCREASED SAFETY MEASURES + COVID-19 TESTING. While women and people over 65 appear to be at greatest risk, studies remain conflicted as to the actual risk. Statin medications work steadily and reliably to help regulate LDL levels — even if you come up short on exercise or indulge in a slice of cheesecake once too often. Bitter oranges, pomelos, tangelos, and Seville oranges contain high levels of furanocoumarin and should also be avoided. Problems can occur for those who are sensitive to statin medications or those who have kidney disease or other illnesses. We do not endorse non-Cleveland Clinic products or services. The introduction of statin medications has helped patients: It’s true that changing your diet and lifestyle can help bring down LDL levels, but sticking to a strict diet and exercise regimen isn’t easy. J Adv Pract Oncol. Cardiologist Steven Nissen, MD, points out that only certain statin medications interact negatively with grapefruit. Updated July 18, 2017. Kurata, M.; Hagiwara, H.; Ohmomo, T. et al. Furanocoumarins are also found in other fruit (eg, pomegranates), and in vegetables (eg, parsnips and celery), however, they are especially concentrated in grapefruit juice and fresh grapefruits. Grapefruit juice and some drugs don't mix. Policy. Dr. Hazen says the original studies linking grapefruit ingestion to delayed statin metabolism involved over two quarts of grapefruit juice per day. Advertising on our site helps support … Read More, Fitness, health and wellness tips sent to you weekly. The interaction is caused by an organic compound in grapefruit known as furanocoumarin.1 Furanocoumarins are found in ot… Err on the side of caution and restrict drinking and eating grapefruit if … Atorvastatin interacts with grapefruit juice if you drink large quantities (more than 1.2 litres daily), but an occasional glass is thought to be safe. Thank you, {{form.email}}, for signing up. The grapefruit effect. Big effect. Limit your consumption of grapefruit or switch to "safe" citrus fruits, such as blood oranges, clementines, lemons, limes, mandarins, navel oranges, and tangerines. PCSK9 Inhibitors for Cholesterol—Are They Really Miracle Drugs? High dosages are correlated with increased side effects. Cleveland Clinic © 1995-2020. Avoid a second heart attack if they have cardiovascular disease. The AAFP recommends avoiding lovastatin (Mevacor, Altoprev) and simvastatin (Zocor) if you are taking macrolide antibiotics for bacterial infections. Grapefruit Juice and Statins. Policy. One study showed that drinking a glass of grapefruit juice with simvastatin or lovastatin increased blood levels of these statins by 260%. 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. Side effects from grapefruit-statin interaction can be mild, such as muscle and joint pain. Richard N. Fogoros, MD, is a retired professor of medicine and board-certified internal medicine physician and cardiologist. Unfortunately, a compound in grapefruit known as bergamottin interferes with the enzymes needed to metabolize certain statin drugs, including atorvastatin (Lipitor®), simvastatin (Zocor®), and lovastatin (Mevacor®). Cleveland Clinic is a non-profit academic medical center. All Rights Reserved. Calcium channel blockers When statin takers eat large amounts of grapefruit, the level of statins in their blood can increase, raising the possibility of side effects. What is known is that statin drug levels can increase by anywhere from 80 percent to 260 percent if the medication is taken at the same time as grapefruit. If taken 12 hours apart, that drops to between 44 percent and 66 percent. Do Face Mask Brackets Work — And Are They Safe? What You Should Know About Cardene (Nicardipine), How the Atrogin-1 Gene May Cause Muscle Pain for Statin Users, Crestor: Uses, Side Effects, Dosages, Interactions, Statin Drugs May Not Be Beneficial for Some Older Adults, What to Know Before Starting a Bile Acid Resin to Lower LDL, Chemistry and health effects of furanocoumarins in grapefruit, Basic review of the cytochrome p450 system. Why Grapefruit and Statin Drugs Do Not Mix, Ⓒ 2020 About, Inc. (Dotdash) — All rights reserved. Most doctors will tell you that an occasional serving of juice or fruit will do you no harm. This is because the two drugs are broken down by an entirely different enzyme known as CYP2C9. 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. In addition to lowering "bad" LDL cholesterol and raising "good" HDL cholesterol, statin drugs can also decrease the level of triglyceridescirculating in your blood. And statins help keep LDL levels in check for those patients who find simple diet and lifestyle changes are not enough. What is most important is that you avoid the regular consumption or overconsumption of furanocoumarin in any form. Hung WL, Suh JH, Wang Y. Chemistry and health effects of furanocoumarins in grapefruit. Grapefruit and ca n't do without it, ask your doctor about switching to another statin or your. 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