There’s a lot to like about this tropical beverage—but it can be a risky choice if you’re taking certain statin medications. Show
 Blink Health,Jun 25, 2020 • 3 min read If you have high cholesterol, your doctor may have prescribed a statin to lower your “bad” cholesterol (LDL)—and with good reason. Research shows this lipid-lowering medicine may lower heart attack risk by at least 25 percent and may also help patients with heart disease avoid cardiac procedures such as coronary stents. According to the CDC, almost one-third of all adults over 40 are taking a statin or other cholesterol-lowering medication. But if you’re one of those people and grapefruit is your juice of choice, you may want to give your morning drink a second look. Here's what you should know about how statins work and why grapefruit juice can be risky with certain medications. What are statins and how do they work?Cholesterol is necessary in order for the body to function. But too much of it can stick to the walls of your arteries and narrow, or even block them, leading to heart issues. If lifestyle measures don’t reduce cholesterol to a safe level, a statin can help. These medicines interfere with an enzyme in the liver that helps produce cholesterol. Statins also boost the liver’s ability to remove LDL cholesterol that’s already in the blood. So what’s the deal with grapefruit juice?Grapefruit juice contains furanocoumarins, compounds that inhibit an enzyme in the digestive tract that normally breaks down statins (as well as other drugs). Because of that, more of the drug gets absorbed into the bloodstream at one time, making it more potent, and increasing the possibility of side effects. However, the juice affects some statins more than others. “It’s only the statins that are metabolized by a particular enzyme pathway in the liver,” says Alyssa Browning, MD, a cardiologist at Einstein Medical Center Philadelphia. Here’s a chart of how they stack up: Big effect: atorvastatin (generic Lipitor), lovastatin (generic Mevacor), simvastatin (generic Zocor) Little to no effect: fluvastatin (generic Lescol), rosuvastatin (generic Crestor), pravastatin (generic Pravachol), pitavastatin (generic Livalo) So should you switch your medication if it’s one of the most affected? “Unless you’re guzzling grapefruit juice by the gallon, it’s generally not an issue,” says Dr. Browning. Most of the studies looked at a quart or more of grapefruit juice, which most people don’t drink. And eating a half a grapefruit or even more with breakfast won’t produce nearly that much juice. Just to be sure, Dr. Browning suggests taking your statins at night, so not around the time you’re having the grapefruit juice. “I would not recommend that people on statins avoid grapefruit,” stresses Dr. Browning. “Generally, it’s a healthy food that contains fiber, vitamin C, and other important nutrients.” Statins are a common medications people take to lower cholesterol and treat heart disease. However, they may interact with compounds in grapefruit juice, and in some cases, this interaction can be dangerous. Certain molecules occurring naturally in grapefruit juice may increase the level of statins in a person’s blood, which can amplify their effects. However, drinking a small glass of grapefruit juice may not have severe effects. But a person taking statins should always speak with a healthcare provider before consuming grapefruit or grapefruit juice. This article explores how grapefruit and statins can interact, which statins may interact most, and the risks and side effects a person may experience. Grapefruit and grapefruit juice can interact with some statins, leading to potentially dangerous results. Essentially, compounds in grapefruit prevent the body from metabolizing statins normally, which increases their concentration in a person’s blood. Normally, when a person consumes statins without grapefruit juice, the enzyme CYP3A breaks them down within the intestines and liver. This process normally lowers the amount of statins reaching the bloodstream. However, furanocoumarins, compounds that occur naturally in grapefruit, deactivate this enzyme, preventing it from breaking down statins. Therefore, the body absorbs more statins than normal from the gut into the bloodstream. According to one review by the research team that discovered the grapefruit-statin interaction, more than 85 drugs may interact with these compounds in grapefruit — not just statins. In addition, other citrus fruits may contain compounds with similar interactions. These include:
However, some varieties of citrus do not contain these interacting compounds, including navel oranges. A person taking statins can ask a healthcare provider what citrus fruits to avoid. People taking statins may wish to know whether the type they are taking interacts more or less with grapefruit juice. Not all statin medications are the same in terms of their interaction with grapefruit. When a person takes certain statins with grapefruit, their blood concentrations of the drug can become several times higher than the normal concentrations of others taking statins. Statins that interact moreThe following statins tend to interact more with the furanocoumarins in grapefruit juice:
Statins that interact lessThese statin medications tend to interact less with grapefruit juice:
Consuming grapefruit or grapefruit juice when taking statins comes with a rare but serious risk of rhabdomyolysis. This condition affects less than 0.1% of people taking statins. It can occur when statin levels become too high in the blood. Characteristics of rhabdomyolysis involve damage to the body’s skeletal muscle tissue. This can cause muscle cells to leak their contents into the bloodstream, leading to elevated levels of protein in the blood. Complications of rhabdomyolysis include:
There are three main symptoms a person with rhabdomyolysis may experience:
However, people with this condition may not experience all three. In addition, some people who are experiencing an interaction between grapefruit and statins may experience mild muscle damage that may appear as myalgia. One case report involved a 40-year-old female who was taking the statin simvastatin. She experienced rhabdomyolysis after eating grapefruit daily for 10 days. However, if healthcare providers can treat rhabdomyolysis, it is possible for them to prevent or reverse complications in the body. In rare cases, this condition can lead to death. Learn more about rhabdomyolysis here. Whether it is safe to consume grapefruit or grapefruit juice while taking statins depends on the statin and the person’s specific condition. Before consuming any grapefruit products, people taking statins should discuss with a healthcare provider whether it is safe for them. It is not advisable to consume any grapefruit or grapefruit juice with the statin simvastatin. With this in mind, drinking a single, occasional glass of grapefruit juice while taking some statins is unlikely to cause harm, according to Harvard Health Publishing. One analysis found that taking grapefruit juice with certain statins may actually have beneficial effects, reducing levels of low-density lipoprotein, or “bad,” cholesterol by up to approximately 6 percentage points. Because of this likelihood, some scientists argue that healthcare providers should not prohibit people from taking grapefruit in moderation with certain statins. A person taking some statins may only start to see harmful effects if they drink 1 quart (946 milliliters) or more of grapefruit juice. Eating grapefruit is less risky because the typical serving size — about half a grapefruit — contains less than a typical glass of juice a person might have with breakfast. However, taking a statin medication at a different time to consuming grapefruit may still cause an interaction. For some statins, this may be a lower interaction than if a person took them simultaneously. Nevertheless, it may be better and simpler to avoid consuming grapefruit products when taking statins. If a person is taking statins and enjoys consuming grapefruit, they should discuss this with a doctor. A healthcare professional can advise whether it is safe to consume this fruit alongside their particular medication. People should also speak with a doctor as soon as possible if they take statins and are experiencing
These are common symptoms of the severe condition rhabdomyolysis. Compounds in grapefruit and grapefruit juice can interact with statins. In extreme cases, this may lead to rhabdomyolysis and even death, but this is rare. The degree of interaction depends on:
Some researchers say that most people taking some statins can consume the occasional glass of grapefruit juice safely. However, those taking certain statins, including simvastatin, should avoid this fruit altogether. If taking statins, it is always best to consult with a healthcare professional first before consuming grapefruit. How long after taking Lipitor can you eat grapefruit?It takes about one serving of grapefruit juice (or one whole grapefruit), 4 hours after consuming, to block half of the enzyme activity that can break down statins.
Can I eat grapefruit in the morning and take atorvastatin at night?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. Currently, healthcare professionals advise it is safe to drink grapefruit juice and eat grapefruit if you're taking other types of statins.
How long after eating grapefruit can you take medication?Interactions can happen up to three days after eating or drinking grapefruit. This means you cannot drink grapefruit juice in the morning and take your medications later in the day to stop possible medicine interactions.
What happens if you take statins and eat grapefruit?Grapefruit contains a chemical that can interfere with your body's ability to break down or metabolize certain statin medications. When statin takers eat large amounts of grapefruit, the level of statins in their blood can increase, raising the possibility of side effects.
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Can i eat grapefruit in the morning and take lipitor at night
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