Drug food interactions are common and there can be significant negative consequences from these interactions. A common misconception amongst healthcare professionals who may not have as much experience with drug interactions is that ALL statins interact with grapefruit juice. I have heard and read this type of comment before, and it is not true.
Grapefruit juice is a lightning bolt when it comes to dietary products/foods that interact with medications. It is well-known that many common statins do interact with grapefruit juice, but it is also true that some statins aren’t significantly altered by it.
Let’s start with a little background. Grapefruit juice can inhibit the enzyme CYP3A4. CYP3A4 breaks down numerous medications including some of the most common statins. By blocking this enzyme, you essentially allow concentrations to escalate higher than they normally would and thus increase the risk of adverse effects like myopathy and rhabdomyolysis.
The five most common statins I see used in clinical practice are atorvastatin, rosuvastatin, simvastatin, pravastatin, and lovastatin. Not all of these statins are primarily broken down by CYP3A4. Here’s a quick breakdown:
Statins Broken Down By CYP3A4 – Likely to Interact With Grapefruit Juice
- Atorvastatin
- Simvastatin
- Lovastatin
Statins NOT Dependent Upon CYP3A4 Metabolism – Unlikely to Interact With Grapefruit Juice
- Rosuvastatin
- Pravastatin
In clinical practice, having different drugs that use different breakdown pathways is helpful as it allows us to have options to avoid drug interactions. How can we use this information clinically? If you have a patient that loves grapefruit juice, recommending an agent like rosuvastatin over atorvastatin can be helpful to avoid a drug-food interaction and minimize the risk of statin adverse effects.
If you are looking for a trusted resource and more information on food and medication interactions, I’d recommend the Amazon Best Seller, Meded101 Guide to Drug Food Interactions. The book covers over 500 of the most commonly used medications in clinical practice.
I just had this quest and reviewed the atorvastatin package insert. They state that atorvastatin can be taken with smaller volumes of grapefruit juice..less than 750ml I think. Curious about your thoughts? Thanks for the good work.