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.
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:
- Seville oranges
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 more
The following statins tend to interact more with the furanocoumarins in grapefruit juice:
- atorvastatin (Lipitor)
- lovastatin (Mevacor)
- simvastatin (Zocor)
Statins that interact less
These statin medications tend to interact less with grapefruit juice:
- fluvastatin (Lescol)
- pitavastatin (Livalo)
- pravastatin (Pravachol)
- rosuvastatin (Crestor)
Consuming grapefruit or grapefruit juice when taking statins comes with a rare but serious risk of rhabdomyolysis.
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:
- sore muscles, or myalgia
- tea-colored urine
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.
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
- muscle weakness
- muscle soreness
- tea-colored urine
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:
- the statin
- how much grapefruit a person consumes
- a person’s specific condition
- other factors
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.