Other citrus fruits such as Seville oranges which are often used in marmalades , as well as limes, and pomelos all contain this family of compounds. Grapefruit is simply the most widely studied of these fruits Bailey, Drugs that are taken orally, like Lipitor, are absorbed into the bloodstream from the gastrointestinal GI tract and pass through the liver before being distributed to the rest of the body.
During this process, your body uses certain enzymes to break down the drugs. CYP3A4 helps break down the medication in the small intestine, thereby reducing the amount that ever makes it into your blood. But furanocoumarins interfere with this process, which may lead to higher than expected levels of drugs in the body Fukazawa, Drinking grapefruit juice has been shown in past studies to increase the blood levels of certain medications, including some statins, allergy medications, immunosuppressive drugs, and anti-HIV medications.
Statins, also known as HMG-CoA reductase inhibitors, work to lower cholesterol by—as the name suggests—inhibiting HMG-CoA reductase, an enzyme that controls the rate at which cholesterol is made by the body. The risk of developing rhabdomyolysis by combining statin drugs with grapefruit is minimal, A review published in the American Journal of Medicine proposed that not only is the risk of rhabdomyolysis and serious potential complications low, the resulting increased concentration of statin drugs when combined with grapefruit juice actually improved cholesterol levels Lee, To be on the safe side, many researchers suggest you avoid consuming grapefruit entirely when taking statins such as Lipitor.
Although past research has generally required participants to drink almost a liter of grapefruit juice a day to test how it affects liver enzymes that break down drugs, the amount it takes to affect that process appears to be far lower. Some studies have found that the amount of grapefruit that interferes with critical liver enzymes is small: about one whole grapefruit or a mL slightly under seven ounces glass of grapefruit juice is enough Bailey, In the end, the consensus currently stands that consumption of 8 oz or less of grapefruit juice per day while taking statins is generally considered to be okay Reddy, , UpToDate, With that being said, the U.
The secret to the interaction between grapefruit and these statins is in furanocoumarins, according to a study. Furanocoumarins are organic chemical compounds present in many different plants, including grapefruit. This compound deactivates the CYP3A4 enzyme that the body uses to metabolize, or process, these particular statins.
Interestingly, the interaction between grapefruit and medications poses a danger only when taken orally. This is because the interaction happens in your digestive tract. If you use a skin patch or receive your medication through an injection, you may have a lower risk of adverse effects.
Women and people ages 65 and older are at a higher risk of developing side effects from these statins. The FDA reports that the risk of muscle breakdown and liver damage can lead to kidney failure. Neurological side effects include confusion and memory loss , according to the Mayo Clinic. The exact amount of grapefruit it takes to have a negative reaction when taking lovastatin, atorvastatin, or simvastatin is unknown.
Just one grapefruit or one glass of grapefruit juice could be enough to cause an interaction in some people. Others may need to consume more of the fruit or juice to have an interaction. According to the Cleveland Clinic , there are instance when consuming moderate amounts of grapefruit appear to be safe.
Most incidents of negative reactions involved consuming large amounts of grapefruit. No one has the same reaction when mixing grapefruit with lovastatin, atorvastatin, or simvastatin. 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. Be mindful that other citrus fruits might also interact with lovastatin, atorvastatin, and simvastatin. The list includes tangelos, pomelos, bitter oranges, and Seville oranges.
These foods can also affect how your body metabolizes the medication. There have been no documented problems with lemons, tangerines, clementines, mandarins, navel oranges, and blood oranges. These include many drugs used to treat blood vessel and heart conditions. 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.
Similar to how it affects certain statins, furanocoumarins in grapefruit can suppress the enzyme that helps your body process these medications. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
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