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Statins and Grapefruit Juice — What's the Deal?

Updated: May 30, 2021

The drug class, commonly known as statins, is prescribed for treating high cholesterol.

Many people already know this, in fact, 35 million people in the US know this because they are taking a statin. It's one of the most commonly prescribed medication classes in the US because approximately 71 million people in the US are diagnosed with high cholesterol!

If you happen to be one of the 35 million people taking a statin right now, I'm sure that when you first started the medication, your pharmacist counseled you to NOT have grapefruit juice while taking this medication.

At least, I hope your pharmacist did because drinking grapefruit juice while on statin medication is a recipe for a major drug-food interaction!

Have you ever wondered WHY or HOW this drug interaction happens?

Why Grapefruit Juice And Statins Don't Mix

Grapefruit juice contains a compound called furanocoumarin that inhibits the liver enzyme CYP3A4. This enzyme is responsible for metabolizing the medication.

Without CYP3A4, statin levels remain in the blood in higher concentrations than they should be (as the enzymes aren't around to begin the breakdown process).

Side-effects of Grapefruit + Statin Medication Include:

  • Muscle pain

  • Muscle damage

  • Liver damage

  • Type 2 diabetes

High levels of statin in the blood can lead to toxicity and side effects including, myopathy (muscle pain and damage) or the rare, but more life-threatening form of muscle damage, called rhabdomyolysis.

Elevated levels of statins in the blood can also cause liver damage by increasing liver enzymes and liver inflammation. There is also a small risk that statins can increase blood sugar levels and can cause Type 2 diabetes in those people who are pre-diabetic or already have elevated blood sugar levels. However, statins have been proven to decrease the risk of major cardiovascular events such as heart attacks and strokes, and the benefits in most cases outweigh the risks and hence are strongly recommended in anyone who has a clear indication for one.

What Can You Do To Enjoy Citrus With Statins?

So back to grapefruit juice, what is the real deal and what should you really be doing?

Indeed you really should not consume grapefruit juice, some experts say that eating a grapefruit might be OK because it will have a lower concentration of furanocoumarin because it takes 2 or 3 grapefruits to make 1 glass of grapefruit juice—But why take the risk?

I'll take it a step further and let you know that some other bitter citrus fruits also have furanocoumarins, such as pomelos, Seville oranges, lemons, and limes. However, the tangerine and tangelo (tangerine and grapefruit hybrid) have not been shown to have a significant amount of furanocoumarins. So you can enjoy tangerines and tangelos!

Another tip is if you really really LOVE grapefruits and their juice and don't want to give it up for the rest of your life, you can talk to your doctor about switching your statin medication to one that has little or almost no drug-food interaction.

The statins that have the biggest interaction:

  • Lipitor

  • Mevacor

  • Zocor.

The statins that have a little interaction:

  • Lescol

  • Pravachol

  • Crestor

  • Livalo.

Of course, finding the right medication for you may also depend on what your insurance will cover and what statin is on your insurance's formulary. But, I just want to underscore that there are options available to you.

I hope this blog helped explain and gave some tips about how to manage the statin and grapefruit juice interaction because it is an important one!

The Takeaway: Don't Mix Grapefruit Juice And Statin Medication

Grapefruit juice and statins don't mix well because a compound in grapefruit juice stops the liver metabolism process of the medication, which leads to higher, and dangerous levels of statins in the blood.

If you don't want to miss out on your favorite citrus beverage, you have some options.

Your first option is to switch your citrus fruit—tangerines and tangelos are statin-friendly citrus fruits, or you can speak with your doctor about changing the medication brand for one with fewer interactions.

As a health and wellness coach with a Doctorate Degree in Pharmaceuticals, I'm happy to discuss optimizing any of your prescribed medications to help you live a healthier life. You can book an appointment with me on my about page.

If you'd like more nutrition tips and medication optimization advice, feel free to subscribe to my newsletter where I'll share occasional updates on how you can take better care of your health.

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