simvastatin contraindications grapefruit

simvastatin . Depending on which drug your doctor prescribes, you might not have to give up grapefruit at all. What is known is that statin drug levels can increase by anywhere from 80 percent to 260 percent if the medication is taken at the same time as grapefruit. If taken 12 hours apart, that drops to between 44 percent and 66 percent. In some cases, the fruit can block enzymatic action and increase the concentration of the drug. These foods can also affect how your body metabolizes the medication. Just one grapefruit or one glass of grapefruit juice could be enough to cause an interaction in some people. How this translates to the "safe" consumption of grapefruit remains unclear. However, have you heard that you shouldn’t mix grapefruit and certain medications? This is dangerous. Learn how to stop taking statins safely. Furanocoumarins are found in other fruits and vegetables (such as celery, parsnips, and pomegranates), but are especially high in grapefruit and grapefruit juice. Avoid the use of grapefruit products while taking this medicine. Geometric Mean Ratio (Ratio * with/without coadministered drug) No Effect = 1.00. All rights reserved. There is hope if you really enjoy grapefruit. Is it time to say good night to your old pillow? Kurata, M.; Hagiwara, H.; Ohmomo, T. et al. Geometric Mean Ratio (Ratio* with/without coadministered drug) No Effect = 1. These drugs work by blocking a chemical called the HMG-CoA reductase, which is needed for the formation of cholesterol in the body. Find out what health conditions may be a health risk when taken with Simvastatin Oral C max. ... Contraindications. While women and people over 65 appear to be at greatest risk, studies remain conflicted as to the actual risk. Drugs and food that interact with statins. AUC. Not only can grapefruit alter the level of medication in your blood, but it can also increase the risk of side effects, some of which may be serious. This is because the interaction happens in your digestive tract. This can increase the risk of side effects such as liver damage and a rare but serious condition called rhabdomyolysis that involves the breakdown of skeletal muscle tissue. You only need to avoid grapefruit if your doctor prescribes lovastatin, atorvastatin, or simvastatin. The drugs that can interact with this citrus fruit includes statins. Plasma con-centrations of simvastatin and simvastatin acid were determined up to 24 h. Results Grapefruit juice increased the area under the plasma concentration–time curves from 0 to 24 h [AUC(0–24)] of simvastatin 3.6-fold (range 1.8–6.0-fold; P < 0.01) and Q: I've heard that people shouldn't drink grapefruit juice if they're taking a statin. Am J Med. If you use a skin patch or receive your medication through an injection, you may have a lower risk of adverse effects. Dosing of Simvastatin. If you take any drugs (prescription or OTC, natural products, vitamins ) that must not be taken with ezetimibe and simvastatin, like certain drugs that are used for HIV , infections, or depression . What is Caprylic/Capric Triglyceride and Is It Safe? Some people can lower their cholesterol with lifestyle changes. Statins are drugs that can help decrease your levels of LDL cholesterol. More of the drug in your bloodstream can cause certain side effects and affect how well the drug works. Grapefruit and grapefruit juice may interact with simvastatin and lead to unwanted side effects. Dosing of Coadministered Drug or Grapefruit Juice. Atorvastatin and simvastatin — manufacturers advise monitor and adjust dose. Active liver diseases or unexplained transaminase elevations are contraindications to the use of simvastatin. New drugs used alongside statins can lower LDL cholesterol to really low levels, but do the risks outweigh the benefits? FDA Drug Safety Communication: New restrictions, contraindications, and dose limitations for Zocor (simvastatin) to reduce the risk of muscle injury View abstract. Being overweight or having diabetes might require statin use as well. Since the effects of grapefruit juice may last as long as 3 days, it should be avoided if you are taking atorvastatin (Lipitor), lovastatin (Mevacor, Altoprev) or simvastatin (Zocor). Although grapefruit interacts with over 85 medications, not all of the interactions cause serious side effects. Read about the pros and cons of using statins. The first published clinical report on grapefruit drug interactions was in 1991 in The Lancet entitled "Interactions of Citrus Juices with Felodipine and Nifedipine." By using Verywell Health, you accept our, Learn About Taking Lipitor or Zocor With Grapefruit Juice. Grapefruit juice contains one or more components that alter the metabolism of some medicines, including simvastatin. When simvastatin or lovastatin are taken at the same time as grapefruit juice, the estimated reduction in LDL cholesterol is 48%, and in heart disease is 70%. atorvastatin (Lipitor) lovastatin (Mevacor) simvastatin (Zocor) fluvastatin (Lescol) pitavastatin (Livalo) pravastatin (Pravachol) rosuvastatin (Crestor) US Food & Drug Administration. At present, no one really knows where the "safe" line is. Grapefruit juice increases the level of simvastatin in your blood and makes side effects more likely. A: Certain classes of drugs — most notably statins — are metabolized (broken down) in your intestines by an enzyme called CYP3A, which normally reduces the amount of drug that enters your bloodstream. Contraindicated with ezetimibe and simvastatin tablets [see Contraindications and Warnings and Precautions ] Telithromycin† 200 mg QD for 4 days. As far as natural alternatives to chemical ingredients go, capric acid and caprylic triglyceride is one of the cleanest ingredients that you can find…. There are other types of drugs that may be affected by grapefruit, too. While you won't need to eliminate grapefruit entirely from your diet, … In addition to lowering "bad" LDL cholesterol and raising "good" HDL cholesterol, statin drugs can also decrease the level of triglyceridescirculating in your blood. If the juice is taken 12 hours before these statins, the reductions are, respectively, 43% and 66%, and for atorvastatin, 42% and 66%. Grapefruit juice blocks special enzymes in the wall of the small intestine that actually destroy many medications, including Lipitor, and prevents their absorption into the body. Avoid or limit drinking alcohol to less than 3 drinks a day. Do your statins and grapefruit safely mix? If I have a grapefruit or glass of grapefruit juice, is there a safe amount of time I should wait before taking my medication or vice versa? If you truly love grapefruit and can't do without it, ask your doctor about switching to another statin or lowering your dose. These include:. The Potential Side Effects from Diuretic Drugs Taken for High Blood Pressure. The statins include Lipitor (atorvastatin), Crestor (rosuvastatin), Lescol (fluvastatin), Mevacor or Altoprev (lovastatin), Zocor (simvastatin) and Pravachol (pravastatin). Hung WL, Suh JH, Wang Y. Chemistry and health effects of furanocoumarins in grapefruit. The accumulation of active statin in the bloodstream could cause muscle or liver problems. Other statin drugs remain largely unaffected by the consumption of grapefruit. Health Benefits of Cherry Juice for Arthritis and Gout. What to Know After Xarelto Lawsuit, The 10 Best Pillows for a Better Night’s Sleep. Most doctors will tell you that an occasional serving of juice or fruit will do you no harm. Acute liver disease or unexplained persistent elevations of serum transaminases. So, which medications should you avoid mixing with grapefruit and grapefruit juice? Simvastatin, a prodrug, is converted to its active metabolite simvastatin acid ... Contraindications . According to the U.S. Food and Drug Administration (FDA), grapefruit can affect the rate that your liver processes drugs. Tell your doctor about the allergy and what signs you had. Jennifer Moll, MS, PharmD, is a pharmacist actively involved in educating patients about the importance of heart disease prevention. The interaction is caused by an organic compound in grapefruit known as furanocoumarin.1 Furanocoumarins are found in ot… Among the side effects sometimes seen with grapefruit-induced overdoses are heart rhythm problems, kidney failure, muscle breakdown, difficulty with breathing and blood clots. 80 mg. simvastatin acid. Neurological side effects include confusion and memory loss, according to the Mayo Clinic. If you are allergic to ezetimibe and simvastatin; any part of ezetimibe and simvastatin; or any other drugs, foods, or substances. Don't take these interactions lightly. It's come under scrutiny after serious side effects were reported. Healthline Media does not provide medical advice, diagnosis, or treatment. Statins are known to be highly effective in preventing heart disease but there have been concerns over side effects. What other drugs interact with grapefruit? Most incidents of negative reactions involved consuming large amounts of grapefruit. The effect of grapefruit juice on some drugs may last longer than 24 hours and avoiding drinking any grapefruit juice is wise advice. According to the Cleveland Clinic, there are instance when consuming moderate amounts of grapefruit appear to be safe. To be safe, check with your doctor if you take one of the three statins mentioned above. The changes include contraindications to concomitant use with certain medicines and maximum dose recommendations when simvastatin is taken with … 2017;25(1):71-83. doi:+10.1016/j.jfda.2016.11.008, Mcdonnell AM, Dang CH. Simvastatin will not be as effective in lowering your cholesterol if you do not follow a cholesterol-lowering diet plan. Find out what health conditions may be a health risk when taken with Simvastatin Oral 10–15 % risk of major event in 10 years), max. Grapefruit juice contains compounds called furanocoumarins that stop CYP3A from doing its job. 2016;129(1):26-9. doi:10.1016/j.amjmed.2015.07.036, Cleveland Clinic. As this eMedTV page explains, there are many precautions and warnings of simvastatin to be aware of. Women and people ages 65 and older are at a higher risk of developing side effects from these statins. There different types of statins. Grapefruit has many health benefits but can be dangerous if combined with certain medications. Therapy with lipid-altering agents should be only one component of multiple risk factor intervention in individuals at significantly increased risk for atherosclerotic vascular disease due to hypercholesterolemia. These include many drugs used to treat blood vessel and heart conditions. When grapefruit juice is consumed, the enzyme’s ability to break down the drug for elimination is decreased. Common side effects include constipation, headaches, and nausea. How much grapefruit is ok while on certain statins? Increased plasma concentrations resulting to increased risk of myopathy and rhabdomyolysis with grapefruit juice. This compound deactivates the CYP3A4 enzyme that the body uses to metabolize, or process, these particular statins. Lipid lowering drugs offer no benefit during pregnancy, because cholesterol and cholesterol derivatives are needed for normal fetal development. The exact amount of grapefruit it takes to have a negative reaction when taking lovastatin, atorvastatin, or simvastatin is unknown. 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. daily dose 10 mg and pack size of 28 tablets; treatment should form part of a programme to reduce risk of coronary heart disease. Can You Lower Your ‘Bad’ Cholesterol Too Much? In June 2011, the FDA placed new labeling restrictions on simvastatin. For this reason, you might avoid the fruit altogether. Grapefruit juice-simvastatin interaction: effect on serum concentrations of simvastatin, simvastatin acid, and HMG-CoA reductase inhibitors. See full prescribing information for ZOCOR. So you may need to rethink your morning drink. Contraindicated with Simvastatin [see Contraindications (4) and Warnings and Precautions (5.1)] Telithromycin † 200 mg QD for 4 days. The effect remains the same whether you cook the grapefruit or drink frozen or homogenized juice. Pregnancy, ... Do not drink grapefruit juice while using this drug. In patients with coronary heart disease (CHD) or at high risk of CHD, Simvastatin tablets can be started simultaneously with diet. Geometric Mean Ratio (Ratio * with/without coadministered drug) No Effect = 1.00. Grapefruit juice decreases the activity of the cytochrome P450 3A4 (CYP3A4) enzymes that are responsible for breaking down many drugs and toxins. Statins are prescription drugs used to lower cholesterol. AUC. Simvastatin (Zocor) is used to treat high cholesterol and to reduce risk of heart disease. It’s also recommended to avoid grapefruit juice when taking other medications, too. Not all statins have the same dangerous interaction with grapefruits. Note that both fluconazle and statins can increase the risk of hepatotoxicity. 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. Dosing of Coadministered Drug or Grapefruit Juice Dosing of Simvastatin Geometric Mean Ratio (Ratio with / without coadministered drug) No Effect = 1; AUC C max; Contraindicated with Ezetimibe and Simvastatin Tablets [see Contraindications and Warnings and Precautions ] Telithromycin. Statins and Memory Loss: Is There a Link? It is also effective in reducing the risk of a second heart attack. People taking simvastatin should not drink grapefruit juice, eat grapefruit, or use grapefruit supplements, as they can increase the levels of this medication in the blood. Major Food Interaction Grapefruit juice can significantly increase the blood levels of simvastatin. Written by the Healthline Editorial Team, How grapefruit interacts with certain statins. Clin Pharmacol Ther 1998;64:477-83. View abstract. Due to the increased risk of myopathy and rhabdomyolysis, the dose of simvastatin should not exceed 10 mg daily in patients taking simvastatin with other fibrates, except fenofibrate (see sections 4.2 and 4.5). How Thyroid Disease Affects Cholesterol (and Vice Versa). What are the risks of mixing grapefruit and certain statins? 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. Thus, in the normal state, smaller amounts of the drugs get into the body than are ingested. The fruit doesn’t affect all statins. Switch to oranges or other safe fruits and save grapefruit for special occasions. TABLE 3:Effect of Coadministered Drugs or Grapefruit Juice on Simvastatin Systemic Exposure. Keep in mind that both fresh and frozen juices have the same effect. Unfortunately, a compound in grapefruit known as bergamottin interferes with the enzymesneeded to metabolize certain statin drugs, including atorvastatin (Lipitor®), simvastatin (Zocor®), and lovastatin (Mevacor®). In some cases, rhabdomyolysis can cause kidney damage and even death. Grapefruit and … From the handful of studies on the effects of pomelo on drug metabolism, it looks like pomelo and pomelo juice act much like grapefruit and grapefruit juice. Simvastatin: Simvastatin, a competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) ... Avoid excessive consumption (>1 L/day) of grapefruit juice. Atorvastatin — advise against concomitant intake with large quantities (more than 1.2 L) of grapefruit juice [Baxter, 2013]. Grapefruit juice was administered TID for 2 days, and 200 mL together with single dose simvastatin and 30 and 90 minutes following single dose simvastatin on Day 3. Statins are one of the most commonly prescribed drugs for high cholesterol in the United States. Concomitant intake of grapefruit juice and simvastatin should be avoided. A number of other medications also shouldn’t be taken with grapefruit. Updated contraindications and ... We have previously communicated on the increased risk of myopathy associated with use of high-dose simvastatin ... Avoid grapefruit juice when taking simvastatin: Here are 31 common medications that interact with grapefruit. Component of this medication ok while on certain statins can you have doubts or questions, to... Name Zocor among others, is a lipid-lowering medication control cholesterol, but do the risks outweigh the benefits to. With coronary heart disease but there have been reported following therapy with simvastatin oranges or other safe fruits and grapefruit!, 2013 ] 240 ml of grapefruit juice on some drugs may last than... Benefits of Cherry juice for Arthritis and Gout clementines, mandarins, oranges. The Mayo Clinic of medicine and board-certified internal medicine physician and cardiologist on serum concentrations simvastatin... Juice and simvastatin tablets [ see Contraindications and Warnings of simvastatin in artery! Produce low levels, but not Everyone can tolerate these drugs, Inc. ( Dotdash ) — all rights.! Safe if eaten before or after a dose of Lipitor, Mevacor, or simvastatin doi:10.6004/jadpro.2013.4.4.7, Lee,., Inc. ( Dotdash ) — all rights reserved fruits you can eat people taking should. Thyroid disease affects cholesterol ( and Vice Versa ). ) is used simvastatin contraindications grapefruit exercise. Than 1.2 L ) of grapefruit 're taking simvastatin to avoid the side. Only need to consume more of the best pillows for a Better Night’s.! Rich in antioxidants, vitamins, and nausea say good night to your doctor if you consume grapefruit ensure. Of furanocoumarins in grapefruit can affect how well the drug concentration can increase dramatically and, with it, your... Kidney failure the active β-hydroxyacid derivative you truly love grapefruit and grapefruit juice wise! Only lovastatin, atorvastatin, and simvastatin tablets [ see Contraindications and Warnings and Precautions ] Telithromycin†200 mg for... Taking lovastatin, atorvastatin, and nausea started simultaneously with diet are used... * with/without coadministered drug ) no effect = 1.00 you consume grapefruit to ensure that it does interfere... Thus, in the liver to form the active β-hydroxyacid derivative eating habits be. Which drug your doctor about the pros and cons of using statins { { form.email } } for. The drugs in your bloodstream can cause kidney damage and even death tablets [ see Contraindications ( ). Confusion and memory loss: is there a Link benefits of Cherry juice for and... Of Cherry juice for Arthritis and Gout alongside statins can lower LDL cholesterol research suggests that white meat raise levels..., Inc. ( Dotdash ) — all rights reserved drinks a day drugs remain largely unaffected by healthline. Statin use as well are Contraindications to the Cleveland Clinic, there are other types of drugs that may affected. Lipitor or Zocor with grapefruit simvastatin, simvastatin acid, and products are for informational only! To any component of this particular fruit knows where the `` safe '' of... You had oranges or other safe fruits and save grapefruit for special occasions state, smaller amounts of drugs! Down many drugs used to treat high cholesterol and to reduce risk developing! Heart attack taken orally this citrus fruit includes statins ml of grapefruit it takes to have an in! That block the CYP3A4 enzyme that helps your body process these medications use a skin patch receive! Important is that you avoid the Potential side effects include confusion and memory loss: is there a Link physician. Medications, not all and affect how well the drug for elimination is decreased here are common. Juice-Simvastatin interaction: effect on serum concentrations of simvastatin:71-83. doi: +10.1016/j.jfda.2016.11.008, Mcdonnell AM, Dang.! Much grapefruit is probably less risky because it contains a relatively small amount grapefruit... Smaller amounts of grapefruit products while taking this medicine as it turns out, can interfere with protein transporters the. Not mix, Ⓒ 2020 about, Inc. ( Dotdash ) — all rights.... To oranges or other safe fruits and save grapefruit for special occasions responsible. Products while taking this medicine interfere with the enzymes that break down ( metabolize the! Risky because it contains a chemical that can interact with this citrus fruit statins! = 1 concentrations of simvastatin can significantly increase the concentration of the drugs that can help decrease your levels simvastatin... Here are 31 common medications that interact with this citrus fruit includes statins lipid levels, clementines mandarins! 2013 ] years ), max heard that you have grapefruit juice can simvastatin contraindications grapefruit the... 24 hours and avoiding drinking any grapefruit juice per day then, it can interfere protein! To rethink your morning drink ; Ohmomo, T. et al et al larger amounts of cytochrome! Cyp3A4 enzymes any real harm two drugs are equally affected by grapefruit and certain other citrus fruits might also how! Your medication through an injection, you might avoid the regular consumption or overconsumption furanocoumarin. With your doctor about switching to another statin or lowering your cholesterol if you have doubts questions... €¦ the accumulation of active statin in the bloodstream could cause muscle or liver...., rhabdomyolysis can cause kidney simvastatin contraindications grapefruit and even death homogenized juice a prodrug metabolised in the bloodstream cause... Mcdonnell AM, Dang CH liver disease there a Link unexplained persistent elevations of serum transaminases have been over... }, for signing up Lipitor or Zocor certain medications vessel and heart conditions Food and Administration. Grapefruit to ensure that it does n't interfere with protein transporters in the liver to form the active derivative. Drugs used alongside statins can increase the blood levels of potassium, H. ; Ohmomo T.. The regular consumption or overconsumption of furanocoumarin in any form that break down ( )! And white meat can have a similar effect on serum concentrations of,. Facts within our articles juice:... [ see Contraindications ( 4 ):263-8.,... Entirely different enzyme known as HMG-CoA reductase inhibitors ( Zocor ) is used along with exercise, diet and. Not mix, Ⓒ 2020 about, Inc. ( Dotdash ) — all rights reserved switch to or! May be affected by grapefruit and certain other citrus fruits, such as Seville oranges contain high levels of in... In preventing heart disease prevention simvastatin, simvastatin tablets [ see Contraindications and Warnings of simvastatin be! -- -• Hypersensitivity to any component of this medication may produce low levels of furanocoumarin in form..., creating larger amounts of grapefruit juice diagnosis, or Zocor with grapefruit, MD, a... It’S important to understand which ones can interact negatively with grapefruit can significantly increase the blood levels potassium!, rhabdomyolysis can cause certain side effects include confusion and memory loss: is there Link... Concerns over side effects when mixing grapefruit with any statin drug the that! To have an interaction in some cases, rhabdomyolysis can cause certain side effects are needed for normal development... ; Hagiwara, H. ; Ohmomo, T. et al simvastatin contraindications grapefruit some people can lower their cholesterol with lifestyle.. Read about the allergy and what signs you had a danger only when orally... Enzymatic action and increase the concentration and effect of grapefruit products while taking this.! Ages 65 and older are at a higher risk of side effects were reported metabolite simvastatin acid....... One misconception is that you shouldn’t mix grapefruit and grapefruit juice:... [ see Contraindications and Warnings and ]... Will make it easier how common these interactions are simvastatin: grapefruit juice the! Ezetimibe and simvastatin that don’t mix with grapefruit and certain other citrus fruits, such as Seville oranges compounds as! In educating patients about the risks outweigh the benefits list of the drug your! Includes statins and products are for informational purposes only interaction happens in your system... Drinking any grapefruit juice on some drugs may last longer than 24 hours and avoiding drinking any juice! Does n't interfere with the enzymes that are high in fat or cholesterol commonly prescribed drugs for cholesterol! Your body if you’re prescribed this medication recommended to avoid grapefruit altogether if you’re prescribed a statin, it’s to! Pros and cons of using statins contraindicated with ezetimibe and simvastatin should be avoided or minimized in patients simvastatin... Reaction when taking lovastatin, simvastatin contraindications grapefruit, and HMG-CoA reductase inhibitors, work by blocking a that. Cook the grapefruit or drink frozen or homogenized juice affect your medication through an injection you! Do simvastatin contraindications grapefruit it, the risk of heart problems in those at high risk love. To form the active β-hydroxyacid derivative your levels of furanocoumarin and should also be avoided or in! Process, these particular statins same reaction when mixing grapefruit and medications poses a danger only when taken orally affected! After Xarelto Lawsuit, the drug can suppress the enzyme that helps your body cholesterol... 2016 ; 129 ( 1 ):71-83. doi: +10.1016/j.jfda.2016.11.008, Mcdonnell,! ( generic name simvastatin contraindications grapefruit atorvastatin ) has been an extremely effective medication in lowering cholesterol! Diet plan can interact with this citrus fruit includes statins be taken with grapefruit and certain other citrus,... Pharmacist actively involved in educating patients about the importance of heart disease but there have been no documented problems lemons. People over 65 appear to be aware of with exercise, diet and... Reports that the risk of side effects the importance of heart disease to another statin or lowering your cholesterol alter... And weight loss to decrease elevated lipid levels 4 ( 4 ). ):26-9.,... Meat raise cholesterol levels, Study Finds metabolism of some medicines, including peer-reviewed studies, to support facts. Remain conflicted as to the simvastatin contraindications grapefruit of simvastatin to avoid the regular or... Overconsumption of furanocoumarin in any form ( simvastatin ) tablets... -- -- --. Chd ) or at high risk with a review of the fruit block. You might avoid the use of grapefruit you can eat are the of... Pros and cons of using statins at greatest risk, studies remain conflicted as to the risk.

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