Just last week, the issue of consuming grapefruit with statins came up again (click here to watch my 2010 CHAMP video blog on this topic). This time, it came up during a presentation when a consumer asked me about drinking grapefruit juice (GFJ) with pravastatin (Pravacol). That same day, an email arrived in my inbox from the U.S Food and Drug Administration (FDA): “Don’t take this with that! Grapefruit causes problems when taken with certain medications.”*

Because this question comes up so often, here’s a quick summary of the HMG-CoA reductase inhibitors (statins) that can interact with GFJ, and the advice/recommendations about the interaction generally given in the U.S. and Great Britain (UK):

HMG-CoA Reductase Inhibitors (Statins)*

Atorvastatin

• In the US: Advise that GFJ can increase atorvastatin concentrations
• In the UK: Recommendation given that large quantity of GFJ should be avoided (no more than 1 to 2 small glasses daily)

Simvastatin

• In the US: Recommendation that large quantities of GFJ should be avoided
• In the UK: Recommendation that GFJ is to be avoided

Pravastatin

• Studies have demonstrated that grapefruit juice has no significant effect

Although the GFJ question seems to come up most frequently about statins, other drugs that can be impacted include amlodipine, cyclosporine and carbamazepine.

I contacted a drug information specialist colleague who said that the clinical impact of the grapefruit interaction differs greatly depending upon which drugs are involved. His take? It can make a difference if we’re talking about cyclosporine, but it’s not such a big deal if we’re talking about atorvastatin or amlodipine. The FDA just wants to raise our consciousness and make sure we read the labels.

SO, remind your patients to talk to their pharmacist or prescriber about grapefruit!

Dennee Frey, CHAMP Pharmacy Expert

P.S. To find other tools that can help you and your team teach patients which foods and food groups may need to be avoided with certain medications, visit our Tools page, choose “Medication Management” from the “All Topics” drop-down list, type “food” in the “Text search” box, then click “Search”. Also, see the University of Florida web site www.druginteractioncenter.org, where consumers or professionals can check which medications interact with grapefruit.

* Both the FDA’s advisory and the information about statin-grapefruit interactions in this blog post are based on a 2010 review article Grapefruit-drug interactions (Seden K. Dickinson L. Khoo S. Back D. Grapefruit-drug interactions. Drugs. 2010; 70(18): 2373-407), which outlines the mechanisms of grapefruit-drug interactions and presents a comprehensive summary of those agents affected and whether they are likely to be of clinical relevance.