grapefruit and statins

[GingerSue]

I know that grapefruit juice increases the serum level of statins - does it affect all of them?

Can a person have grapefruit/grapefruit juice earlier in the day? - in order to avoid the problem

This is what I found so far (but it's not a recent source, sounds like grapefruit itself might contribute to the problem - earlier in this source it says that the effects of grapefruit juice can

continue for 3 days):

"The updated recommendations suggest those on a statin (other than pravastatin and fluvastatin) should avoid grapefruit juice altogether. 6, 10 A recent study showed that as little as 250mls (one 8oz glass) of grapefruit juice can interact with statins.6 In addition, with daily consumption of grapefruit juice, the effects of the interaction can persist for up to three days after the last glass.6 For this reason, it is in the patient’s best interest not to drink grapefruit juice while on HMG CoA reductase inhibitors (or other drugs metabolized by CYP 3A4). Certain references suggest the fruit itself could also be a potential problem.6, 10

The question now posed to pharmacists is what juice or fruit would not interact with statins. Pharmacists can safely suggest orange juice as a good alternative to grapefruit juice.6 With respect to fruit, the data is limited and very preliminary. Sweet oranges and tangerines appear to be safer then sour oranges.6 Lime juice may potentiate the interaction, however lemons likely do not.6"

[AmaurosisFugax]

Grapefruit juice is an inhibitor of CYP3A4 (a metabolizing enzyme) so any drug metabolized by CYP3A4 will have elevated levels if taken with concomitant grapefruit juice. This includes several statins like Lipitor, lovastatin & Zocor. If I recall correctly pravastain, fluvastatin & rosuvastatin are not metabolized by CYP3A4. For some drugs specific reduced doses if taken with concomitant CYP3A4 inhibitors are recommended; I don't know whether data exist for statins.