Can You Mix Statins and Grapefruit?

“Don’t mix grapefruit with prescription medications.” This warning isn’t just folk wisdom, it’s based on real research into the interactions between grapefruit consumption and certain types of prescription drugs.

While many medications don’t react at all to eating grapefruit or drinking grapefruit juice, statins, medications that are prescribed to lower cholesterol, do have serious interactions with grapefruit.

In this article, I’ll explore whether it’s safe to mix statins and grapefruit.

I’ll talk about which kinds of statins interact with grapefruit and which don’t, and I’ll talk about the risks that come with any interactions. 

I’ll discuss how statins work, and discuss any other interactions they might have with other drugs or foods. And I’ll overview the other medications that grapefruit has an effect on, as well.

Is It Safe to Mix Statins and Grapefruit?

Currently, the US Food and Drug Administration (FDA) recommends that you not mix certain types of statins with grapefruit or grapefruit juice.

Statin medications that should NOT be taken with grapefruit are:

• Atorvastatin (Lipitor)
• Simvastatin (Zocor, FloLipid)
• Lovastatin (Altoprev)

Other common statins, including fluvastatin (Lescol XL), pitavastatin (Livalo); pravastatin (Pravachol); rosuvastatin (Crestor, Ezalor), do not have any interactions with grapefruit.

If you’re on these medications, you can eat as much grapefruit as you want.

Risks

For some medications, grapefruit interactions make the drug less effective at treating your underlying medical condition. This is not the case with grapefruit and statins.

Rather, grapefruit seems to boost statins’ power to act on the body, while also potentially boosting its side effects.

In fact, studies have shown greater reductions in cholesterol levels when taking statins and grapefruit together.

That’s because grapefruit affects an enzyme that normally breaks statins down. 

When that enzyme is suppressed by grapefruit, statins stick around your body for longer, and in higher concentrations. This can lead to even greater cholesterol reductions.

However, the concern with grapefruit and statins is that the “boosting” effect that grapefruit provides may also boost some of the side effects people experience with statins. 

Some of those side effects can be dangerous, even if they’re only experienced in a very small percentage of people who take statins.

Side effects of taking statins include: 

• Abdominal pain
• Headache
• Constipation
• Dizziness
• Diarrhea
• Memory loss
• Skin problems
• Muscle weakness
• Muscle pain
• Nausea
• Depression
• Fatigue
• Heartburn
• Pregnancy complications

In some rare cases, statins may also cause liver, kidney, and muscle damage.

This includes a rare but serious condition called rhabdomyolysis, in which muscle tissue breaks down and releases proteins and electrolytes into the blood. 

Symptoms of rhabdomyolysis include dark, tea-colored urine, general fatigue and malaise, and extremely sore muscles. 

If you do begin to experience these more serious side effects, speak to your doctor to discuss whether changing or stopping your statin may be right for you.

If you have signs or symptoms of rhabdomyolysis, go to the ER right away. 

How much is ok?

In recent years, some medical researchers have begun to argue that the risks of combining grapefruit and statins have been overstated, or poorly defined.

They’ve also argued that the “boosting” effect grapefruit has on cholesterol may outweigh any risks.

However, most healthcare providers still recommend that you avoid combining grapefruit and statins until more research is done.

That’s because the studies done to date have shown that grapefruit and statin interactions vary widely from patient to patient. 

In other words, some patients have shown few negative side effects and have beneficial cholesterol reductions, all while eating large quantities of grapefruit.

But some patients have experienced more serious complications from eating just a small amount of grapefruit. 

For now, it’s too hard to predict which group you’d fall into, which is why most health agencies around the world still recommend you avoid combining grapefruit and statins.

If you slip up and eat an occasional grapefruit, however, it’s unlikely that you’ll experience immediate or serious negative side effects.

What Are Statins?

Statins are medications that reduce the inflammation in your artery walls that can lead to blockages that damage your organs. 

When so-called “bad” cholesterols (also known as low-density lipoprotein, or LDL) build up in your bloodstream, they can form fatty deposits called plaque. 

This can cause the arteries to narrow and become less flexible, which is a condition called atherosclerosis that increases the risk of heart attack, stroke, coronary artery disease, and other heart problems.

Statins help decrease these risks by slowing the buildup of plaque. Your medical provider may prescribe a statin if lifestyle changes alone don’t work to lower your high cholesterol.

How statins work

Statins work by blocking a liver enzyme needed to produce certain kinds of cholesterol. This lowers your body’s overall levels of low-density lipoprotein (LDL) cholesterol levels. 

They also raise your levels of so-called “good” cholesterol, or high-density lipoprotein (HDL). HDL absorbs bad cholesterol and carries it back to your liver, where it’s flushed from the body. 

Statins typically come as tablets to take once a day by mouth, with or without food. Full effectiveness usually kicks in after around six weeks of taking statins.

Other Interactions with Statins

Certain health conditions, including thyroid disease, metabolic syndrome, and genetic mutations linked to mitochondrial dysfunction, increase the risk of side effects from statins. 

Additionally, medications used to treat these comorbidities can lead to drug interactions, which can also cause side effects. 

HIV protease inhibitors, oral contraceptives, clarithromycin, cyclosporin, and itraconazole are all drugs with known interactions with some stations.

These interactions often lead to increased side effects.

Some statins can also reduce the effectiveness of certain antihistamines, including fexofenadine (Allegra).

Other Drugs that Interact with Grapefruit

According to the FDA, some other medications that interact with grapefruit include:

• Some drugs that treat high blood pressure, such as nifedipine (Procardia and Adalat CC)
• Some organ-transplant rejection drugs, such as cyclosporine (Neoral and Sandimmune)
• Some anti-anxiety drugs, such as buspirone (BuSpar)
• Some corticosteroids that treat Crohn’s disease or ulcerative colitis, such as budesonide (Entocort EC and Uceris)
• Some drugs that treat abnormal heart rhythms, such as amiodarone (Pacerone and Cordarone)
• Some antihistamines, such as fexofenadine (Allegra)

When to Seek Medical Attention

If you think you are experiencing side effects related to taking statins, check in with your doctor immediately, but don’t stop taking your medication unless they tell you to. 

They may suggest altering your dosage or trying a different statin instead. If you are experiencing severe pain or concerning symptoms, seek emergency care.

Tell your healthcare provider right away if you have:

• Muscle or joint pain or tenderness
• Weakness
• Fever
• Dark urine
• Other new symptoms