# Grapefruit and Lipitor **URL:** \ **Category:** Factual Questions\ **Created:** [March 16, 2011, 9:57am UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894 "2011-03-16T09:57:28Z")\ **Posts on this page:** 17\ **Page:** 1
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [March 16, 2011, 9:57am UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/1 "2011-03-16T09:57:28Z")
OK, I have been faithfully avoiding grapefruit and grapefruit juice for over a year now, because the doc has me on lipitor. I am getting this wild jones for some pink grapefruit juice. What can hypering the lipitor with drinking grapefruit juice do to me? I feel like ditching the damned stuff for a week or however long I need to so I can have some damned juice ☹ ---
**Author:** ![psychonaut](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/psychonaut/32/4655_2.png) [@psychonaut](https://boards.straightdope.com/u/psychonaut)\ **Post date:** [March 16, 2011, 10:06am UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/2 "2011-03-16T10:06:15Z")
Quoth [Wikipedia](http://en.wikipedia.org/wiki/Lipitor): > [@](#): > > Grapefruit juice components are known inhibitors of intestinal CYP3A4. Co-administration of grapefruit juice with atorvastatin may cause an increase in Cmax and AUC, which can lead to adverse reactions or overdose toxicity. The source listed for that claim is Kane, GC; Lipsky, JJ (September 2000). “Drug-grapefruit juice interactions”. Mayo Clin Proc 75 (9): 933–42. doi:10.4065/75.9.933. PMID 10994829. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [March 16, 2011, 10:09am UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/3 "2011-03-16T10:09:06Z")
Well…how much do you like your kidneys? 😃 Basically, grapefruit/juice/extracts slows down the excretion of Lipitor by (we think) interfering with the production of an enzyme used to break down the med. It keeps the medication in your body longer, making it more likely that you’ll overdose on it. Overdose symptoms include muscle pain (\*severe \*muscle pain), then muscle weakness as the muscle cells are broken down (myopathy and rhabdomyolysis) and then kidney damage as the protein from the broken down muscle overwhelms the kidneys and pours out in your urine (myoglobinuria). Worst case scenario is acute kidney failure. Now - is this likely from a single grapefruit or glass of juice? No. Is it likely from a steady diet high in grapefruit products four times a day? Yes. Somewhere in between is this vast ground of “we dunno”. Can I interest you in a tangerine instead? ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [March 16, 2011, 4:07pm UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/4 "2011-03-16T16:07:39Z")
Talk to your pharmacist. At low doses, it may not be a problem. ---
**Author:** ![Triskadecamus](https://avatars.discourse-cdn.com/v4/letter/t/b19c9b/32.png) [@Triskadecamus](https://boards.straightdope.com/u/Triskadecamus)\ **Post date:** [March 16, 2011, 4:23pm UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/5 "2011-03-16T16:23:58Z")
Among the common foods that interact with commonly used pharmaceuticals, the grapefruit, and it’s juice is the undisputed champion. It causes changes in metabolisis of many drugs, alters the absorption, causes sedimentation, and directly blocks or enhances the effects of a surprising number of drugs. Try the tangerine, really. Tris ---
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [March 16, 2011, 5:07pm UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/6 "2011-03-16T17:07:18Z")
> [@WhyNot](#): > > Well…how much do you like your kidneys? 😃 > > Basically, grapefruit/juice/extracts slows down the excretion of Lipitor by (we think) interfering with the production of an enzyme used to break down the med. It keeps the medication in your body longer, making it more likely that you’ll overdose on it. Overdose symptoms include muscle pain (\*severe \*muscle pain), then muscle weakness as the muscle cells are broken down (myopathy and rhabdomyolysis) and then kidney damage as the protein from the broken down muscle overwhelms the kidneys and pours out in your urine (myoglobinuria). Worst case scenario is acute kidney failure. > > Now - is this likely from a single grapefruit or glass of juice? No. Is it likely from a steady diet high in grapefruit products four times a day? Yes. Somewhere in between is this vast ground of “we dunno”. > > Can I interest you in a tangerine instead? No thanks, don’t like tangerines =( But that is exactly what I asked, informationwise =) Though I may actually go off lipitor for a week or so so I can do a grapefruit orgy on the weekend =) ---
**Author:** ![mrklutz](https://avatars.discourse-cdn.com/v4/letter/m/ebca7d/32.png) [@mrklutz](https://boards.straightdope.com/u/mrklutz)\ **Post date:** [March 16, 2011, 5:15pm UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/7 "2011-03-16T17:15:41Z")
My doctor told me that I can have my grapefruit juice as a rare treat while on Lipitor. I just can’t make it a habit. I’d suggest you talk to your doctor, but s/he will probably tell you the same thing. As with so many things, “The dose makes the poison.” In this case, the poison is pretty severe, so some doctors prefer to make grapefruit strictly off-limits rather than trusting their patients’ interpretation of “rare treat”. ---
**Author:** ![robby](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/robby/32/11048_2.png) [@robby](https://boards.straightdope.com/u/robby)\ **Post date:** [March 16, 2011, 5:23pm UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/8 "2011-03-16T17:23:34Z")
What about [Fresca](http://en.wikipedia.org/wiki/Fresca) (Original Citrus/Grapefruit flavor)? Does anyone have any idea if there is enough grapefruit juice in it to be of concern? (I’m on Lipitor, and Fresca is my favorite soft drink.) ---
**Author:** ![teela\_brown](https://avatars.discourse-cdn.com/v4/letter/t/d9b06d/32.png) [@teela\_brown](https://boards.straightdope.com/u/teela_brown)\ **Post date:** [March 16, 2011, 6:07pm UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/9 "2011-03-16T18:07:34Z")
I hear you. I love Texas ruby grapefruit as a snack, but I haven’t tasted one for a couple of years now, since I’ve been on cholesterol medication. They taunt me from their bin at the supermarket, especially right now, because they’re particularly good in winter. ---
**Author:** ![beowulff](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/beowulff/32/542_2.png) [@beowulff](https://boards.straightdope.com/u/beowulff)\ **Post date:** [March 16, 2011, 6:12pm UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/10 "2011-03-16T18:12:26Z")
> [@teela\_brown](#): > > I hear you. I love Texas ruby grapefruit as a snack, but I haven’t tasted one for a couple of years now, since I’ve been on cholesterol medication. > > They taunt me from their bin at the supermarket, especially right now, because they’re particularly good in winter. I have a huge tree full of grapefruits. I saw this thread and wondered if grapefruit juice interacted with other statins, like the one I’m on - Simvastatin. [Sure enough, it does](http://cholesterol.about.com/od/statindrugs/a/grapefruitstat.htm), so I guess I’ll have to give them all away. ---
**Author:** ![Shmendrik](https://avatars.discourse-cdn.com/v4/letter/s/ee7513/32.png) [@Shmendrik](https://boards.straightdope.com/u/Shmendrik)\ **Post date:** [March 16, 2011, 7:29pm UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/11 "2011-03-16T19:29:16Z")
> [@beowulff](#): > > I have a huge tree full of grapefruits. I saw this thread and wondered if grapefruit juice interacted with other statins, like the one I’m on - Simvastatin. [Sure enough, it does](http://cholesterol.about.com/od/statindrugs/a/grapefruitstat.htm), so I guess I’ll have to give them all away. There are some statins which are not metabolized by the CYP3A4, so you can ask your doctor about switching to a different one if grapefruit is that important to you. ---
**Author:** ![Washoe](https://avatars.discourse-cdn.com/v4/letter/w/ecae2f/32.png) [@Washoe](https://boards.straightdope.com/u/Washoe)\ **Post date:** [March 16, 2011, 8:33pm UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/12 "2011-03-16T20:33:30Z")
> [@Triskadecamus](#): > > Among the common foods that interact with commonly used pharmaceuticals, the grapefruit, and it’s juice is the undisputed champion. What are some of the others, and where can I get comprehensive information on the subject? I have about four or five clinical pharmacology texts right here at my fingertips and none of them even broaches the topic other than to mention grapefruit. There seems to be an astonishing lack of information available concerning drug-nutrient interactions. I’ve never even met a doctor or pharmacist who is aware that Earl Grey tea contains the same enzyme inhibitor. ---
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [March 16, 2011, 9:31pm UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/13 "2011-03-16T21:31:00Z")
> [@Washoe](#): > > What are some of the others, and where can I get comprehensive information on the subject? I have about four or five clinical pharmacology texts right here at my fingertips and none of them even broaches the topic other than to mention grapefruit. There seems to be an astonishing lack of information available concerning drug-nutrient interactions. I’ve never even met a doctor or pharmacist who is aware that Earl Grey tea contains the same enzyme inhibitor. no shit? I damn near drink that by the gallon …:smack: I even just indulged in 1000 bags of it from that twinings deal here:( I could do pink grapefruit and their juice as a rare treat [and i would consider rare treat to be a grapefruit or 8 oz glass of the juice as a sunday morning treat] It isn’t like I want to swill it constantly, being diabetic that would be seriously bad for me. ---
**Author:** ![bizerta](https://avatars.discourse-cdn.com/v4/letter/b/3be4f8/32.png) [@bizerta](https://boards.straightdope.com/u/bizerta)\ **Post date:** [March 17, 2011, 1:00am UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/14 "2011-03-17T01:00:12Z")
I was led to believe (but I can’t remember where I heard that) that grapefruit and statins were only a problem if taken within three hours of each other. I take my statins in the evening so I thought it was safe to have grapefruit juice for breakfast once or twice a week. Am I risking something? ---
**Author:** ![Washoe](https://avatars.discourse-cdn.com/v4/letter/w/ecae2f/32.png) [@Washoe](https://boards.straightdope.com/u/Washoe)\ **Post date:** [March 17, 2011, 3:05am UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/15 "2011-03-17T03:05:15Z")
> [@Shmendrik](#): > > There are some statins which are not metabolized by the CYP3A4, so you can ask your doctor about switching to a different one if grapefruit is that important to you. To the best of my knowledge, pravastatin is the only one. ---
**Author:** ![Triskadecamus](https://avatars.discourse-cdn.com/v4/letter/t/b19c9b/32.png) [@Triskadecamus](https://boards.straightdope.com/u/Triskadecamus)\ **Post date:** [March 17, 2011, 6:13am UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/16 "2011-03-17T06:13:38Z")
> [@Washoe](#): > > What are some of the others, and where can I get comprehensive information on the subject? Best I can remember it was a bunch of statins, and several mood drugs, a couple of anti-epileptics. I don’t remember the specific drugs, because our Pharmacist decided to just get out the news that Grapefruit Juice was a dangerous combination with a whole lot of commonly used drugs in our work place, and the safest thing was simply not to drink it. Since then (about twelve years ago) I have heard several times in caregiver news letters of newer drugs (including some anitbiotics) that were also affected antagonistically by elements of grapefruit juice. I must admit I have not paid much attention, since I just gave up the juice, and quit worrying about it. Tris ---
**Author:** ![manila](https://avatars.discourse-cdn.com/v4/letter/m/e5b9ba/32.png) [@manila](https://boards.straightdope.com/u/manila)\ **Post date:** [March 17, 2011, 6:20am UTC](https://boards.straightdope.com/t/grapefruit-and-lipitor/574894/17 "2011-03-17T06:20:14Z")
I too adore grapefruit and also take a statin. ( Simvastatin max dosage) Under docs advice I drink no more than a litre of grapefruit a month and so far no evil effects. However, I was once treated with Erythromycin and was not asked whether I was taking a statin. Within two weeks I started suffering muscle weakness in my long muscles. Imagine that one leg can no longer support your weight! You can’t climb out of a car or climb up ladders without heavily using your arms to yank yourself up. After a little self research I realised that I may be starting rhabdomyolysis and stopped the Erythromycin and headed straight to my regular GP. She immediately recognised the symptoms and agreed I should stop the antibiotic. It uses the same enzyme to for metabolising as the statin ( and grapefruit) It took me over 6 months to regain the strength in my leg muscles. She advised that one litre of grapefruit per month should be okay but take the statin at night and grapefruit 12 hours later. Overdosing on statins accidentally is not a pleasant experience.