Statins and grapefruit

I think most of us are aware that grapefruit or its juice are contraindicated for those of us taking statins (in my own case, I’m on Lipitor, aka atorvastatin). Since I’m no grapefruit fan anyway, not a problem for me personally, but I’m wondering just what’s in grapefruit that doesn’t play nicely with statins, and is that found in other citrus? I would be rather unhappy to give up oranges, for example.

Mostly it is only grapefuit.

More than you ever wanted to know.

You should avoid pomelo - most people recognize that as a type of grapefruit.

The problematic compound is named after the bergamot orange.

I don’t think bergamot oranges are something you often encounter as a fresh fruit, certainly not to eat in any substantial quantity because they are sour. You may encounter bergamot oil.

Bergamottin is in more than just grapefruit. Skincare products, perfumes, and food flavorings use its namesake the bergamot orange but consumers rarely eat the whole fruit. Oil of bergamot contains a litany of phototoxic and carcinogenic compounds, including bergamottin and psoralen, which cause redness and increase skin cancer risk after sun exposure.2

Bergamot oil contains anti-cholesterol compounds; these compounds worsen bergamottin’s statin-boosting effects.3 Earl Grey tea, certain fruit jams (e.g. containing Seville orange peels), and bergamot-flavored products (including pharmaceuticals) are often overlooked sources of bergamot oil.

Eating a whole grapefruit or drinking a cup of grapefruit juice can cause a clinically significant interaction with a host of medications. Repeated consumption has a greater effect than one exposure but certain medications’ effects are sensitive to consistent drug levels (e.g. cyclosporine).4 The impact of other bergamottin sources is unclear.

How Well Do You Know the Grapefruit Drug Interaction?

I’m only aware of that because I read it here a few years back. Neither my doctor nor my pharmacist mentioned it. I did check after learning it and it’s buried in the fine print of the materials they provide with the Rx.

Neither did mine - and I can’t entirely figure out the quantities involved. Some articles make it seem that daily consumption of a glass of juice/a whole grapefruit will cause a problem and smaller quantities are OK while others leave the impression that I shouldn’t have so much as a grapefruit flavored seltzer once a week

My doctor said it was fine to eat oranges while on atorvastatin; just not grapefruit.

You could doublecheck with your doctor, or with your pharmacist.

Interesting. I often drink Earl Grey. Maybe I should ask about that – nobody mentioned it.

Not good. I got told by the doctor prescribing it, and the pharmacy puts a sticker on the medication label.

Star fruit or carambolas also shouldn’t be eaten if one is taking statins.

Grapefruit interacts with tamoxifen, a hormonal cancer treatment that uses the same metabolic pathway. My oncologist allowed half a grapefruit a week.

Since I am on Lovastatin, and I also enjoy drinking Earl Gray tea once in a while, which as we know contains Bergamot Oil,I tried to find a medical article stating that drinking Earl Gray tea occasionally while on statins is dangerous if you don’t have any statin side effects. Can someone point me to something that says it’s either okay or not okay to infrequently mix these two? I stay away from grapefruit for the most part.

What about blood oranges ?

I’d hate to give up my morning blood orange juice…

Having just read @Francis_Vaughan’s cite to real medical research, not dumbed-down consumer crap, only some statins are affected by grapefruit, not all. In fact the article includes a list of statins that should be prescribed instead if grapefruit avoidance is a problem.

As well the article lists some fruits beside grapefruits that are problems, such as lemons. But states other citrus that are not problems, like ordinary sweet oranges.

The critical point of the chemical interaction is that the substances in the problem fruits can greatly amplify the amount of statin (or other meds, it’s not just statins) that gets from the pill in your guts into your blood. Leading to a possible multi-X overdose.

Do ya feel lucky? Well … Do ya?

I worry about your heath care providers. Even if I hadn’t already known about this (husband was briefly on Lipitor a few years ago, had side effect issues), both the prescribing doctor and the pharmacist I talked to when picking up the prescription mentioned it.

I have an appointment with my doctor tomorrow anyway, so I’ll ask her about other citrus. I haven’t eaten star fruit in a long time, so that’s not a huge worry.

That was my experience as well. “Avoid grapefruit’ is printed on my prescription for atorvastatin (Lipitor).

Not being a fan of it (or of Earl Grey), I never concerned myself with the ‘why’, but now that I now the reasons, I can see how it makes sense.

Also, do not drink green tea within a couple of hours of taking a statin.

Don’t drink black tea if you are taking synthroid.

More clarity and specificity is needed. You need only defer from black tea for less than an hour after levothyroxine.

……The caffeine in tea and coffee can affect the absorption of one common thyroid drug known as levothyroxine. Instead of eschewing all caffeine, however, the U.K. National Health Service advises simply waiting to drink caffeinated beverages until 30 minutes after you take your thyroid medication.

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Tea & the Thyroid - Healthy Eating | SF Gate

Hmmm - having done this sort of thing for a living (but long retired), I thought to myself, “I’ll just google up some review or other with a list of foods…” Much more difficult than I was expecting.

Cytochrome P450 exists in a whole bunch of isoforms (variations) many of which are involved in the metabolism of drugs and foodstuffs (isoform 3A4 being the most problematic). Some things act as inhibitors of the enzymes (so they don’t metabolize as well, resulting in higher than intended drug levels); some act as inducers, increasing levels of the enzymes and thus reducing drug levels.

This is probably the most comprehensive listing I found (note: recent but pre-proof).

Table 2 is all about AUC (= Area Under the Curve, the curve being a graph of blood levels of drug over time) - the bigger the AUC, the larger the exposure to the drug. So “AUC increased 2.6 fold” means you have 2.6 times the expected exposure to the drug.

Tables 4 and 5 list reported effects. The color coding relates to the evidence available and is explained in Table 1.

Table 6 is the most useful, as it concentrates on clinically relevant interactions with 3A4. I think this is one of those situations where you can over-react, so I like Table 6 as a summary. Grapefruit is definitely a problem, and some other items are definitely potential problems.

This paper also was useful, particularly as it concentrates on fruit juices (Tables 2, 3, 4). I have it in my mind (but no cite) that the reason juices are emphasized is that it’s much easier to chug a liter of grapefruit juice (for example) than it is to eat the equivalent amount of fruit.

Having set myself up as someone with (rusty) familiarity with the area, feel free to ask me questions (but steel yourself against disappointment).


My favorite soft drink is Squirt. And I take Zocor. I always figured there was so little actual grapefruit in the pop, that it was perfectly safe to consume it.

Huh. I thought grapefruit negated the efficacy of statins. If I read correctly, grapefruit makes the effect stronger – sometimes toxically so.

One thing I’ve never been clear on: Is there a time frame within which it’s OK to consume grapefruit? e.g., Four hours before or after taking a pill? Or is grapefruit forbidden fruit?

I’ve read somewhere that grapefruit contains an enzyme that prevents your stomach acid from breaking down certain drugs, making it very easy to OD on them. In my case, I can start to get serotonin syndrome, if I have a full grapefruit in the morning, which sucks. I love fresh grapefruit.

I can have a whole grapefruit about four hours after I take my medicine without adverse effects.