My wife is on statins, which means she can’t have grapefruit. But she does love her grapefruit.
Now there are plenty of grapefruit seltzers on the market. I assume they use natural grapefruit flavor. The question is whether the flavor contains the chemical that creates the problem.
Also, since there’s far less grapefruit in seltzer, is it likely to cause an interaction problem?
Talk to your pharmacist or Primary care doc. Both of mine told me not to worry when I asked about both fruit and full strength juice. (My dose is on the low side).
Based on that, I can’t imagine a problem with seltzer.
Only some statins are affected by grapefruit.
Two that are not (to any relevant degree) are pravastatin (Pravachol) and rosuvastatin (Crestor).
Here’s a link to a seemingly reputable (and brief) article on the topic and I draw your attention to the table it contains.
That’s interesting since I use pravachol and the pharmacist’s label proscribes grapefruit entirely. I used to love grapefruit. I would eat a whole fruit, peeling it like an orange and gnawing off sections. The linked article makes it sound like that is even less likely to cause a problem. I will ask my doctor.
I don’t think seltzer has any actual fruit content. It’s just flavoring. I understand that grapefruit is a very popular seltzer flavor.
(Personally, I hate grapefruit. An orange that tastes like aspirin. Yech. Being on Lipitor has given me a great excuse to turn down any offers of grapefruit.)
I thought I heard somewhere that it was only either red or white grapefruit that was the problem, the other being fine. But people like to be on the safe side and just avoid grapefruit altogether.
Having said that, I’ve talked to people in the juice industry who have said that as the grapefruit/medication interaction got more and more popular over the last 20 years or so, they’ve all but eliminated grapefruit based juices from their lineup. One person that owns a (very large, nationally distributed) juice business mentioned that 20 years ago, they were bottling grapefruit juice every few days, now it’s maybe once a month.
I’m not sure if the stats are going to be available anywhere on the internet, but it would be interesting to see how that lines up with sales of Squirt or Ocean Spray grapefruit juice over the past few decades.
Here is an article from the Cleveland Clinic to discuss with your physician.
Often (and maybe always), pharmacists and on-line drug interaction checkers will label ALL members of a drug class with a caution or even a contraindication, when only one or some members of the class are affected.
Take a look at Table I in this CMAJ article from a few years ago that not only documents for which drugs grapefruit MUST be avoided, but also lists alternatives of the same class.
BTW, Pravachol and Crestor not only are immune to the grapefruit interaction, they also have a very much lower chance of causing the muscle breakdown (rhabdomyolysis) that is THE big risk for people using statins (however rare).
I, too missed my grapefruit when my doc put me on statins. I mentioned it to him and he told me that I could still eat grapefruit; I just couldn’t eat it with the statins. He explained that the enzyme in grapefruit that knocks out the statin can only do it while both are in the stomach. So I take my meds and eat my grapefruit an hour later. (He told me 20-30 minutes, but I wanted to be safe).
Spindrift Seltzer (which I find very tasty) claims 10% real fruit juice In their grapefruit seltzer.
According to this study, not necessarily.
In other words, the enzyme suppressed by grapefruit doesn’t recover immediately. Your body recovers its ability to process statins slowly, about half of the knocked-out capability every 23 hours. Impacts up to 3 days after ingestion of grapefruit.
I don’t know if this study is the final best word on the subject, however.
I take atorvastatin (Lipitor), and my doctor says it’s ok to drink Ocean Spray “Diet” grapefruit juice. It’s not the same as regular juice, but a good compromise.
“Natural grapefruit flavor” may come from a grapefruit (e.g. skin oils) even if it contains zero percent juice. Or the flavor may be bacteria poop. Or something else. Some of the flavor compounds in actual grapefruit also have drug interactions, but the compounds in grapefruit flavor may be the same or completely different.
I started last week. Neither the doctor nor pharmacist said a thing about grapefruit. The SDMB probably saved my life.
My father’s doctor told him not to have them at the same meal, as the statins would not be as effective.
Since my father lost weight, his latest blood test indicates that he doesn’t need any statins so he can go back to freely drinking grapefruit juice.
It wouldn’t kill you, it just makes them less effective. You would just get a cholesterol screen later and the doctor would notice the meds aren’t working and hopefully your grapefruit addiction would come up.
You’re probably right. I was overreacting to this from the article.
No, this is not the issue. Grapefruit is metabolised by an enzyme called CYP3A4. It just so happens that this is the enzyme responsible for metabolism of many pharmaceuticals, including some statins. Metabolism of grapefruit (specifically the furanocoumarins it contains) “uses up” the CYP3A4 - the net result being that the drug in question - in this case a statin - is not metabolised as fast as expected, and so it can build up in the body, effectively creating an overdose and leading to the toxicities expected with overdosing.
This does not make the drug in question “less effective” - and in extreme cases with some drugs it could kill you. Certainly it has the potential to harm you. The two things that are important are (a) is the statin in question metabolised by the 3A4 pathway; and (b) does the selzer contain the 3A4 inhibitors?
It’s such a well known interaction that it’s pretty easy to figure out if the statin in question would be a problem. The potentially more difficult question, as others have pointed out, is whether the selzer in question contains the problem chemicals in significant quantity.
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