It is taken by mouth. 1, 2 This interaction was discovered by coincidence in the course of an ethanol–drug interaction study in which grapefruit juice was used to mask the taste of the ethanol vehicle. Grapefruit and certain other citrus fruits, such as Seville oranges, can interfere with several kinds of prescription medications. History. Grapefruit juice does not affect all the drugs in the categories above. We studied the effect of grapefruit juice on the pharmacokinetics of atorvastatin and pravastatin. In stroke, interaction with nimodipine may cause systemic hypotension. Grapefruit juice-simvastatin interaction : Effect on serum concentrations of simvastatin, simvastatin acid, and HMG-CoA reductase inhibitors Author LILJA, J. J; KIVISTÖ, K. T; NEUVONEN, P. J Department of Clinical Pharmacology, University of Helsinki, and Helsinki University Central Hospital, Finland Source. As little as one grapefruit or one 8-ounce glass of grapefruit juice can cause an effect that may last more than 24 hours. Frequently, when grapefruit becomes a part of the diet, the side effects of a drug-food interaction are noted in those established on Lipitor drug therapy 2. Simvastatin and grapefruit juice interaction. Simvastatin and grapefruit should not be combined because the presence of grapefruit in a person's system makes it hard to break down the active chemical in simvastatin. Grapefruit juice-simvastatin interaction: effect on serum concentrations of simvastatin, simvastatin acid, and HMG-CoA reductase inhibitors. Manufacturer advises avoid. Doctors give trusted answers on uses, effects, side-effects, and cautions: Dr. Weixel on zocor and grapefruit interaction: When fluvoxamine is taken with grapefruit juice, or even taken some time apart, the grapefruit juice may cause the fluvoxamine to build up in your body. Grapefruit juice-simvastatin interaction: effect on serum concentrations of simvastatin, simvastatin acid, and HMG-CoA reductase inhibitors. Avoid grapefruit juice when taking simvastatin Effects of other medicinal products on simvastatin. Grapefruit juice moderately decreases the exposure to aliskiren. Duration of effect of grapefruit … You can also check your Patient Medication Guide that accompanies your prescription, and your pharmacist may include a label on your bottle warning you of an interaction. Clin Pharmacol Ther. Grapefruit has the following interaction information: Abemaciclib. Although there have been no systematic investigations of a grapefruit-simvastatin interaction regarding the duration of consumption, to be on the safe side, patients taking simvastatin are advised now not to eat grapefruit or drink grapefruit juice. the maximum recommended dose for simvastatin in conjunction with amlodipine or diltiazem is now 20 mg/day A full updated listing of all the interactions is provided in the table below. Grapefruit juice is predicted to increase the exposure to abemaciclib. It is already known that grapefruits contain a group of chemicals, furanocoumarins, which can affect drug metabolism – the amount of time it takes for a drug to be broken down by the body. Clin Pharmacol Ther 1998;64(5):477-83. I like to drink grapefruit juice but hear that it can interfere with some prescription medications. There is hope if you really enjoy grapefruit. Interaction between ergotamine for migraine and grapefruit juice may cause gangrene or stroke. Is grapefruit unsafe with all statins? Eating a whole grapefruit or drinking a cup of grapefruit juice can cause a clinically significant interaction with a host of medications. Reamy BV, Stephens MB. For example, if a 20-mg dose is administered, only 1 mg reaches the systemic circulation. I was picking up my prescription as usual. Although all statins may be affected by drug interactions, simvastatin is exceptionally sensitive for several reasons. Answers from Katherine Zeratsky, R.D., L.D. There was a marked interindividual variability in the grapefruit juice–simvastatin interaction, e.g. Grapefruit juice greatly increased serum concentrations of simvastatin and simvastatin acid and, to a lesser extent, those of active and total HMG‐CoA reductase inhibitors. This time it was about Simvastatin. Currently, more than 85 drugs, most of which are available in Canada, are known or predicted to interact with grapefruit. They informed me not to eat any grapefruit. Grapefruit juice increases serum concentrations of atorvastatin and has no effect on pravastatin. 5. Severity of interaction: Moderate Evidence for interaction: Theoretical. Grapefruit juice, which is widely consumed for its positive health benefits, can have severe, sometimes fatal, interactions with drugs. Don't take these interactions lightly. Common Questions and Answers about Simvastatin and grapefruit juice interaction. Provides a summary of interactions with vitamins, herbs, and food Interactions involving inhibitors of CYP3A4. Additional grapefruit juice drug interactions, and interactions with other juices, can be researched in the Drug Interaction Checker. This increased amount of fluvoxamine will have a greater effect of both desired and undesired effects. Background: Grapefruit juice greatly increases the bioavailability of lovastatin and simvastatin. Some can cause potentially dangerous health problems. Simvastatin is a substrate of cytochrome P450 3A4. Why can’t I eat grapefruit? Clinical pharmacology and therapeutics. 5. Plasma concentrations of simvastatin and simvastatin acid were determined up to 24 h. Results This interaction substantially increased the systemic exposure to felodipine and by this amplified its pharmacodynamic effects. But this time the pharmacist’s assistant had me talk to the pharmacist about the prescription drug. The news is based on a review that has highlighted grapefruit-medication interactions that can cause serious side effects. Clin Pharmacol Ther 1998;64(5):477-83. cyclosporine). 7. Evidence shows that only one instance of grapefruit or grapefruit product consumption can be enough to cause these drugs to build up in your system, and timing doesn't matter much either. Clin Pharmacol Ther 1999;66(2):118-27. Simvastatin and the Grapefruit Connection came up today. Aliskiren. The first published clinical report on grapefruit drug interactions was in 1991 in The Lancet entitled "Interactions of Citrus Juices with Felodipine and Nifedipine." Grapefruit juice-simvastatin interaction: effect on serum concentrations of simvastatin, simvastatin acid, and HMG-CoA reductase inhibitors. [Dr. Bailey was part of the Canadian research team that discovered grapefruit interactions with the blood pressure medicine felodipine (Lancet, Feb. 2, 1991). Simvastatin: Avoid grapefruit juice and the whole fruit: Tacrolimus: Avoid grapefruit juice and the whole fruit : Adapted from New Zealand Formulary - Interactions. This interaction enhances … Common side effects include constipation, headaches, and nausea. The grapefruit-drug interaction debate: role of statins. Methods: Two randomized, two-phase crossover studies were performed--study I with atorvastatin in 12 healthy volunteers and study II with pravastatin in 11 healthy volunteers. But I do love grapefruit. One of the unique properties of simvastatin is very low bioavailability (<5%) due to high firstpass metabolism. Yes. Further information about fruit/medicine interactions is available in Stockley's Drug Interactions. When simvastatin is taken 24 hours after ingestion of “high‐dose” grapefruit juice, the effect of grapefruit juice on the AUC of simvastatin is only about 10% of the effect observed during concomitant intake of grapefruit juice and simvastatin. Lilja JJ, Kivisto KT, Neuvonen PJ. Repeated consumption has a greater effect than one exposure but certain medications’ effects are sensitive to consistent drug levels (e.g. the increase in the C max of simvastatin ranged from 2.3‐fold to 9.3‐fold and that in the AUC(0–24) from 1.8‐fold to 6.0‐fold. If grapefruit, Pomelos and Seville oranges are a part of your daily diet, notify your physician before starting therapy with Lipitor, since a lower dose might avert a potential problem 2. 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