Atorvastatin, also known by the brand name Lipitor, is a common cholesterol-lowering medication. It belongs to a class of drugs called statins. Atorvastatin works by blocking an enzyme in the liver that is needed for making cholesterol. This causes the liver to remove cholesterol from the blood.
Grapefruit and grapefruit juice can interact with atorvastatin and increase the levels of the drug in your body. This interaction can cause side effects from atorvastatin to become more likely or more severe. Let’s discuss in more detail how grapefruit affects atorvastatin and what can happen if you eat them together.
How does grapefruit interact with atorvastatin?
Grapefruit contains a compound called furanocoumarin. Furanocoumarin inhibits certain enzymes in your small intestine that normally break down medications like atorvastatin before they enter your bloodstream.
By preventing the breakdown of atorvastatin, grapefruit causes more of the drug to be absorbed into your blood. Having higher levels of atorvastatin in your blood increases your risk of side effects.
One study found that drinking one glass of grapefruit juice with atorvastatin increased blood levels of the drug by about 15%. Drinking four glasses of grapefruit juice at once increased atorvastatin blood levels by 84%.
The effects of grapefruit last for 1-3 days. So they persist even if you consume grapefruit and atorvastatin hours apart.
Increased risk of side effects
Higher blood levels of atorvastatin mean that you are more likely to experience side effects. Some potential side effects of atorvastatin include:
– Muscle pain or weakness
– Liver damage
– Digestive issues like gas, constipation, or diarrhea
– Headache or dizziness
– Skin rash
– Increase in blood sugar levels
The most serious potential side effect is muscle damage called rhabdomyolysis. This can cause severe muscle pain, weakness, brown urine, and kidney damage.
By raising atorvastatin levels, grapefruit increases the chances of developing rhabdomyolysis. Cases of rhabdomyolysis have been reported when grapefruit was consumed with atorvastatin or similar statin drugs.
Severely impaired breakdown of atorvastatin
Some people have genetic differences that make them completely unable to break down certain medications in the small intestine. This includes the enzyme CYP3A4 that normally metabolizes atorvastatin.
In people with impaired CYP3A4 function, consuming grapefruit with atorvastatin could cause an even larger spike in blood levels. This dramatically increases their risk of severe side effects.
If you experience any unusual or bothersome symptoms after eating grapefruit, contact your doctor. You may need a dose adjustment or change to an alternative statin drug. Your doctor can order a blood test to measure your atorvastatin levels if an interaction with grapefruit is suspected.
Other citrus fruits
While grapefruit has the most significant effect, other citrus fruits have been found to interact with atorvastatin as well. These include oranges, tangerines, lemons, and limes. However, these fruits contain lower amounts of furanocoumarin compared to grapefruit.
One study found that orange juice increased atorvastatin levels by about 50% compared to an 84% increase with grapefruit juice. Still, you may want to be cautious when consuming large amounts of citrus juice alongside atorvastatin.
Recommendations
Here are some recommendations for avoiding issues when taking atorvastatin:
– Avoid consuming grapefruit or grapefruit juice within 24 hours of taking atorvastatin.
– Limit grapefruit to no more than one serving (1/2 grapefruit or 6 oz juice) every 2-3 days.
– Be cautious with other citrus juices like orange or lemon around the time you take your atorvastatin dose.
– Take atorvastatin at least 2 hours before or 4 hours after consuming any grapefruit or citrus juice.
– Check with your pharmacist or doctor about any other fruit juices that could interact.
– Tell your doctor if you experience unexplained muscle pain, weakness, or other side effects after eating grapefruit or citrus fruits.
Alternative cholesterol medications
If you are unable to avoid drinking grapefruit juice or eating grapefruit, talk to your doctor about switching to an alternative cholesterol medication.
Some options that do not interact with grapefruit include:
– Rosuvastatin (Crestor)
– Pravastatin (Pravachol)
– Fluvastatin (Lescol)
– Pitavastatin (Livalo)
Conclusion
Grapefruit furanocoumarin causes atorvastatin to accumulate to higher levels in the blood by preventing its breakdown. This increases the risk of side effects like muscle damage, liver toxicity, and kidney problems.
Avoid consuming grapefruit and grapefruit juice within 24 hours of taking atorvastatin. Limit citrus consumption in general around the time of your dose. Speak to your healthcare provider if you experience any unexplained side effects. Your doctor may be able to switch you to an alternative cholesterol medication that does not interact with grapefruit.
Frequently Asked Questions
How long does the grapefruit effect last with atorvastatin?
The effects of grapefruit on atorvastatin can persist for 1-3 days after consuming it. This is because grapefruit irreversibly inhibits the CYP3A4 enzyme that breaks down atorvastatin. It takes over a day for your body to produce more CYP3A4 enzymes. Always separate taking atorvastatin and consuming grapefruit by 24 hours.
Can I eat oranges, tangerines, or other citrus fruits with atorvastatin?
Other citrus fruits also contain furanocoumarin but in lower amounts than grapefruit. Eating small amounts of oranges, tangerines, lemons, or limes should not cause a significant interaction. But avoid drinking large quantities of these citrus juices near the time you take atorvastatin.
What are the symptoms of an atorvastatin and grapefruit interaction?
Symptoms of too much atorvastatin due to grapefruit include muscle pain, tenderness, or weakness (potentially rhabdomyolysis), nausea, stomach pain, headache, increased blood sugar, and liver dysfunction. Contact your doctor immediately if you experience any unusual side effects after consuming grapefruit.
Can I eat grapefruit if I take atorvastatin every other day?
It’s best to avoid grapefruit completely if you’re prescribed atorvastatin daily, even if at a lower dose. If you only take atorvastatin every other day, you could consume grapefruit on your off days as long as it’s been over 24 hours since your last atorvastatin dose. But check with your doctor or pharmacist first.
What other drugs should I avoid with grapefruit?
In addition to statins like atorvastatin, grapefruit interacts with several other common medications. These include certain calcium channel blockers, immunosuppressants, HIV medications, erectile dysfunction drugs, antidepressants, and benzodiazepines. Always check with your pharmacist.
Tables and Data
| Medication Class | Example Drugs |
|---|---|
| Statins | Atorvastatin, simvastatin, lovastatin |
| Calcium channel blockers | Amlodipine, felodipine, nifedipine |
| Immunosuppressants | Cyclosporine, tacrolimus |
| HIV medications | Maraviroc, raltegravir |
| Erectile dysfunction drugs | Sildenafil, tadalafil |
| Benzodiazepines | Diazepam, triazolam |
This table shows some of the main drug classes besides statins that interact with grapefruit and increase side effects when taken together.
| Citrus Juice | Increase in Atorvastatin Levels |
|---|---|
| Grapefruit juice | 84% |
| Orange juice | 50% |
| Apple juice | No significant effect |
This table compares the effects of different fruit juices on atorvastatin blood levels. Grapefruit juice causes the largest increase.
