Why can't I eat grapefruit while taking certain drugs?

Written by Shivam Patel, PharmD, BSPS, RPh | Posted December 26, 2019

It’s early in the morning, your brain has just started to warm up and it’s time for breakfast. For some people, starting each day with a glass of grapefruit juice is preferred! But this also happens to be the time when most take prescribed medications. If you are one of these people, you may have to reconsider your favorite daily beverage as it could have an impact on your medication that treats high cholesterol, high blood pressure, and more.

Why can’t I eat grapefruit with my cholesterol medication (statins)?

Statins, like atorvastatin (Lipitor), are a class of medications prescribed for the treatment of high cholesterol and triglyceride levels in the blood. Statins are used to prevent events associated with cardiovascular disease, such as stroke, heart attack, and angina. Statins work by reducing the amount of cholesterol that sticks to the walls of your arteries, thus preventing blood flow blockage to the heart, brain, and rest of your body.

According to the American Heart Association, statins are the only class of drugs that have been directly associated with a reducing the risk of stroke or heart attack.

When you take a statin, it is broken down in your body with an intestine enzyme, CYP3A. This enzyme allows your body to reduce the absorption of the drug into your bloodstream. Grapefruit juice has chemical compounds called furanocoumarins in it that stop the enzyme CYP3A from functioning properly in your intestine. When this happens, more of the drug is absorbed into your body, resulting in it becoming too powerful and, in some cases, causing toxicity which can lead to life-threatening muscle damage called rhabdomyolysis.

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Which statins are safe with grapefruit?

Grapefruit juice doesn’t affect all statin drugs equally, and if you love your grapefruit juice, there are less affected statins you could suggest switching to with your clinician.

Statins Affected by Grapefruit Juice

Large effect from Grapefruit Juice Slight or no effect from Grapefruit Juice
atorvastatin (Lipitor) rosuvastatin (Crestor) (no effect in most patients)
simvastatin (Zocor) pravastatin (Pravachol) (no effect in most patients)
lovastatin (Mevacor) fluvastatin (Lescol)
  pitavastatin (Livalo)
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I am worried I drank a glass of grapefruit juice with my statin. What will happen now?

Check the chart above and see if your statin is even largely affected by grapefruit juice. If you had a small glass, according to Harvard Medical School, you will probably be ok. This is because the studies that concluded dangerous effects with grapefruit juice and statins compared a quantity of furanocoumarins that would be found in over a quart of grapefruit juice.

According to the American Academy of Family Physicians, interactions between statins and grapefruit can occur up to three days after eating or drinking grapefruit. This means the effect of drinking grapefruit juice with statins can last for several days, so taking your statin at night then your grapefruit juice the next morning will not solve the problem.

However, we recommend to always play it safe and check with your clinician concerning any side effects you may experience as well as to avoid taking your statins with grapefruit juice.

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Isn’t grapefruit good for lowering cholesterol?

According to the American Chemical Society’s Journal of Agricultural and Food Chemistry, consuming a red grapefruit daily for 30 consecutive days along with regular balanced meals has been shown to lower LDL cholesterol by up to 20 percent. There are antioxidant compounds, called limonoids and lycopene, found in red grapefruit pulp that may yield these positive benefits.

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Why can’t I eat grapefruit juice with my high blood pressure medication?

When you take certain blood pressure medications, similar to statins, it is broken down in your body by the CYP3A enzyme. When you introduce grapefruit juice into the body, the CYP3A is not able to function like it should resulting in too much drug absorption in your body. When this happens, the medication will be stronger than normal and may cause your blood pressure to drop lower than the healthy goal determined by your clinician.  

Blood pressure medications, aka antihypertensives, are used to lower high blood pressure (HBP or hypertension). When blood pressure is high, your heart has to work much harder than usual to pump blood, which causes arteries to harden. This can lead to heart disease and even stroke. High blood pressure can also lead to kidney disease, blindness and congestive heart failure. As there are many classes (see below) of drugs to treat high blood pressure, finding the best one that works for you can be tricky, but your clinician will help you find the best regimen.

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What blood pressure medications are affected by grapefruit?

Grapefruit juice doesn’t affect all blood pressure medications, but if you are taking any of the ones listed below, speak to your clinician before you consume it.

Blood Pressure Medications Affected by Grapefruit Juice

Brand Name Generic Name
Felodipine Plendil
Nifedipine Adalat, Procardia
Losartan Cozaar
Eplerenone Inspra
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What other medications should not be taken with grapefruit?

Please be aware there are many classes of drugs (shown below) that should not be taken with grapefruit juice. If you're taking any medications, check with your doctor before eating grapefruit or drinking the juice.

Per the US FDA, examples of some types of drugs that grapefruit juice can create interactions with:

    •    Certain statin drugs to lower cholesterol, like Zocor (simvastatin) and Lipitor (atorvastatin)
    •    Certain drugs that treat high blood pressure, like Procardia and Adalat CC (both nifedipine)
    •    Certain drugs that treat abnormal heart rhythms, like Pacerone and Nexterone (both amiodarone)
    •    Certain organ-transplant rejection drugs, like Sandimmune and Neoral (both cyclosporine)
    •    Certain antihistamines, like Allegra (fexofenadine)
    •    Certain anti-anxiety drugs, like buspirone
    •    Certain corticosteroids that treat Crohn’s disease or ulcerative colitis, like Entocort EC and Uceris (both budesonide)

This is not a complete list. You can visit Drugs.com where they have a drug interaction checker you can utilize to check your medications for interactions including grapefruit.

Remember: Do not stop taking your medication without consulting your clinician first.

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