Why Can’t I Have Grapefruit With My Statin?

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Roni Shye
Roni Shye, PharmD BCGP BCACP, is a licensed pharmacist in the states of Florida, Ohio, and Pennsylvania.
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If you take a statin like Lipitor (atorvastatin) or Zocor (simvastatin) to lower your cholesterol, you’ve probably been told to avoid grapefruit and grapefruit juice. You might be wondering—why? If so, here’s your answer.

Statins are metabolized in the liver by a select group of enzymes. Grapefruit can also attach to these enzymes, which can lead to decreased statin metabolism—meaning your body won’t process the medication the way it’s supposed to. So, grapefruit and statins together can lead to increased levels of the statin in your body. This can cause a five-fold increased risk of adverse events (unpleasant or harmful side effects), most commonly muscle pain (myopathy). This interaction only applies to grapefruit, and will not occur with any other fruits or vegetables.

There is hope, however, if you really enjoy grapefruit. Not all the statins have the same interaction. The effect is only seen with Lipitor, Zocor, and Mevacor (lovastatin). Lipitor and Zocor are the most widely used statins in the country, so many people associate statins with the restriction, but the ban on grapefruit is actually for those three in particular.

It’s fine to continue enjoying your grapefruit with Pravachol (pravastatin), Crestor (rosuvastatin), Lescol (fluvastatin), or the newest statin, Livalo (pitavastatin). However, Crestor and Livalo are brand-name only and the cost can be significantly higher, even with insurance. And Pravachol and Lescol are both low-potency statins, so keep in mind that you may end up needing a stronger option.

If you must take Lipitor, Zocor, or Mevacor, you will need to avoid grapefruit and find an alternative fruit to enjoy. If you love grapefruit or grapefruit juice, one of the alternatives may be for you.

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