How can we use this information clinically? If you have a patient that loves grapefruit juice, recommending an agent like rosuvastatin over atorvastatin can be helpful to avoid a drug-food interaction and minimize the risk of statin adverse effects. In clinical practice, having different drugs that use different breakdown pathways is helpful as it allows us to have options to avoid drug interactions. Statins NOT Dependent Upon CYP3A4 Metabolism – Unlikely to Interact With Grapefruit Juice Here’s a quick breakdown: Statins Broken Down By CYP3A4 – Likely to Interact With Grapefruit Juice Not all of these statins are primarily broken down by CYP3A4. The five most common statins I see used in clinical practice are atorvastatin, rosuvastatin, simvastatin, pravastatin, and lovastatin. By blocking this enzyme, you essentially allow concentrations to escalate higher than they normally would and thus increase the risk of adverse effects like myopathy and rhabdomyolysis. CYP3A4 breaks down numerous medications including some of the most common statins. Grapefruit juice can inhibit the enzyme CYP3A4. It is well-known that many common statins do interact with grapefruit juice, but it is also true that some statins aren’t significantly altered by it. Grapefruit juice is a lightning bolt when it comes to dietary products/foods that interact with medications. I have heard and read this type of comment before, and it is not true. A common misconception amongst healthcare professionals who may not have as much experience with drug interactions is that ALL statins interact with grapefruit juice. Drug food interactions are common and there can be significant negative consequences from these interactions.
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