6/26/2023 0 Comments Grapefruit and statinsFor these drugs, interactions are usually specific to the statins via the CYP3A4 pathway. In 2014, the FDA issued a warning 3 about the use of statins with protease inhibitors and non-nucleoside reverse transcriptase inhibitors. However, the following may need to be avoided with any statin: gemfibrozil, grapefruit (and related fruit juice), St. Rosuvastatin, pravastatin, pitavastatin, and fluvastatin are metabolized through different enzyme pathways and may potentially have fewer severe drug-drug interactions than the previously mentioned statins. Because atorvastatin is less dependent on CYP3A4, it may be less susceptible to interactions mediated by that enzyme system, but may nevertheless interact with similar drugs. 2īoth simvastatin and lovastatin are more dependent on CYP3A4 for elimination and so the likelihood of drug-drug interactions is higher than with other drugs in the class. 1 In 2013, the American College of Cardiology/American Heart Association made a strong statement against using gemfibrozil with any statin. The maximum concentration is generally not affected when statins are combined with fenofibrate. Gemfibrozil can increase the maximum statin concentration of most agents except fluvastatin. 1įenofibrate is generally the fibrate of choice, when combined with a statin. However, experts recommend starting Asians and Asian-Americans on low doses of all statins. Labeling for pitavastatin, atorvastatin and fluvastatin does not include a special population warning for Asians. Rosuvastatin labeling also includes information about higher blood levels of statins in Asians. In particular, the FDA has cautioned against treating Chinese patients with simvastatin doses higher than 20 mg/day, when combined with niacin. Serum statin levels are often higher in Asians compared to whites, because of genetic differences in the expression of membrane transporter proteins that play a role in statin metabolism. Separating consumption of these juices from statin administration by 4 hours may also limit the interaction. Patients should either avoid these juices altogether or limit consumption to 60 mL per serving. Tangerines are related to sweet orange and may also inhibit OATP. Sweet orange (citrus sinensis) may inhibit OATP, which helps mediate hepatic uptake and facilitates statin metabolism. CYP3A4 and OAT are membrane transporters involved in the metabolism of certain statins. Grapefruit juice can inhibit CYP3A4 and OAT for up to 24 hours. Please click below for answer and next question.
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