Although the authors measured increases in plasma levels of simvastatin and its active metabolites, they did not report any adverse effects. In a Finnish study 3, healthy volunteers consumed multiple daily doses of double-strength GFJ prior to and on the day of taking a first dose of 60mg simvastatin (cf. The key literature regarding simvastatin is as follows. Furthermore, the BNF considers only simvastatin-not atorvastatin-to have a “potentially serious” interaction with grapefruit juice. To this end, it is important to confirm and reiterate that there is no contraindication to GFJ consumption in those taking pravastatin, fluvastatin or rosuvastatin. As such, the British National Formulary (BNF) cites an interaction between grapefruit juice and these two drugs. GFJ has been shown experimentally to decrease the pre-systemic metabolism of simvastatin and atorvastatin, thus increasing drug bioavailability. This negative slant on GFJ-particularly in the context of statin therapy-has led us to detail some of the key publications, which span the last 13 years, in an attempt to better balance the editorial and enable appropriate discussion with patients. ![]() Likewise, there is little formal evidence of an impact, even from large scale clinical trials, with adjudicated and well documented endpoints. This is despite our day to day experience of managing patients on statins, calcium channel antagonists, anti-platelet agents and anti-arrhythmics, which covers over 10,000 patients in the last 10 years alone. In our experience, and in that of our experienced colleagues, we have yet to come across clinically meaningful interactions of drugs and GFJ. In some cases this may be a barrier to concordance with the recommended therapy. When prescribing statins for example, primary care colleagues are commonly taught to advise patients to completely remove the fruit and the juice from their diet. GFJ is rich in flavonoids, that have a preventive influence on many chronic diseases 2, but this fact is overshadowed by the possible risk of interactions between drugs and GFJ. This picture is rather biased and adds to the burden of fear that GFJ and drug interactions have attracted amongst healthcare providers and patients alike. The numerous health benefits of GFJ were not described, nor was the rarity of clinically significant GFJ-drug interactions. It focused significantly on “severe, sometimes fatal, interactions” and was based on pharmacology and case reports. ![]() In a recent editorial 1, Prof Pirmohamed provided a concise update on the interactions between grapefruit juice (GFJ) and various drugs.
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