Rhabdomyolysis Risk for Statin Users Increased By Drinking Grapefruit Juice

Risk is Most Significant for Patients on Cholesterol-lowering Zocor

There is an increased risk of developing rhabdomyolysis, a potentially life-threatening muscle disorder, for patients taking statins when they drink grapefruit juice.  This problem occurs because grapefruit contains a chemical that inactivates a liver enzyme involved in drug metabolism, and regular consumption of grapefruit juice can lead to excessively high levels of the medicine in the blood.  The risk of developing rhabdomyolysis due to this drug-food interaction of a statin and grapefruit juice is greatest with cholesterol-lowering Zocor, according to the British Medicines and Healthcare Products Regulatory Agency.

More generally, the muscle toxicity condition called rhabdomyolysis is a recognized adverse reaction for patients taking high doses of any statin drug.  Simply put, with rhabdomyolysis a person’s muscle fibers break down and are released into the blood circulation system, thereafter potentially damaging the kidneys.

During the past year or so, the risk of rhabdomyolysis due to the use of Crestor — which is the most potent of all anti-cholesterol drugs — has been the subject of a relatively high-profile debate between the consumer advocacy group Public Citizen and AstraZeneca, the manufacturer of Crestor.  A March 2005 letter by Public Citizen to the FDA regarding Public Citizen’s allegation that Crestor has higher rates of rhabdomyolysis compared to other statins can be viewed here:

http://www.citizen.org/publications/release.cfm?ID=7370

The use of cholesterol-lowering statin medications among persons aged 45 and older more than tripled during recent years.  A statin was prescribed 40.5 physician visits per 100 population in 2001 to 2002, compared to 12.3 physician visits per 100 population in 1995 to 1996.  This trend is expected to continue due to new cholesterol treatment guidelines.

(Posted by: Tom Lamb)

4 responses to “Rhabdomyolysis Risk for Statin Users Increased By Drinking Grapefruit Juice”

  1. Joseph Baddick Avatar
    Joseph Baddick

    I have been on statin drugs for approx. 8-10 yrs. In the first 7 yrs. it was pravachol and I tolerated it okay but my prescription plan changed and it wasn’t covered anymore. My doctor put me on Lipitor and it lowered my total cholest. but my legs would throb and my toes would tingle. He then told me to try Red Yeast Rice. I did and got terrible leg cramps at night while sleeping. He told me to discontinue both the Lipitor and RYR. After a few days the cramps subsided and went away. Then my doctor said we needed to lower my LDL so he suggested Vytorin. I took it for 3 nights and on the 3rd night I jumped out of bed with terrible leg cramps again. I stopped taking it and a few days later the cramps were gone. I am also on Neurontin and have doubled my dosage at night and also started taking Ginko Biloba to increase blood flow. It has been working, my legs feel much better. If I have been experiencing Rhabdomyolysis, can I take anything to help the muscles or build them up again to where they were, or will they take care of themselves? Thanks.

  2. Jay Avatar
    Jay

    I have been on simvastatin 40mg for 5 months. After reading the enclosed leaflet, I asked my GP if I should avoid grafefruit altogether, or only at the time of day that I took my simvastatin tablet. She told me that I need only avoid taking grapefruit at the same time as the tablet. Recently I had a small bowl of tinned grapefruit pieces for my breakfast – the first time I’d had any grapefruit – and in the following two weeks I have had increasingly severe muscle pain in my arms, shoulders and back. I have been prescribed pain killers and told to stop taking simvastatin for a week and then to start taking Atorvastatin instead. I have only now linked the grafefuit juice with this reaction after finding your article and some others on this topic. I do not know how much muscle damage I have or how long it will take to repair – assuming it will. At the moment I am halfway through the non-statin week and the pains have in no way decreased. It is extremely worrying. I feel very strongly that more doctors need to be aware of this risk and give better advice to patients when prsecribing statins.

  3. Tom Lamb Avatar

    Thanks for the comment, and for reading Drug Injury Watch.
    Hopefully the information that you have shared will help patients (and doctors) become aware of this problem so other people taking statins do not have to go through what you are experiencing.
    Tom Lamb

  4. Anita Norris Avatar
    Anita Norris

    I’ve just recently started Simvastatin 20mg. At the same time I’ve started eating fresh grapefruit to get more Vitamin C, not knowing there was any potential problem from the combination. Thank you for having this information available. I’ll stop the grapefruit!

Leave a Reply to Joseph Baddick Cancel reply

Your email address will not be published. Required fields are marked *