How Much Grapefruit Can You Safely Consume On Lipitor (Atorvastatin)?

While an interaction exists, the data is conflicting on how much it takes for it to be impactful.

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Jun 13, 2019

nomen nescio asked

Is there a safe amount of grapefruit to consume if I'm taking atorvastatin? I'm interested specifically in Spindrift grapefruit sparkling water, which contains 10% grapefruit juice (so 1.2 ounces per can). Thank you.

At a glance

  • Grapefruit and grapefruit juice can inhibit CYP3A metabolizing enzymes, which are responsible for Lipitor (atorvastatin) metabolism. Studies offer conflicting data on just how much grapefruit it takes to produce a clinically significant interaction.

Answer

Grapefruit Cut Up On Table With Text - How Much Is Safe To Take With Lipitor?

It has been fairly well documented that grapefruit juice can interact with several drugs, including Lipitor (atorvastatin), a 'statin' medication used to lower cholesterol.

However, how much grapefruit juice one needs to consume to produce a clinically significant drug interaction isn't entirely known.

Several sources report eating as little as one grapefruit can cause issues. In terms of the actual juice, some studies have shown that less than one cup (~240 mL) of 100% grapefruit juice can cause an interaction.

Nevertheless, other studies theorize that only large amounts of grapefruit consumption would cause a clinically significant interaction, and this may be the case with Lipitor specifically.

The FDA-approved prescribing information for Lipitor does warn about a grapefruit juice interaction, but only when consuming very large amounts (1.2 liters of juice!):

References
  1. Time course of recovery of cytochrome p450 3A function after single doses of grapefruit juice. PubMed
  2. Relationship between time after intake of grapefruit juice and the effect on pharmacokinetics and pharmacodynamics of nisoldipine in healthy subjects. PubMed
  3. Interactions between grapefruit juice and cardiovascular drugs. PubMed
  4. Lipitor Prescribing Information. Access FDA
  5. Grapefruit Juice and Statins. PubMed

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