Patients often don’t understand drug interactions. In this scenario, I’ll discuss the statin and grapefruit juice interaction and really what we can do about it. For more clinical pearls on statins, be sure to check out this podcast!
Upon assessment of a patient’s medications, your patient reports that she isn’t taking her statin medication. She has a past history of heart attack, stroke, as well as type 2 diabetes. She is certainly at risk of future cardiac and stroke events and the use of a statin is a must if possible.
When questioned why she wasn’t taking her simvastatin, she had stated that she was taking grapefruit juice and that she believed that the grapefruit juice would do the same thing. The statin and grapefruit juice interaction doesn’t quite work that way. In the patient’s defense, she had never been explained how the interaction works and that the concentration of the statin is increased by enzyme inhibition. After explaining this, she understood that the grapefruit juice likely wasn’t benefitting her as far as reducing her risk of heart attack and stroke.
She still stated she was going to do her grapefruit or grapefruit juice every morning because it really makes her feel good. In this situation, it makes most sense to switch simvastatin to pravastatin or maybe more likely since she is at such high risk for future problems, a higher intensity statin like rosuvastatin which will likely not have the same interaction than the simvastatin would. Another potential option would be to continue the simvastatin and monitor labs and looking out for signs and symptoms of statin toxicity. I probably prefer a switch since she wasn’t taking the medication anyway at this point in time.
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