MAJOR — Use With Caution
🔴 MAJOR — Do NOT combine grapefruit with Simvastatin. Switch to pravastatin or rosuvastatin if you eat grapefruit regularly.
Evidence level: STRONG
Grapefruit can increase simvastatin levels by up to 15 times. This dramatically raises the risk of severe muscle damage (rhabdomyolysis), a potentially life-threatening condition.
Furanocoumarins in grapefruit irreversibly inhibit intestinal CYP3A4, increasing simvastatin bioavailability up to 15-fold and raising risk of rhabdomyolysis.
Completely avoid grapefruit and grapefruit juice while taking simvastatin. Even small amounts are dangerous. Ask your doctor about switching to pravastatin or rosuvastatin, which are not affected.
Take Simvastatin in the evening. CRITICAL: Grapefruit and grapefruit juice inhibit CYP3A4 and can dramatically increase blood levels of atorvastatin, lovastatin, and simvastatin — this raises rhabdomyolysis risk. Pravastatin and rosuvastatin are less affected. Grapefruit can be consumed normally unless it is grapefruit.
Elderly, high-dose statin users, patients with kidney or liver disease
Unexplained muscle pain, dark urine, extreme fatigue, muscle weakness
Ask about switching to pravastatin or rosuvastatin if grapefruit is part of your diet
Statin interactions often involve liver enzyme competition. Ask your doctor about alternative statins (rosuvastatin and pravastatin have fewer CYP interactions) or spacing doses 12 hours apart. CoQ10 supplementation may help with statin-related muscle discomfort.
Grapefruit can increase simvastatin levels by up to 15 times. This dramatically raises the risk of severe muscle damage (rhabdomyolysis), a potentially life-threatening condition.
Take Simvastatin in the evening. CRITICAL: Grapefruit and grapefruit juice inhibit CYP3A4 and can dramatically increase blood levels of atorvastatin, lovastatin, and simvastatin — this raises rhabdomyolysis risk. Pravastatin and rosuvastatin are less affected. Grapefruit can be consumed normally unless it is grapefruit.
Unexplained muscle pain, dark urine, extreme fatigue, muscle weakness
Statin interactions often involve liver enzyme competition. Ask your doctor about alternative statins (rosuvastatin and pravastatin have fewer CYP interactions) or spacing doses 12 hours apart. CoQ10 supplementation may help with statin-related muscle discomfort.
Ask about switching to pravastatin or rosuvastatin if grapefruit is part of your diet
Or browse the full interaction database (121,000+ pairs).