yatzek

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whats the deal here, i told a pt today that they can have up to a quart (4 cups) of gf juice with their simvastatin 20mg and still be ok... but im looking up info on the internet and they are saying that even 1 cup will inhibit 3A4 and be harmful.... what do you guys say? i dont want this pt to come back with rhabdo and blame me
 

psurocks

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put em on pravastatin which doesnt have this interaction :)

i recommend them to switch over to orange juice
 
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girllein

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No grapefruit juice. It's a fundamental drug-food interaction.
 

girllein

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If grapefruit juice is that important to them and they take roughly the same amount of grapefruit juice every day/week you can dose around it...start low...titrate up...
Yeah. Like them helpin's of greens that old people eat who take rat poison (warfarin). They shouldn't be gettin' an extra scoop of greens from the old folk's home cafeteria ladies even if they can schmooze it out of 'em.

Consistency, consistency, consistency.
 

Quiksilver

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who in their right mind actually chooses to drink grapefruit juice?
fyi, its effects can last up to 72 hours

Why don't you just balance it out and take some st john's wort?


I guess this proves not to give advice blindly. If you don't know 110% then maybe you should be less reassuring.
 

girllein

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Or you could suggest some ginkgo in case you really wanted to spike their levels.
 

RxWildcat

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Conclusions
Even one glass of grapefruit juice, taken daily, considerably increases the plasma concentrations of simvastatin and simvastatin acid. Grapefruit juice may increase both the cholesterol-lowering effect and the risk of adverse effects of simvastatin.

Link

So did you just guess at the answer to give the patient? I say you better tell them the correct info the next time you see them.
 

janeno

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whats the deal here, i told a pt today that they can have up to a quart (4 cups) of gf juice with their simvastatin 20mg and still be ok... but im looking up info on the internet and they are saying that even 1 cup will inhibit 3A4 and be harmful.... what do you guys say? i dont want this pt to come back with rhabdo and blame me
My recommendation would be to call a patient, apologize, and recommend them to avoid grapefruit juice (most pharmacies have patient phone numbers). There are several data suggesting increased simvastatin concentrations with gf juice consumption, and 4 cups of juice is A LOT. Also, I would be more concerned about elevation of liver enzymes than rhabdo with gf juice.
 

meister

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Yeah dude I'm afraid you just won a ticket on the home phone call pharmacist apology train. Enjoy! I'm sure he'll be glad to know that not only can he not drink grapefruit juice anymore, but his simvastatin blood levels are way out of whack currently. Cool!

I never understood why the older patients care so much about grapefruit juice, give me a break. Just being contrarian windbags.
 

yatzek

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eh...,i talked to the pharmacy manager, she said she always tells them its ok to have some grapefruit juice... (she actually thinks its a bunch of bs, lol)... hopefully this dude is not some serial binge grapefruit drinker... he is only on 20mg anyway...
i looked up epocrates and uptodate and they both say up to 1 quart is ok... nevertheless, im not going to say its ok anymore...

-ps, that paper posted above was about daily consumption of gf juice... the inhibition doesnt rev up like induction so if they only have a cup every now and then the statin levels will only be elevated momentarily... not saying its safe but another reason to worry less
 

FORTLIVINGROOM

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Where do you "practice" so I can make sure my family never goes there!

I mean honestly, giving pt's advice when you don't even know the implications?

That's called negligence. And if something happens to the pt and it comes back to your "advice"...kiss your license goodbye.
 

aboveliquidice

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eh...,i talked to the pharmacy manager, she said she always tells them its ok to have some grapefruit juice... (she actually thinks its a bunch of bs, lol)... hopefully this dude is not some serial binge grapefruit drinker... he is only on 20mg anyway...
i looked up epocrates and uptodate and they both say up to 1 quart is ok... nevertheless, im not going to say its ok anymore...

-ps, that paper posted above was about daily consumption of gf juice... the inhibition doesnt rev up like induction so if they only have a cup every now and then the statin levels will only be elevated momentarily... not saying its safe but another reason to worry less

You never, ever hear about something in pharmacy unless it has happened and been a problem. I would imagine at one point people thought it was a great idea to use Tylenol the night of to get over hangovers...

You now know about grapefruit juice and CYP3A4. You can now apply that same concept to every drug that is predominantly CYP3A4... trust me, your gonna see this interaction again.

Don't be so quick to pass off things just because your preceptor doesn't care. Its your clinical judgment under development - not his.
 

RxWildcat

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eh...,i talked to the pharmacy manager, she said she always tells them its ok to have some grapefruit juice... (she actually thinks its a bunch of bs, lol)... hopefully this dude is not some serial binge grapefruit drinker... he is only on 20mg anyway...
i looked up epocrates and uptodate and they both say up to 1 quart is ok... nevertheless, im not going to say its ok anymore...

-ps, that paper posted above was about daily consumption of gf juice... the inhibition doesnt rev up like induction so if they only have a cup every now and then the statin levels will only be elevated momentarily... not saying its safe but another reason to worry less


"well they said it would be OK" is never an acceptable reason to do something! Try using that line on rotations and see what happens.
 

meister

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eh...,i talked to the pharmacy manager, she said she always tells them its ok to have some grapefruit juice... (she actually thinks its a bunch of bs, lol)... hopefully this dude is not some serial binge grapefruit drinker... he is only on 20mg anyway...
i looked up epocrates and uptodate and they both say up to 1 quart is ok... nevertheless, im not going to say its ok anymore...

-ps, that paper posted above was about daily consumption of gf juice... the inhibition doesnt rev up like induction so if they only have a cup every now and then the statin levels will only be elevated momentarily... not saying its safe but another reason to worry less
You have to consider what we're talking about here. If someone flinches when you mention eliminating grapefruit juice from their diet, you can safely assume they don't drink it in moderation because any normal person would say "Oh well that's fine since grapefruit juice is disgusting anyway." So the people who are double-checking are the serial consumers already.
 

Ross434

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switch to a different drug
grapefruit juice is too awesome to cut down on
 
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