Why Can’t I Drink Grapefruit Juice with Zocor?

Summary: Drinking grapefruit juice while taking Zocor can cause the levels of Zocor in the body to rise and can lead to a serious side effect called rhadomyolysis. The only options are to not drink grapefruit juice at all or switch to other less effective or more costly medications.

Dear Curtis: I have high cholesterol and my doctor has prescribed Zocor because it’s available in generic. The pharmacy that gave me the tablets put a warning label on the bottle that said not to take it with grapefruit juice. Problem is I love the stuff and usually have 2 or 3 glasses a week with breakfast. Will it really hurt that much to just have an occasional glass?

The most important thing is that you understand WHY all this happens. That will allow you and your doctor to make the decision that is best for you.

Grapefruit juice actually inhibits an enzyme in your liver called cytochrome P450 3A4. This is the same enzyme that is used to break down Zocor. So, when grapefruit juice inhibits that enzyme, your body can’t break down Zocor and the chances of the drug building up in your body rise.

When that happens you run the risk of seeing some of the more serious side effects of Zocor. Primarily one called rhabdomyolysis. Which is essentially a product of muscle breakdown. This condition is characterized by severe muscle pains.

Unfortunately, Zocor is probably the worst culprit of any of the ‘statin’ cholesterol medications in regards to the grapefruit juice interaction. In short, you should completely avoid drinking grapefruit juice with simvastatin.

Other medications in the statin class, like lovastatin (Mevacor) and atorvastatin (Lipitor), are still not recommended to be taken with grapefruit juice. However, studies indicate that there isn’t as severe an interaction with these drugs and grapefruit juice as there are with Zocor. It is suggested with Mevacor and Lipitor that if you keep your grapefruit juice to no more than 8 ounces it should be okay.

Other Options

There are cholesterol medications that you can switch to that don’t have any interaction with grapefruit juice. For example, pravastatin (Pravachol), fluvastatin (Lescol) and rosuvastatin (Crestor). None of the medications are involved in the same enzyme pathway with grapefruit juice.

However, the biggest problems with these medications are twofold:

  1. Effectiveness: while Zocor, on a milligram for milligram basis, isn’t the most potent statin medication. It is probably second in line behind Lipitor (atorvastatin). Which leads to…
  2. Cost: Lipitor is, at the time of this writing, only available as brand and is much more expensive than generic Zocor. The same with Crestor. So Zocor gives you good combination of price and effectiveness.

Or course, this is something you’ll have to discuss with your doctor but as far as a combination of price and effectiveness, generic Zocor does a pretty good job. You’ll have to decide if your morning glass of grapefruit juice is worth the switch to another medication.

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