Abstract:

Aims

Simvastatin, a substrate for CYP3A4, is extensively metabolized during the first pass. Our aim was to investigate the effect of regular consumption of grapefruit juice on the pharmacokinetics of simvastatin. Methods

In a randomized cross-over study with two phases, 10 healthy volunteers ingested grapefruit juice 200 ml or water (control) for 3 days. On day 3, a single 40-mg dose of simvastatin was administered with grapefruit juice 200 ml or water. Plasma concentrations of simvastatin and simvastatin acid were determined up to 24 h. Results

Grapefruit juice increased the area under the plasma concentration–time curves from 0 to 24 h [AUC(0–24)] of simvastatin 3.6-fold (range 1.8–6.0-fold; P < 0.01) and that of simvastatin acid 3.3-fold (range 2.1–5.6-fold; P < 0.01), respectively. The peak concentrations (C_max) of simvastatin and simvastatin acid were increased 3.9-fold (range 2.3–9.3-fold; P < 0.01) and 4.3-fold (range 2.7–7.9-fold; P < 0.01) by grapefruit juice. 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.

Keywords: food–drug interaction; grapefruit juice; simvastatin

Document Type: Research article

DOI: 10.1111/j.1365-2125.2004.02095.x

Affiliations: 1: Department of Clinical Pharmacology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland