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Absorption, distribution, metabolism and excretion
- Simvastatin is metabolized by the cytochrome P450 enzyme CYP3A4. This enzyme is inhibited by compounds in grapefruit juice which will lead to an increase in the circulating blood levels of simvastatin and increasing the likelihood of experiencing the known side effects of statins, in particular muscle pain. It is thought that furanocoumarins (e.g. bergamottin) are primarily responsible for inhibiting CYP3A4.
- Not all statins are affected equally by grapefruit juice. Whilst simvastatin, atorvastatin and lovastatin are significantly affected by grapefruit, fluvastatin, pravastatin or rosuvastatin have no contraindication with grapefruit juice consumption. So Mr Ford could ask his GP to change his medication from simvastatin to one of the statins that do not interact with grapefruit.