Metabolized through the liver, can result in DDIs.
Although no specific quantity recommendations are
available, moderate amounts of alcohol (2 standard
drinks in a 24-hour period) offer less concern for pharmacokinetic
and pharmacodynamic effects than larger amounts.
Grapefruit juice contains bergamottin, a natural
furanocoumarin, which can inhibit CYP3A4 and OAT.
This inhibitory effect can last for up to 24 hours. Either
grapefruit juice should be avoided with statins or the
quantity consumed should be kept to less than 60 mL.
Separating administration of grapefruit juice and statins
by 4 hours may limit the interaction.
Like grapefruit, sweet orange (citrus sinensis) juice may
Inhibit OATP. Tangerines are related to the sweet orange
And may also have an interaction. Separation of the fruit or
Juice from statin administration by 4 hours may be advisable.
St John’s wort induces CYP3A4. There are noted
major interactions between statins and St. John’s wort, and
this combination should be avoided. St. John’s wort
mediates P-gp. It will decrease metabolism of simvastatin
and possibly atorvastatin, but not likely pravastatin, fluvastatin,
or rosuvastatin. Red yeast rice is a popular nonprescription
treatment for hyperlipidemia. Red yeast rice has
varying amounts of monacolin K (similar to lovastatin).
Products are not standardized and no red yeast rice product
Should be given to a patient taking a prescription statin.