New Cholesterol Guidelines Pose Interaction Dangers

New guidelines have just been issued for cholesterol control. People at high risk of heart disease are now being encouraged to get bad LDL cholesterol under 70. Their prior goal was 100.
To accomplish this, most patients will need high doses of cholesterol-lowering medications, primarily statins. Diet and exercise alone may not achieve such drastic cholesterol reduction.
Drugs like Lipitor, Zocor, Pravachol, Mevacor, Lescol and Crestor have become extremely popular in recent years. At last count more than 10 million Americans take statins, a number that is likely to increase with the new guidelines.
Cardiologists believe that nearly 40 million people need these medications.
Although statins are effective for lowering cholesterol and reducing the risk of heart disease, they have risks and interactions. One of the most interesting is with grapefruit. Both the fruit and the juice can increase blood levels of Mevacor (lovastatin), Lipitor and Zocor.
Doctors occasionally advise patients taking these drugs simply to avoid grapefruit. The Florida citrus industry has suffered as a result.
But some readers have suggested turning lemons into lemonade: “Here’s an a idea to help offset the rising cost of medications. If research shows that grapefruit can raise the blood levels of certain drugs, wouldn’t it be possible to allow the patient to continue eating grapefruit as part of a daily regimen and lower the dose of the medication? This would allow the patient to use less of the medicine and therefore save money.”
There may be people who could implement this idea with their physicians’ supervision. But it would be tricky. The grapefruit reaction varies greatly from one person to another. A patient would need to get an identical amount of grapefruit daily, and the doctor would need to determine if the dose were working properly.
Side effects such as muscle aches and pains could be more common on grapefruit-boosted statins, however. This might be especially hazardous with the higher doses of drugs like Lipitor and Zocor now being recommended to get LDL cholesterol below 70.
For doctors and patients who don’t want to worry about grapefruit interactions, beneficial or harmful, some cholesterol-lowering medications may be a better choice than others. Grapefruit should not affect Crestor, Lescol or Pravachol.
To learn more about how grapefruit interacts with statins, blood pressure medicines, sleeping pills, heart drugs and anti-seizure medications, we offer readers of this column our Guides to Grapefruit Interactions and Cholesterol-Lowering Drugs. Anyone who would like copies, please send $3 in check or money order with a long (no. 10) stamped (60 cents), self-addressed envelope:
Graedons’ People’s Pharmacy, No. JL-97, P. O. Box 52027, Durham, NC 27717-2027.
Other interactions may also be troublesome with high doses of certain statins.
Adding cholesterol-lowering drugs like niacin or gemfibrozil to achieve low LDL goals may increase the risk of muscle breakdown. Some antibiotics and antifungal medications can also pose risks. To maximize the benefits of statins, patients need to monitor their response closely and stay in touch with their doctors.