Despite having unmatched benefits for the treatment of high cholesterol, adherence to statins remains an issue due to side effects. These aftereffects are possible with the use of all statins, but they are generally dose-dependent. Certain fruit juices, however, may raise the likelihood of deleterious effects from statins taken at regular doses.
According to the Food and Drug Administration, the vast majority of drugs are broken down with the help of the enzyme CYP3A4.
Certain drinks, namely grapefruit juice, can block the action of intestinal CYP3A4.
This means that instead of being metabolised, more of the drug enters the blood and stays in the body longer, heightening the risk of side effects.
In early reports published in the American Journal of Cardiology, the case of a 48-year-old statin user with possible myopathy (muscle soreness) was described where pomegranate juice was identified as the potential trigger.
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The patient began treatment with rosuvastatin 17 months prior to the onset of his symptoms.
“Three weeks before presentation, he began drinking pomegranate juice twice weekly,” states the report.
He eventually presented to an emergency department with thigh pain and elevated serum creatine kinase levels.
The authors noted: “This report suggests that pomegranate juice may increase the risk of rhabdomyolysis during rosuvastatin treatment.”
Elevated creatine kinase (CK) levels are a well-established indicator of recent muscle damage.
Though blood tests offer no clues as to which muscles are damaged and the exact cause of the injury, high CK levels arouse suspicion of rhabdomyolysis in healthcare practitioners.
The researchers attributed the reaction to the inhibitory effects of pomegranate juice on the hepatic enzyme P450 3A4.
Though the preliminary research proposes that pomegranate juice may interact dangerously with statins, other studies have suggested otherwise.
READ MORE: Elderly woman was hospitalised after mixing juice with statins
Past studies have suggested that the addition of pomegranate to statins may protect cells in the body against oxidative stress.
Taken together, some research provides evidence for the additional cardioprotective effects of statins, enabled by the antioxidant activity of pomegranate juice.
Pomegranate juice is loaded with disease-fighting agents that have immeasurable benefits for blood pressure and other cardiovascular risk factors.
Scientists have even suggested that a combination of pomegranate and statins may allow for lower doses of the drug, which in turn would help avoid any deleterious side effects.
Statin side effects generally involve muscle cramping, soreness, fatigue, and weakness.
The National Institutes of Health warns that in rare cases, skeletal muscle side effects include “rapid muscle breakdown that leads to death (i.e. rhabdomyolysis)”.
Because the characteristics of myopathy are wide-ranging, making an accurate and prompt diagnosis can be a challenge for researchers.
As muscle tissue starts releasing proteins into the blood, the chief complaints tend to be muscle pain, weakness and brown urine.
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