This is the most important post in this entire thread. Rapa CAN NOT be combined with tacrolimus/ cyclosporine in the same table when discussing drug interactions. This is highly misleading and suggests a risk with rapa + statins that doesn’t exist.
Yes. When I did my preliminary research, it appeared Ezetimibe or an Omega-3 supplement would provide a roughly equal benefit and would provide the same benefit whether you took only one or both. So taking Ezetimibe on top of Omega-3 seems like just a waste of time and money. I’d rather stick with Omega-3 for brain health and cardiovascular protection.
That is very interesting. My personal n of 1 experience is a little different though. I started taking high dose Omega 3 (3-4g per day) in order to get my triglycerides under control. This appeared to work. I resorted to this because even though my doctor kept raising my statin dose (from 20mg through to 80mg) my triglycerides remained stubbornly high. Once my triglycerides were under control I gradually started backing off the Omega 3 dose to 1g. This was primarily due to cost (I take Omega 3 from algae as a vegan and they are comparatively expensive).
I added the Ezetimibe in March of this year to try and further lower my LDL. I tested after two months and my LDL was significantly improved vs the Atorvastatin monotherapy. My triglycerides remained low too so I question the Omega 3 absorption conflict - at least for me personally. I suppose time will tell with future testing. Good luck with your journey Chris.
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I take ezetimibe and rosuvastatin. Upped the dose about 4 months ago to 4x a week from 3x (my lipids were ok but I wanted better). Haven’t noticed any problems and lipids have improved. I had some concern with ezetimibe because I take GF juice with Rapa but everything is ok. I do take the lipid pharmaceuticals on different days.
I just read an article on placebos. What makes this article interesting is that many times the placebo works even if the patient knows it is a placebo. It could explain why hemopathy works.
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AnUser
#26
No wtf, GFJ interacts with atorvastatin since it is metabolized by CYP3A4 which GFJ inhibits…
My god GFJ discussion should be completely banned to discussed here. All CYP3A4 inhibitors should be banned. The discussion is just bad, just to save some money.
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GFJ is fine to take with Rapamycin if you are aware of what it does. But it also can multiply some statins.
J0hn
#28
If memory serves me right, I think some statins (fluvastatin, rosuvastatin, or pravastatin), are relatively unaffected by GFJ
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Appreciate the concern. Atorvastatin is one of those affected by grapefruit which is why I reduce the dose (even 14 hours after having the grapefruit) as a precaution.
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AnUser
#30
Why do you think taking atorvastatin 14 hours after GFJ will prevent it from interacting?
The interactions happen even after 24 hours, even for a few days.
It’s exactly because I expect the grapefruit to interact that I reduce the dose. I’m sorry if that wasn’t clear. I’ve been doing this for seven months now and haven’t had any problems yet (and nothing that’s shown up in any bloodwork). But perhaps I should reduce the dose a little further just to be absolutely certain.
AnUser
#32
It’s a large increase at 24h.
Anyway it doesn’t make sense to me to take grapefruit juice while taking an interacting medicine.
Usually, the peak inhibition of the liver enzymes by GFJ occurs 1-4 hours after intake. So, 14 hours after taking GFJ, the liver enzymes should be replenished and there should not be any increase of statin effectiveness. That’s how it works with Rapamycin at least.
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Thanks for clarifying this. Clearly this is something I should remain vigilant with though. Safety first. I appreciate all the help and guidance.
GFJ effect is long lasting.
“ The interval between the ingestion of grapefruit and the adminstration of the interacting drug has some effect on pharmacokinetics. For example, a single glass (200 mL) of grapefruit juice ingested within 4 hours before felodipine produced the maximal pharmacokinetic interaction.Thereafter, an increased interval between ingesting the 2 substances slowly decreased the size of the effect — an interval of 10 hours produced an effect that was 50% of the maximum, and an interval of 24 hours produced an effect that was 25% of the maximum.Thus, a modest solitary quantity of grapefruit can have sufficient duration of action to affect interacting drugs that are administered once daily at any time during the dosing interval. Furthermore, repeated ingestion of grapefruit (200 mL of juice, 3 times/d for 7 d) doubled the size of the interaction for 24 hours, consistent with a cumulative inhibitory action.”
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Thank you Joseph, this has set my mind to rest for now. Especially this part:
“taking atorvastatin in the evening and drinking grapefruit juice in the morning (300 mL/d from a specific lot prepared by the Florida Department of Citrus) resulted in drug serum concentrations that were 119%–126% of those seen with no consumption of grapefruit, with no evidence of skeletal muscle toxicity (e.g., elevated creatine phosphokinase, myalgia).”
So by pure fluke and exercising some caution I appear to have accidentally got it right by reducing my atorvastatin from 80mg to 60mg on the grapefruit day (which is only once per fortnight). If the comparative serum concentration is then 126% (at worst) then my 60mg would be equivalent to 76mg. My usual dose is 80mg so happy days!
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@约瑟夫_拉维尔 Thanks for the paper. It differs a little bit with the Rapamycin and GFJ study I read before which said after 4 hours there was a large drop off of added effectiveness. Either way, I’d assume the worst and if you take it after 4 hours it looks like about a 2X multiplier for some statins.
But since I only take GFJ and Rapamycin once per week this isn’t an issue for those doing this. As for statins, which are taken daily, it’s important to know that the dose is being multiplied as well and this should be taken into account.
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I looked for data because I recall reading here that some people did GFJ the night before a rapa dose as well as the morning of. This paper would suggest there is a bigger multiplier for repeated GFJ dosing before rapa. I have been doing a 12 hours prior (night before), 2 hours prior (morning of) and concurrent GFJ with my rapa dosing. But I haven’t gotten a blood test to assess blood levels…I’ve been going off feel…which has, in part, led me to shift to a 2 week cycle.
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burton
#39
be careful with statins, the data for their efficacy is weak.
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burton
#41
Ad hominem attacks serve no useful purpose, I have read the original scientific papers on statins, I have reviewed the positions of the European and American Cardiology associations which curiously are distancing themselves from the cholesterol hypothesis. My purpose in posting a low level but accurate video link was to offer an easy introduction to the problems of this drug class without posting papers that require hours to comprehend. Dr. Attia’s book endorses statins however the data does not support this position. People need to understand the incredible bias of medical literature. If one examines the COVID response by our journals, FDA, CDC, Universities then willful blindness as personified by your unquestioning support of the cholesterol hypothesis can be bad for your health.
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