Simvastatin
Statins competitively inhibit 3-hydroxy-3-methylglutaryl-coenzyme A reductase, the rate-limiting enzyme in hepatic cholesterol biosynthesis.
Kitchen Food, Drink & Dietary Conflicts
Biochemical interactions with common foods, beverages & cooking ingredientsEat a low-fat, low-cholesterol diet. Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. You can also visit the National Cholesterol Education Program (NCEP) website for additional dietary information at https://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf . Talk to your doctor about eating grapefruit or drinking grapefruit juice while taking this medicine.
Grapefruit / Pomelo (Citrus paradisi / Citrus maxima)
Destroys enterocyte CYP3A4 enzymes, collapsing first-pass drug metabolism and causing up to 12-fold spikes in bioavailability for oral CYP3A4 substrates (statins, calcium channel blockers, immunosuppressants, PDE5 inhibitors).
Fresh Orange Juice & Apple Juice (OATP Influx Blockers)
Unlike CYP3A4 inhibitors that increase drug levels, fruit juice bioflavonoids block the enterocyte OATP influx pumps, plummeting absorption of oral fexofenadine (Allegra), ciprofloxacin, and atenolol by 30-70%.
Alcoholic Beverages (Beer, Wine, Spirits)
Multiplies respiratory depression and profound sedation with opioids and sedatives; blocks hepatic lactate uptake with metformin (lactic acidosis); triggers acute disulfiram-like vomiting and tachycardia with metronidazole; and accelerates dose-dumping in extended-release capsules.
Prescription & OTC Drug Interactions (DDI)
Documented pharmacological conflicts & contraindicated co-prescriptionsDietary Supplements, Herbs & Minerals (DNI)
Interactions with over-the-counter vitamins, minerals, and herbal preparationsSt. John's Wort (Hypericum perforatum)
Hyperforin potently activates the Pregnane X Receptor (PXR), inducing hepatic CYP enzymes and intestinal P-gp pumps. This accelerates medication clearance and precipitates therapeutic failure.
Drug-Induced Nutrient Depletion & Nutritional Defense
Micronutrient depletions caused by pharmacological pathways & recommended replenishmentCoenzyme Q10 (Ubiquinone / CoQ10)
Krause and Mahan's Food & Nutrition Care ProcessDepletion Pathway: Statins competitively inhibit HMG-CoA reductase, blocking synthesis of mevalonate—an essential shared precursor for endogenous ubiquinone production.
Chronotherapy & Meal Administration Protocols
Optimal absorption, meal-timing rules & GI tolerability protocolsTake the suspension once a day in the evening on an empty stomach.
Rationale: Food constituents interfere with gastrointestinal absorption or gastric emptying.
Frequently Researched Drug-Substance Combinations
Explore pairwise interaction dossiers and laboratory safety analysesSimvastatin and Grapefruit
Pairwise Clinical Analysis & Safety RatingSimvastatin and Grapefruit-juice
Pairwise Clinical Analysis & Safety RatingSimvastatin and Grapefruit / Pomelo
Pairwise Clinical Analysis & Safety RatingSimvastatin and Alcoholic Beverages
Pairwise Clinical Analysis & Safety RatingTaking Simvastatin alongside daily coffee, supplements, or other medications?
Add all your daily medications, foods (Dairy, Spinach, Coffee, Grapefruit), and botanicals (Ashwagandha, Curcumin, Melatonin) into the SafeStack interactive engine to run full multi-way synergy collision analysis in real time.
Data on this clinical monograph is compiled from the U.S. National Library of Medicine (MedlinePlus), openFDA Structured Product Labeling (SPL Section 7 Drug Interactions), the NIH Office of Dietary Supplements (ODS), and Krause and Mahan's Food & Nutrition Care Process.