Dr. Michael Koren joins Kevin Geddings to review some possibly outdated information on modern statin bottles. Kevin reveals that he dutifully takes his statin at night and avoids grapefruit, but cardiologist Michael Koren, MD, gives updated advice. The doctor states that rosuvastatin, a newer statin, is long-acting, and that taking it at night may not be as necessary as in earlier statin types. The doctor then states that rosuvastatin was also developed to avoid the interactions between statins and grapefruit, and that small amounts of grapefruit may be ok for Kevin to consume.
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Episode Transcript
Welcome to the Med Evidence Monday Minutes Radio
Show, hosted by Kevin GeddingWSOS St. Augustine Radio and
powered by ENCOREResearch Group.
Each Monday morning, Dr.
Michael Koren callsin to bring you the latest
medicalupdates and insightful discussions.
MedEvidence iswhere we help you navigate the
real truth behind medicalresearch with Both a clinical
and research perspective.
(00:21):
So sit back, relax, and getready to learn about the truth
behind the data in medicine andhealthcare. This is MedEvidence!
Dr. Michael Koren joinging us live today. Weappreciate him he's a medical
doctor, of course,cardiologists, a research
scientist.
Big part of our family here atWSOS, and of course runs the
show at ENCORE Research Groupwhere you can involve yourself,
(00:43):
get involved in clinicalresearch.
Right there in the Weststonebuilding next door to U.F.
Flagler Hospital.
Lots of stuff going on.
And yeah, I was talking withDr.
Koren about how on my bottlefor the statin that I take every
night, it says, of course, Ishould take it at night before I
go to bed, not in the morning.
That's number one.
But number two, I shouldabsolutely not consume
grapefruit juice.
Why is that, Dr.
(01:04):
Koren?
Dr. Michael Koren (01:06):
Well, Kevin, as we like to say, MedEvidence,
everything you hear isn'tnecessarily true.
Okay.
So actually both of thosestatements are actually
inaccurate.
Kevin Geddings (01:18):
Wow.
Dr. Michael Koren (01:19):
So let's break them down because this is
actually what we do withpatients in research, is we
break down all these myths andmisperceptions and help people
understand the truth behind thedata, as we like to say.
So let me can I ask you whatstatin you're taking?
Kevin Geddings (01:35):
R uh rosovostatin?
Rosastatin?
That's not sort of.
Dr. Michael Koren (01:38):
Okay, Rosuvastatin.
Kevin Geddings (01:39):
Yeah, thank you.
Dr. Michael Koren (01:39):
Rosuvastatin is was known as Crestor.
You probably on a generic uhversion of it.
Kevin Geddings (01:45):
Okay.
Dr. Michael Koren (01:45):
And actually you can take rosuvastatin
anytime day or night.
Kevin Geddings (01:49):
Really?
Dr. Michael Koren (01:49):
Because yeah, rosuvastatin is a long acting
statin.
And some of the earlierstatins, most notably
simvastatin or Zocor, was ashort-acting drug that really
needed to be taken at night.
So it could actually havecertain effects on the liver,
which in turn loweredcholesterol.
But the newer statins, like atorvastatin, Lipitor, or
(02:12):
rosuvastatin, really can betaken anytime.
So that's one of thoseholdovers that's not necessarily
true for your specific product,but that has been sort of a
legacy because of certainproducts in the class.
But I can assure you thatrosuvastatin will work day or
night.
So you don't have to worryabout that.
So that's number one.
And then number two is thetruth is if you took a little
(02:33):
grapefruit juice, it would notbe the end of the world.
And in fact, for rosuvastatin,it probably doesn't matter at
all because the way these drugsthe way uh certain statins and
other drugs interact withgrapefruit juice and mandarin
oranges, by the way, is througha pathway in the liver called
the P450 cytochrome, with aspecific enzyme called the 3A4
(02:59):
cytochrome.
And that sounds fancy andnerdy, but what it is, is the
part of the liver that'sresponsible for metabolizing
drugs and helping the body getrid of drugs.
So our livers are wonderfulthings and they metabolize
different chemicals, uh bothintrinsic chemicals and
extrinsic chemicals.
(03:19):
And when you take a drug thatis reliant on that system in the
liver to remove chemicals, itcan start to compete with other
things.
So what happens when you drinka lot of grapefruit juice or
mandarin oranges is that thatenzyme system is used for the
purpose of metabolizing thatfood, which is the same enzyme
(03:41):
system that's used for certaindrugs, including certain
statins, but actually not somuch for Rosuvastatin.
Rosuvastatin has actually beendeveloped so that it has less of
an interaction with those typeof foods.
So if you were taking againsimvastatin, then that
interaction would be fargreater, or if you're taking
atorvostatin, that interactionwould be considered moderate.
(04:03):
So with a lot of medicines thatwe take, certain medicines for
blood pressure and other things,there is that interaction
between certain foods and thedrugs.
And the beauty is that it getsvery, very complex.
But when you come in forresearch studying, we will do
that evaluation.
We will look at your list ofmedications and your food
choices and make sure therearen't negative drug-drug, or
(04:25):
drug- food interactions.
And that doesn't happen allthat much in clinical practice
because we're just so busy, butit does happen in the research
setting.
So it's another reason why welike to encourage people to at
least get a research evaluation.
Kevin Geddings (04:37):
Yeah.
No, absolutely.
And when you actually doparticipate in these clinical
trials, which I've done, Karenon our team here has done as
well, you're going to get someof the most in-depth, you know,
sort of people paying attentionto your health status and paying
attention to the drugs that youare currently taking than you
probably have ever experiencedbecause that's all part of the
research process, right, Dr.
Koren?
Dr. Michael Koren (04:56):
Absolutely.
Yeah, there's a lot of detailsthat go into it that may not be
that apparent to the averageperson, but people who have
actually participated inresearch understand that we look
at everything extremelycarefully, and people love that
nurturing, they love that extraattention, they love that
attention to detail.
So that's what we have to offerpatients when they get involved
(05:18):
in a research program.
Kevin Geddings (05:19):
Right.
I guess going back a littlebit, like back in the day when
it was determined with the olderstatins that you maybe
shouldn't mix grapefruit juiceor whatever, would that result
have come from research or wouldthat have been because you just
knew the chemistry involved?
Dr. Michael Koren (05:33):
It's both, actually.
So it's it's a great point.
So it does start withchemistry, but we actually do
something called pharmacokineticstudies.
And in a pharmacokinetic study,we're actually looking at
interactions between differentdrugs or different foods and how
it affects the way our bodiesbreak down certain chemicals.
(05:54):
So early on in the days ofStatins, we did these studies
called pharmacokinetic studies,and we determined that the
concentration of the drug inpeople who are drinking more
grapefruit juice or consumingmore mandarin oranges was higher
than those that didn't havethat exposure.
So this is actually the type ofclinical trial that we do on
occasion.
(06:14):
So all the clinical trials havea different endpoint, they have
a different focus.
And in fact, we've done plentyof studies.
As we speak, we're doingstudies that are looking at
pharmacokinetics or how thingsinteract with each other.
Kevin Geddings (06:27):
There's a really good website, medevidence.com,
where you can learn more aboutthat and so many other topics,
right, Dr.
Koren?
Dr. Michael Koren (06:34):
You bet.
Uh we uh we're just gettingtremendous, wonderful feedback
from MedEvidence.
Thank you, everybody who's beenlistening and watching, and uh
more to come.
People are enjoying it as uhjust a very real, very pragmatic
way of learning about medicalissues, and we also like to have
fun, and that doesn't hurt.
Kevin Geddings (06:53):
Yeah.
Dr.
Koren, thank you for callingin.
We appreciate you, and we'lltalk with you in a couple of
days, okay?
Dr. Michael Koren (06:58):
My pleasure.
Announcer (06:59):
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