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Grapefruit juice has been implicated in interactions with a statin for the second time in two weeks.

Atorvastatin (Lipitor) has had a warning added to its summary product characteristics, stating that large quantities of grapefruit juice are 'not recommended' in patients taking the drug.

The caution follows advice from the Committee on Safety of Medicines that patients taking simvastatin should avoid grapefruit juice.

Research by Parke-Davies, who make atorvastatin, found daily intake of more than 1.2 litres for five days increased atorvastatin concentrations in the blood 2.5-fold. Grapefruit juice may cause increased concentrations of the drug via its inhibitory effects on the CYP3A4 enzyme, according to the company's warning.

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