Limes, pomegranates, pomelos, and Seville oranges can also interact with some medications, including statins such as atorvastatin. There just hasn't been as much research published regarding how other types of citrus (apart from grapefruit) interact with statins.

Grapefruit, limes, and other citrus fruits contain furanocoumarins, which are compounds that help protect the fruit from certain insects and infections. The major furanocoumarins found in grapefruit include bergamottin, epoxybergamottin, and 6′,7′-dihydroxybergamottin. Research has previously identified bergamottin as the main statin-interacting substance in grapefruit. Limes, lemons, and bergamot also contain bergamottin, with limes reported to contain the highest amount, especially peel.

Unfortunately, in humans, furanocoumarins block one of the main liver enzymes involved in the metabolism of some statins, called CYP3A4, which could lead to increased blood levels of the interacting drug, leading to more severe side effects, including muscle pain.

Out of all the statins, atorvastatin (Lipitor), simvastatin (Zocor), and lovastatin (Altoprev) have the strongest interaction with grapefruit, and this is likely to be true for other citrus. Grapefruit juice and any grapefruit products should be avoided, as should large quantities of limes or lime peel, although small amounts (such as a twist of lime in a drink) are unlikely to cause a significant interaction.