Atorvastatin drug interactions

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Contents 1 Drug-drug interactions 2 Drug-food/drug-herb interactions 3 References

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Drug-drug interactions

Severity level	Drug and description of interaction
4	clofibrate, fenofibrate, gemfibrozil: The risk of myopathy or rhabdomyolysis is increased when atorvastatin is co-administered with fibric acid derivatives.[1] itraconazole, telithromycin, voriconazole: CYP 3A4 inhibitors may increase serum concentrations of atorvastatin, which may lead to adverse reactions (myopathy, rhabdomyolysis) or toxicity.[2][3][4] statins: Co-administration of atorvastatin with other statins is contraindicated and will most likely result in increased effect/toxicity.[4]
3	amprenavir, clarithromycin, cyclosporine, delavirdine, diltiazem, erythromycin, fluconazole, imatinib, indinavir, ketoconazole, miconazole, nefazodone, protease inhibitors, ritonavir, troleandomycin, verapamil: CYP 3A4 inhibitors may increase serum concentrations of atorvastatin, which may lead to adverse reactions (myopathy, rhabdomyolysis) or toxicity.[1][4][5] colestipol: Colestipol decreases the plasma concentrations of atorvastatin by approx. 25% but does not affect the LDL-C lowering efficacy.[1]
2	amiodarone, aprepitant, conivaptan, daptomycin, ranolazine: CYP 3A4 inhibitors may increase serum concentrations of atorvastatin, which may lead to adverse reactions (myopathy, rhabdomyolysis) or toxicity.[1][6][7][8] antacids: Antacids decrease the plasma concentrations of atorvastatin but do not affect the LDL-C lowering efficacy.[1] bosentan, fosphenytoin, phenytoin: CYP 3A4 inducers may decrease the plasma concentrations of atorvastatin due to CYP3A4 induction. digoxin: Patients taking atorvastatin 80 mg who were concurrently taking digoxin showed an increase in digoxin concentration of 20%.[1] levothyroxine: Atorvastatin increases the effect/toxicity of levothyroxine.[1] niacin: The risk of myopathy or rhabdomyolysis is increased when atorvastatin is co-administered with lipid-lowering doses of niacin.[1]
1	barbiturates, carbamazepine, efavirenz, nevirapine, oxcarbazepine, rifampin, rifamycin: CYP 3A4 inducers may decrease the plasma concentrations of atorvastatin due to CYP3A4 induction. cholestyramine: Cholestyramine may decrease the absorption of atorvastatin if administered closely.[1] clopidogrel: Atorvastatin is known to attenuate the antiplatelet activity of clopidogrel probably due to CYP3A4 inhibition, preventing the conversion of clopidogrel to its active metabolite.[1] fluvoxamine, nelfinavir: CYP 3A4 inhibitors may increase serum concentrations of atorvastatin, which may lead to adverse reactions (myopathy, rhabdomyolysis) or toxicity.[4] oral contraceptives: AUC values for norethindrone and ethinyl estradiol are increased by ~20-30% with the co-administration of atorvastatin.[1]

Drug-food/drug-herb interactions

Severity level	Drug and description of interaction
4	Red yeast rice: Since red yeast rice is thought to have HMG-CoA reductase inhibitory activity, co-administration is not recommended.[9]
3	Grapefruit juice: Grapefruit juice components are known inhibitors of intestinal CYP 3A4. Co-administration of grapefruit juice with atorvastatin may cause an increase in Cmax and AUC, which can lead to adverse reactions or overdose toxicity.[10]
2	None known
1	St. John's Wort: The active compound in St. John's Wort, hypericin, is a known inducer of CYP 3A4, which if co-administered with atorvastatin, may produce sub-therapeutic plasma concentrations.

References

1. ↑ ^{1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10} Lipitor® (atorvastatin calcium) package insert. New York, NY; Parke-Davis; 2006 Dec.
2. ↑ Mazzu AL, Lasseter KC, Shamblen EC, Agarwal V, Lettieri J, Sundaresen P. Itraconazole alters the pharmacokinetics of atorvastatin to a greater extent than either cerivastatin or pravastatin. Clinical Pharmacology & Therapeutics 2000;68(4):391-400.
3. ↑ Ketek™ (telithromycin) package insert. Kansas City, MO: Aventis Pharmaceuticals; 2005 Feb.
4. ↑ ^{4.0 4.1 4.2 4.3} Hansten PD, Horn JR. Cytochrome P450 Enzymes and Drug Interactions, Table of Cytochrome P450 Substrates, Inhibitors, Inducers and P-glycoprotein, withFootnotes. In: The Top 100 Drug Interactions - A guide to Patient Management. 2006 Edition. Edmonds, WA: H&H Publications; 2006:160—174.
5. ↑ Williams D, Feely J. Pharmacokinetic-pharmacodynamic drug interactions with HMG-CoA reductase inhibitors. Clinical Pharmacokinetics 2002;41(5):343-70.
6. ↑ Yamreudeewong W, DeBisschop M, Martin LG, et al. Potentially significant drug interactions of class III antiarrhythmic drugs. Drug Saf 2003;26:421—38.
7. ↑ Emend® (aprepitant) package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2006 Aug.
8. ↑ Cubicin® (daptomycin) package insert. Lexington, MA: Cubist Pharmaceuticals, Inc.; 2006 May.
9. ↑ Wang JJ, Lee CL, Pan TM. Improvement of monacolin K, gama-aminobutyric acid and citrinin production ratio as a function of environmental conditions of Monascus purpureus NTU 601. J Ind Microbiol Biotechnol 2003;30:669—76.
10. ↑ Mevacor® (lovastatin) package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2005 Nov.