![]() Increased risk of myopathy when used with fibrates gemfibrozil increases systemic exposure to atorvastatinĪdditive risk of myopathy cannot be ruled out Increased risk of myopathy when used with fibrates do not exceed 10 mg simvastatin daily (except with fenofibrate) gemfibrozil increases systemic exposure to simvastatin Monitor INR before starting treatment and regularly during treatment, especially with dose changes Limit intake of grapefruit juice to very small quantities (or avoid altogether) Monitor lipid levels to ensure lowest necessary dose of atorvastatin is used No restriction in Summary of Product Characteristics Potent CYP3A4 inhibitors, including itraconazole, ketoconazole, erythromycin, clarithromycin, telithromycin, and HIV protease inhibitorsĪvoid if possible: consider temporary suspension of atorvastatin if interacting drug is taken for short period Itraconazole: do not exceed 40 mg atorvastatin daily Clarithromycin: do not exceed 20 mg atorvastatin daily HIV protease inhibitors: monitor lipid levels to ensure lowest necessary dose of atorvastatin is used ![]() Both drugs interact with grapefruit juice. The table below gives important dose restrictions for atorvastatin and simvastatin when used in combination with other drugs. For atorvastatin and simvastatin the starting dose is 10 mg daily. If co-prescription with a drug that increases systemic exposure to statins is unavoidable, it is particularly important to start on the lowest statin dose. Many important interactions for simvastatin (Zocor) and atorvastatin relate to drugs that inhibit or induce metabolism via the cytochrome P450 (CYP3A4) enzyme, or that affect transport proteins. Simvastatin and atorvastatin: interactions Healthcare professionals should refer to Summaries of Product Characteristics for full details of interactions. It includes updated advice for atorvastatin (Lipitor), particularly potential interactions with clarithromycin, itraconazole, and ciclosporin. This article summarises the most important and common interactions with statins. ![]() Interactions may increase the risk of serious adverse reactions (such as myopathy or rhabdomyolysis) or, in some cases, reduce the effectiveness of treatment. Consideration of possible drug interactions is important because comorbidity is common in statin users. Statins are effective and widely used treatments for the prevention of cardiovascular events. ![]()
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