Meta Information
ID:atorvastatin
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/dietary/grapefruit-pomelo
Target name:
Grapefruit or Grapefruit Juice
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Grapefruit is a strong inhibitor of the CYP3A4 enzyme in the gut, which is responsible for breaking down atorvastatin. This can lead to dangerously high levels of the drug in the blood, increasing the risk of muscle damage (myopathy) and rhabdomyolysis.
Actionable advice:
Avoid consuming grapefruit or grapefruit juice entirely while taking atorvastatin.
Target id:
/class/cyp3a4-strong-inhibitors
Target name:
Strong CYP3A4 Inhibitors
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
These drugs potently block the CYP3A4 enzyme, the primary pathway for atorvastatin metabolism, leading to a significant increase in atorvastatin blood levels and a high risk of severe muscle toxicity.
Actionable advice:
Avoid co-administration; this combination is generally contraindicated.
Target id:
/class/immunosuppressants
Target name:
Cyclosporine
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Cyclosporine is a potent inhibitor of both CYP3A4 and the OATP1B1 transporter, leading to a very large increase in atorvastatin exposure and a high risk of myopathy.
Actionable advice:
Avoid this combination; if necessary, the atorvastatin dose should not exceed 10 mg daily.
Target id:
/intervention/gemfibrozil
Target name:
Gemfibrozil
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Gemfibrozil inhibits atorvastatin's uptake into the liver (via OATP1B1) and its breakdown, drastically increasing drug levels and the risk of severe muscle damage (rhabdomyolysis).
Actionable advice:
Avoid this combination completely; it is contraindicated.
Target id:
/class/antiretrovirals
Target name:
Certain Antiretrovirals (for HIV)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Many HIV protease inhibitors (e.g., ritonavir, tipranavir) are potent inhibitors of CYP3A4, which can dramatically increase atorvastatin levels and the risk of rhabdomyolysis.
Actionable advice:
Combination requires careful dose limitation of atorvastatin or use of an alternative statin.
Target id:
/class/antiretrovirals
Target name:
Certain Hepatitis C Antivirals
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Certain direct-acting antivirals for Hepatitis C (e.g., elbasvir/grazoprevir, glecaprevir/pibrentasvir) can inhibit drug transporters (OATP1B1), increasing atorvastatin levels and the risk of myopathy.
Actionable advice:
Co-administration is contraindicated or requires significant atorvastatin dose reduction.
Target id:
/intervention/red-yeast-rice
Target name:
Red Yeast Rice
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Red yeast rice naturally contains monacolin K, a substance chemically identical to the statin drug lovastatin. Taking it with atorvastatin constitutes duplicative therapy and significantly increases the risk of statin-related side effects like muscle damage.
Actionable advice:
Do not take red yeast rice supplements while on atorvastatin therapy.
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Atorvastatin is contraindicated in pregnancy as it may cause fetal harm by interfering with cholesterol synthesis, which is essential for fetal development.
Actionable advice:
Do not take atorvastatin if you are pregnant, planning to become pregnant, or could become pregnant.
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
It is not known if atorvastatin is excreted in human milk, but due to the potential for serious adverse reactions in a nursing infant, it is contraindicated.
Actionable advice:
Do not take atorvastatin while breastfeeding.
Target id:
/condition/hepatic-impairment
Target name:
Active Liver Disease
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Atorvastatin is metabolized by the liver, and its use in patients with active liver disease can lead to significantly increased drug levels and potential toxicity.
Actionable advice:
Atorvastatin is contraindicated in patients with active liver disease or unexplained high liver enzymes.
Target id:
/class/cyp3a4-moderate-inhibitors
Target name:
Moderate CYP3A4 Inhibitors
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
These drugs inhibit the CYP3A4 enzyme, increasing atorvastatin levels and the risk of muscle-related side effects, though to a lesser extent than strong inhibitors.
Actionable advice:
Use with caution and under medical supervision; a lower dose of atorvastatin may be required.
Target id:
/class/fibrates
Target name:
Fibrates (e.g., Fenofibrate)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Combining fibrates with atorvastatin increases the risk of muscle-related side effects (myopathy), as both drug classes can independently cause muscle toxicity.
Actionable advice:
Use together only when benefits outweigh risks and monitor closely for muscle pain or weakness.
Target id:
/intervention/niacin
Target name:
Niacin (≥1 g/day)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
High doses of niacin (nicotinic acid) when combined with atorvastatin can increase the risk of developing muscle pain or severe muscle damage (myopathy).
Actionable advice:
Use this combination with caution and monitor for any signs of muscle toxicity.
Target id:
/intervention/low-dose-colchicine
Target name:
Colchicine
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Concurrent use of colchicine and atorvastatin has been associated with an increased risk of myopathy and rhabdomyolysis, particularly in elderly patients or those with kidney problems.
Actionable advice:
Exercise caution and monitor for muscle pain or weakness when taking these drugs together.
Target id:
/class/broad-spectrum-inducers
Target name:
Strong CYP3A4 Inducers (e.g., Rifampin, St. John's Wort)
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Description:
These agents speed up the metabolism of atorvastatin via the CYP3A4 enzyme, which can significantly lower its blood levels and reduce its cholesterol-lowering effectiveness.
Actionable advice:
Avoid this combination or monitor cholesterol levels closely to ensure atorvastatin remains effective.
Target id:
/class/bile-acid-sequestrants
Target name:
Bile Acid Sequestrants
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
1
Description:
Bile acid sequestrants can bind to atorvastatin in the intestine, preventing its absorption and reducing its effectiveness.
Actionable advice:
Take atorvastatin at least 1 hour before or 4 hours after taking a bile acid sequestrant.
Target id:
/class/hepatotoxic-agents
Target name:
Other Potentially Liver-Toxic Agents
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Atorvastatin can cause liver enzyme elevations. Combining it with other substances known to be hard on the liver (e.g., excessive alcohol, certain medications) can increase the risk of liver injury.
Actionable advice:
Limit alcohol consumption and inform your doctor of all other medications and supplements you take.
Target id:
/intervention/daptomycin
Target name:
Daptomycin
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Both daptomycin and atorvastatin can cause muscle toxicity. Using them together increases the risk of myopathy and rhabdomyolysis.
Actionable advice:
Consider temporarily discontinuing atorvastatin during a course of daptomycin therapy.
Target id:
/circadian/sleep
Target name:
Bedtime / Evening
Severity:
minor
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
1
Hours after target:
0
Description:
The body's cholesterol synthesis is highest during the night. Taking atorvastatin in the evening aligns its peak effect with this period, potentially enhancing its cholesterol-lowering efficacy.
Actionable advice:
Take your daily dose in the evening or at bedtime for potentially optimal results.
Target id:
/intervention/coq10
Target name:
Coenzyme Q10 (CoQ10)
Severity:
minor
Interaction type:
synergistic
Nature:
absolute
Description:
Statins inhibit HMG-CoA reductase, an enzyme also involved in the synthesis of CoQ10, potentially leading to lower levels. Supplementation may help mitigate some statin side effects like muscle pain, although evidence is mixed.
Actionable advice:
Consider supplementing with CoQ10 to potentially offset statin-induced depletion.
Target id:
/intervention/ezetimibe
Target name:
Ezetimibe
Severity:
minor
Interaction type:
synergistic
Nature:
absolute
Description:
Ezetimibe lowers cholesterol via a different mechanism (inhibiting absorption). When combined with atorvastatin, it provides a powerful, additive cholesterol-lowering effect.
Actionable advice:
This is a common and effective combination therapy for lowering cholesterol.
Target id:
/intervention/ezetimibe
Target name:
Ezetimibe
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Description:
While generally safe, combining ezetimibe with atorvastatin may slightly increase the risk of muscle-related side effects or liver enzyme elevations compared to atorvastatin alone.
Actionable advice:
Monitor for muscle symptoms and have liver function checked as recommended by your doctor.
Target id:
/intervention/digoxin
Target name:
Digoxin
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Description:
Atorvastatin can slightly increase the concentration of digoxin in the blood, potentially increasing the risk of digoxin toxicity.
Actionable advice:
Monitor digoxin levels appropriately when starting or adjusting atorvastatin therapy.
Target id:
/class/estrogens
Target name:
Oral Contraceptives
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Description:
Atorvastatin can cause a small increase in the levels of hormones (norethindrone and ethinyl estradiol) from oral contraceptives, though the clinical significance is generally low.
Actionable advice:
No specific action is usually required, but be aware of this potential interaction.