Drug interactions
atorvastatin + azithromycin
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Overview
Azithromycin may rarely increase atorvastatin exposure and myopathy/rhabdomyolysis risk. Unlike clarithromycin/erythromycin, inhibition is minimal, but case reports warrant monitoring.
Mechanism of action
Unknown; azithromycin is not a significant CYP3A4 inhibitor. Rare reports suggest possible transporter effects (OATP1B1/P-gp) leading to ↑ atorvastatin and myotoxicity.
Clinical management
Continue with caution; counsel on muscle pain/weakness or dark urine. If symptoms occur, check CK and renal function and hold atorvastatin. Consider temporary statin pause in high-risk patients or high-dose therapy.
Drug reference
References
- Managing interactions between macrolides and statins — SPS
- Azithromycin: Drug Interactions — Lexicomp
- Statins: Drug interactions — UpToDate
Frequently asked questions
Can I take atorvastatin with azithromycin?
The interaction is rated: Moderate. Azithromycin may rarely increase atorvastatin exposure and myopathy/rhabdomyolysis risk. Unlike clarithromycin/erythromycin, inhibition is minimal, but case reports warrant monitoring.
How serious is the interaction between atorvastatin and azithromycin?
The interaction is rated: Moderate. Evidence level: Moderate.
How is the interaction between atorvastatin and azithromycin managed?
Continue with caution; counsel on muscle pain/weakness or dark urine. If symptoms occur, check CK and renal function and hold atorvastatin. Consider temporary statin pause in high-risk patients or high-dose therapy.
Why do atorvastatin and azithromycin interact?
Unknown; azithromycin is not a significant CYP3A4 inhibitor. Rare reports suggest possible transporter effects (OATP1B1/P-gp) leading to ↑ atorvastatin and myotoxicity.
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