Minor Monitor patients for the development of peripheral neuropathy when receiving bortezomib in combination with other drugs that can cause peripheral neuropathy like HMG-CoA reductase inhibitors; the risk of peripheral neuropathy may be additive. The possibility of reduced anti-lipemic efficacy should be considered. Monitor cholesterol levels after adding bosentan therapy to evaluate the need for anti-lipemic dosage adjustment.
Moderate Monitor for decreased efficacy of atorvastatin if coadministration with brigatinib is necessary. Calcium Carbonate; Magnesium Hydroxide: Moderate Concomitant use of carvedilol and atorvastatin may result in increased atorvastatin concentrations. Carvedilol is a P-glycoprotein P-gp inhibitor and atorvastatin is a P-gp substrate. Monitor serum lipid profile and for signs and symptoms of myopathy during coadministration.
Moderate Monitor for atorvastatin-related adverse reactions, including myopathy and rhabdomyolysis, if coadministration with ceritinib is necessary. The strength of inhibition of CYP3A4 by ceritinib is unknown. It has also been reported that cimetidine could potentially increase the serum concentrations of HMG-CoA reductase inhibitors via the inhibition of the hepatic isoenzymes.
Cimetidine does not alter the pharmacokinetics of atorvastatin, cerivastatin, or pravastatin. Clinical evidence of pharmacokinetic interactions with lovastatin and simvastatin is not available. Major The risk of developing myopathy during therapy with atorvastatin is increased if coadministered with ciprofloxacin, a CYP3A4 inhibitor. The serious risk of myopathy or rhabdomyolysis should be weighed carefully versus the benefits of combined atorvastatin and ciprofloxacin therapy; there is no assurance that periodic monitoring of CK will prevent the occurrence of severe myopathy and renal damage.
Minor Atorvastatin has been reported to attenuate the antiplatelet activity of clopidogrel potentially by inhibiting CYP3A4 metabolism to its active metabolite; however, conflicting data exists. Patients should be monitored for therapeutic effectiveness when clopidogrel is administered with atorvastatin. Cobicistat; Elvitegravir; Emtricitabine; Tenofovir Alafenamide: Moderate Case reports exist describing the development of myotoxicity i.
Statins involved in the reported cases include simvastatin, atorvastatin, fluvastatin, lovastatin, and pravastatin. Patients receiving these agents concurrently should be monitored for myotoxicity. However, LDL-cholesterol reduction was greater when atorvastatin and colestipol were administered together than when either drug was given alone. Theoretically, similar pharmacokinetic effects could be seen with atorvastatin.
In clinical trials of oral conivaptan, two cases of rhabdomyolysis occurred in patients who were also receiving HMG-CoA reductase inhibitors known to be metabolized by CYP3A4.
According to the manufacturer, concomitant use of conivaptan with drugs that are primarily metabolized by CYP3A4, such as atorvastatin, should be avoided. Subsequent treatment with CYP3A substrates, such as atorvastatin, may be initiated no sooner than 1 week after completion of conivaptan therapy. Minor In clinical evaluation, atorvastatin 20 mg was given once with bazedoxifene 40 mg in 30 postmenopausal women.
The clinical effect of this change is not known. Monitor patients for loss of efficacy and increased side effects during conjugated estrogens; bazedoxifene therapy. In addition, bazedoxifene 40 mg was given for 8 consecutive days prior to co-administration of bazedoxifene 40 mg and atorvastatin 20 mg. The AUC of atorvastatin was unchanged. The possibility of reduced anti-lipemic efficacy should be considered; however, the clinical relevance of this interaction has not been determined, since the AUC exposure of atorvastatin remained unchanged.
Major Avoid the coadministration of atorvastatin and cyclosporine because the risk of developing myopathy increases when these two drugs are given together.
Atorvastatin is a substrate for OATP1B1 transporter; cyclosporine is an inhibitor of this transporter. Concomitant administration of atorvastatin 10 mg and cyclosporine 5. Use of these drugs together may result in elevated Statin serum concentrations, potentially resulting in adverse effects such as myopathy and rhabdomyolysis. Moderate The risk of myopathy and rhabdomyolysis is increased by concomitant administration of danazol with atorvastatin.
Until more data are available, danazol should be used very cautiously, if at all, in patients receiving statins which are CYP3A4 substrates. Moderate Daptomycin has been associated with elevated CPK in clinical trials.
HMG-CoA reductase inhibitors are known to cause myopathy. Since data regarding co-administration of daptomycin with HMG-CoA reductase inhibitors are limited, temporary suspension of HMG-CoA reductase inhibitor therapy should be considered in patients receiving daptomycin. Major Do not exceed 20 mg atorvastatin daily in adults when coadministered with darunavir boosted with either ritonavir or cobicisat.
The risk of developing myopathy or rhabdomyolysis increases when atorvastatin is used concomitantly with darunavir plus ritonavir. Protease inhibitors inhibit the CYP3A4 metabolism of atorvastatin. The atorvastatin AUC was increased 3. The serious risk of myopathy or rhabdomyolysis should be weighed carefully against the benefits of combined 'statin' and darunavir plus ritonavir therapy; there is no assurance that periodic monitoring of CK will prevent the occurrence of severe myopathy and renal damage.
Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Severe Concomitant use of dasabuvir; ombitasvir; paritaprevir; ritonavir with atorvastatin is contraindicated due to the potential for severe adverse reactions, including myopathy and rhabdomyolysis.
Coadministration may result in elevated atorvastatin systemic concentrations. Atorvastatin is a substrate of the hepatic isoenzyme CYP3A4; ritonavir is a potent inhibitor of this isoenzyme. Major Use caution and the lowest atorvastatin dose necessary if atorvastatin must be coadministered with ritonavir. Major The risk of myopathy, including rhabdomyolysis, may be increased when delavirdine is given in combination with HMG-CoA reductase inhibitors.
Coadminister delavirdine and atorvastatin cautiously; use the lowest possible dose of atorvastatin. Delavirdine is a potent inhibitor of CYP3A4. Atorvastatin is a substrate of CYP3A4. If these drugs are coadministered, carefully monitor the patient. Major Measure serum digoxin concentrations before initiating atorvastatin. Digoxin and atorvastatin are both substrates for P-glycoprotein P-gp. Major According to the manufacturer of diltiazem, clinicians should consider use of a non-CYP3A4-metabolized statin e.
Coadministration of atorvastatin 40 mg with diltiazem mg was associated with a higher plasma concentration of atorvastatin. Increased concentrations of atorvastatin are associated with an increased risk of myopathy and rhabdomyolysis. Monitor for signs and symptoms of myopathy in patients receiving dronedarone concurrently with atorvastatin.
Minor Atorvastatin can increase the plasma concentrations of oral contraceptives when the drugs are coadministered. These increases should be considered when administering atorvastatin and oral contraceptives concomitantly.
Drospirenone; Ethinyl Estradiol; Levomefolate: Until data with HMG-CoA reductase inhibitors are available, efavirenz should be coadministered with atorvastatin with caution. Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: Moderate Studies have shown plasma concentrations of atorvastatin are increased when administered concurrently with elbasvir; grazoprevir.
If these drugs are use together, the daily dose of atorvastatin should not exceed 20 mg. Moderate Coadministration of atorvastatin and eliglustat may result in increased plasma concentrations of atorvastatin. Atorvastatin is a P-glycoprotein P-gp substrate; eliglustat is a P-gp inhibitor. Drugs that are substrates for this transporter, such as atorvastatin, may exhibit an increase in systemic exposure if coadministered with eltrombopag; monitor patients for adverse reactions if these drugs are coadministered.
Major Monitor for decreased efficacy of atorvastatin if coadministration with enzalutamide is necessary. The risk of developing myopathy during therapy with atorvastatin is increased if coadministered with erythromycin, a CYP3A4 inhibitor. The serious risk of myopathy or rhabdomyolysis should be weighed carefully versus the benefits of combined atorvastatin and erythromycin therapy; there is no assurance that periodic monitoring of CK will prevent the occurrence of severe myopathy and renal damage.
Coadministration of CYP3A4 substrates, such as atorvastatin, may result in decreased serum concentrations of the substrate. Monitor for decreased efficacy of atorvastatin if coadministered with eslicarbazepine. Adjust the dose of atorvastatin if clinically significant alterations in serum lipds are noted. Ethinyl Estradiol; Ethynodiol Diacetate: Since there are many statins, "it's important to test patients to find out which is the best one for them," Sternfeld said.
He recommends a simple swab test that can determine which drugs a patient can best metabolize. Atorvastatin, and other statins, work by potentially decreasing the production of cholesterol in the body through blocking the cholesterol-producing enzyme in the liver.
Consequently, the amount of cholesterol a fat-like substance that collects in the arteries may be reduced. But our bodies make all the cholesterol that we need. The recommended daily allowance is 0. Significant improvement often depends on combining a medicine, such as atorvastatin, with lifestyle changes. A history of renal impairment may be a risk factor for the development of rhabdomyolysis. Such patients merit closer monitoring for skeletal muscle effects.
The concomitant use of higher doses of atorvastatin with certain drugs such as cyclosporine and strong CYP3A4 inhibitors e. There have been rare reports of immune-mediated necrotizing myopathy IMNM , an autoimmune myopathy, associated with statin use.
IMNM is characterized by: Patients should be advised to report promptly unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever or if muscle signs and symptoms persist after discontinuing LIPITOR. The risk of myopathy during treatment with drugs in this class is increased with concurrent administration of cyclosporine, fibric acid derivatives, erythromycin , clarithromycin, the hepatitis C protease inhibitor telaprevir, combinations of HIV protease inhibitors, including saquinavir plus ritonavir, lopinavir plus ritonavir, tipranavir plus ritonavir, darunavirplus ritonavir, fosamprenavir, and fosamprenavir plus ritonavir, niacin , or azole antifungals.
Physicians considering combined therapy with LIPITOR and fibric acid derivatives, erythromycin, clarithromycin, a combination ofsaquinavir plusritonavir, lopinavir plus ritonavir, darunavir plusritonavir, fosamprenavir, or fosamprenavir plus ritonavir,azole antifungals, or lipid -modifying doses of niacin should carefully weigh the potential benefits and risks and should carefully monitor patients for any signs or symptoms of muscle pain, tenderness, or weakness, particularly during the initial months of therapy and during any periods of upward dosage titration of either drug.
Periodic creatine phosphokinase CPK determinations may be considered in such situations, but there is no assurance that such monitoring will prevent the occurrence of severe myopathy. LIPITOR therapy should be temporarily withheld or discontinued in any patient with anacute, serious condition suggestive of a myopathy or having a risk factor predisposing to the development of renal failure secondary to rhabdomyolysis e. Liver Dysfunction Statins, like some other lipid-lowering therapies, have been associated with biochemical abnormalities of liver function.
The incidence of these abnormalities was 0. One patient in clinical trials developed jaundice. Increases in liver function tests LFT in other patients were not associated with jaundice or other clinical signs or symptoms. Upon dose reduction, drug interruption, or discontinuation, transaminase levels returned to or near pretreatment levels without sequelae.
Get emergency medical help if you have any of these signs of an allergic reaction: Stop taking atorvastatin and call your doctor at once if you have any of these serious side effects: Less serious side effects may include: This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. What is the most important information I should know about atorvastatin Lipitor? You should not take atorvastatin if you are allergic to it, if you are pregnant or breast -feeding, or if you have liver disease.
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