fluconazole and atorvastatin

ModerateUsually manageable, but it must be recognised and monitored.

Mechanism

Fluconazole inhibits CYP3A4, the enzyme responsible for atorvastatin metabolism, leading to increased atorvastatin plasma concentrations.

What it means clinically

Elevated atorvastatin levels increase the risk of dose-related adverse effects, particularly myopathy and rhabdomyolysis, which can be serious.

What to do

Monitor for muscle pain, weakness, and signs of rhabdomyolysis. Consider limiting the atorvastatin dose or using an alternative antifungal. If coadministration is necessary, use the lowest effective atorvastatin dose and monitor creatine kinase.

Evidence

Well established from pharmacokinetic studies and clinical case reports. Prescribing information for atorvastatin recommends dose adjustment when used with CYP3A4 inhibitors such as fluconazole.

The two drugs

fluconazoletriazole antifungalRead the monograph atorvastatinHMG-CoA reductase inhibitorsRead the monograph

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Other interactions involving fluconazole or atorvastatin

Educational reference for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.