lipitor and Itraconazole Interactions

Interactions between lipitor(atorvastatin) and Itraconazole (itraconazole)

itraconazole and atorvastatin (Major Drug-Drug)

GENERALLY AVOID: Itraconazole significantly increases the plasma concentrations of atorvastatin and may increase the risk of rhabdomyolysis. The mechanism is inhibition of hepatic CYP450 3A4 enzymes responsible for HMG-CoA reductase inhibitor metabolism. The AUC of atorvastatin and atorvastatin lactone increased 2.5 to 3.3 fold, respectively, when itraconazole 200 mg/day was administered concomitantly with atorvastatin 20 mg and 40 mg daily.

MANAGEMENT: The concurrent use of azoles with atorvastatin should be avoided. When concomitant use of an azole antifungal and an HMG-CoA reductase inhibitor is required, pravastatin which is not metabolized by CYP450 enzymes, or fluvastatin which is metabolized by CYP450 2C9, are recommended. Patients should be advised to promptly report any unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever. The HMG-CoA reductase inhibitor should be discontinued if creatine kinase is markedly elevated or if myopathy is suspected or diagnosed.