lipitor and Ketoconazole Interactions

Interactions between lipitor(atorvastatin) and Ketoconazole (ketoconazole)

ketoconazole and atorvastatin (Major Drug-Drug)

GENERALLY AVOID: Azole antifungals such as itraconazole and ketoconazole increase the plasma concentrations of some HMG-CoA reductase inhibitors and may increase the risk of rhabdomyolysis. The mechanism has been reported to be inhibition of hepatic CYP450 3A4 enzymes responsible for HMG-CoA reductase inhibitor metabolism. Itraconazole greatly increases levels of lovastatin and its active metabolite, lovastatin acid, significantly increases simvastatin and atorvastatin levels, and has minor effects on fluvastatin or pravastatin levels. Rhabdomyolysis has been reported with ketoconazole and simvastatin.

MANAGEMENT: The concurrent use of azoles with lovastatin, simvastatin, or atorvastatin should be avoided. Caution is also recommended for patients receiving azole antifungals and ingesting red yeast rice. 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.