Compatibility «Atorvastatin» and «Atorvastatin»
Between «Atorvastatin» and «Atorvastatin» found 5 dangerous and 50 negative interactions, joint admission is not recommended without consulting a doctor.
Interaction tableCompare |
Atorvastatin |
✘Atorvastatin Analogs | |
✘Atorvastatin [Atorvastatin and more 1Atorvastatin calcium] Analogs |
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Interactions Atorvastatin with Atorvastatin
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Dangerous interactions
When used concomitantly with letermovir, the dose of atorvastatin 20 mg / day should not be exceeded. Table 18 shows a list of interactions of atorvastatin and other drugs, formed according to clinical studies, reports on cases of interaction, or taking into account the importance and severity of potential interaction (indicated as contraindicated combinations). Increased risk of developing myopathy when used concomitantly with other drugs of this class, including atorvastatin. Simultaneous use of atorvastatin and the combination of glecaprevir + pibrentasvir is contraindicated (see 'Contraindications' and 'Precautions'). Studies on the interaction of atorvastatin and fusidic acid have not been conducted, however, there are reports of cases of fatal rhabdomyolysis in patients who received statins together, in pm atorvastatin, and fusidic acid. -
Negative interactions
It is possible to interact with simultaneous use of atorvastatin with CYP3A4 inhibitors such as grapefruit juice, some macrolide antibiotics (e.g. erythromycin, clarithromycin), immunosuppressants (cyclosporine), azole antifungal drugs (e.g. itraconazole, ketoconazole), vector inhibitors, HIV and hepatitis C protease inhibitors, letermovir or the antidepressant nefazodone. Cyclosporine is an inhibitor of OATP1B1, OATP1B3, multidrug resistance protein (MDR1) and BCRP, as well as CYP3A4, therefore it increases the exposure of atorvastatin. Glecaprevir and pibrentasvir are inhibitors of OATP1B1, OATP1B3, MDR1 and BCRP, therefore they increase the exposure of atorvastatin. The combined use of atorvastatin with drugs containing glecaprevir / pibrentasvir is contraindicated (see 'Contraindications', 'Precautions'). Letermovir inhibits the efflux transporters P-gp, BCRP, MRP2, OAT2 and the hepatic transporter OATP1B1/1B3, thereby increasing the exposure of atorvastatin. Caution should be exercised when using these drugs and atorvastatin together and use the minimum required dose. Simultaneous use of atorvastatin and CYP3A4 inducers (e.g. efavirenz, rifampicin) may lead to a variable decrease in the concentration of atorvastatin in blood plasma. The established or potentially possible interaction of atorvastatin and other drugs. Reduction of LDL-C levels (-45%) with the combined use of atorvastatin at a dose of 10 mg and colestipol at a dose of 20 g compared with the use of these drugs separately (-35% for atorvastatin and -22% for colestipol). The decrease in LDL-C was similar (-53%) with the combined use of atorvastatin at a dose of 40 mg and colestipol at a dose of 20 g compared with the use of atorvastatin alone at a dose of 80 mg. The concentration of atorvastatin in blood plasma decreased (ratio 0.74) with simultaneous use of atorvastatin at a dose of 40 mg and colestipol at a dose of 20 g compared with the use of atorvastatin alone at a dose of 40 mg. However, the combined use of these drugs was less effective in reducing TG levels than monotherapy with atorvastatin in all degrees of hypercholesterolemia. When atorvastatin and colestipol or any other ion-exchange resin are used simultaneously, the interval between doses should be at least 2 hours, etc.; absorption of atorvastatin may be reduced by the action of ion-exchange resin. With the combined use of atorvastatin once at a dose of 40 mg and gemfibrozil at a dose of 600 mg 2 times a day and monotherapy with atorvastatin, the ratio of AUC and Cmax of atorvastatin was 1.35 and 1, respectively. With the combined use of atorvastatin once at a dose of 40 mg and fenofibrate at a dose of 160 mg 2 times a day and monotherapy with atorvastatin, the ratio of AUC and Cmax of atorvastatin was 1.03 and 1.02, respectively. Simultaneous use of atorvastatin and gemfibrozil should be avoided. The benefit/risk ratio in the combined use of atorvastatin and fenofibrate, bezafibrate and niacin should be carefully evaluated, a lower initial and maintenance dose of atorvastatin should be considered. An increase in ss'>Css digoxin after the combined use of digoxin at a dose of 0.25 mg and atorvastatin at a dose of 80 mg / day (the ratio of AUC and max'>Cmax atorvastatin 1.15 and 1.2, respectively, according to compared with the use of atorvastatin alone). After the combined use of atorvastatin with an oral contraceptive containing 2 mg of norethisterone and 35 mcg of ethinyl estradiol, plasma concentrations (AUC levels) of norethisterone (ratio AUC and max'>Cmax atorvastatin 1.28 and 1.23, respectively, compared with the use of atorvastatin alone) and ethinyl estradiol (ratio AUC and the max'>Cmax of atorvastatin 1.19 and 1.3, respectively, compared with the use of atorvastatin alone) increased. In clinical studies, atorvastatin was used simultaneously with estrogen replacement therapy without evidence of a clinically significant adverse interaction to date. After the combined use of atorvastatin with an antacid (algedrate + magnesium hydroxide in suspension), a decrease in the concentration of atorvastatin in blood plasma was observed (the ratio of AUC and max'>Cmax atorvastatin 0.66 and 0.67, respectively, compared with the use of atorvastatin alone). There was no effect on the change in LDL-C levels, possibly an effect on the TG-lowering effect of atorvastatin. This reduction in exposure should be taken into account when prescribing atorvastatin with antacids. It does not affect the plasma concentration (the ratio of AUC and max'>Cmax of atorvastatin 1 and 0.89, respectively, compared with the use of atorvastatin alone) or the effectiveness of atorvastatin in reducing LDL-C levels. Reduces the TG-lowering effect of atorvastatin from 34 to 26%. A decrease in the TG-lowering effect of atorvastatin should be taken into account when used concomitantly with cimetidine. Diltiazem at equilibrium increases atorvastatin exposure (by about 50%, based on AUCLASTs of a single dose of atorvastatin) (ratio of AUC and max'>Cmax atorvastatin 1.51 and 1, respectively, compared with the use of atorvastatin alone). An increase in the concentration of atorvastatin in blood plasma with its simultaneous use at a dose of 10 mg 1 time per day with nelfinavir at a dose of 1250 mg 2 times a day. The dose of atorvastatin in combination with nelfinavir should not exceed 40 mg / day. Caution should be exercised when using atorvastatin and the combination lopinavir + ritonavir together and prescribe atorvastatin at the minimum required dose (see 'Precautions'). Simultaneous use of atorvastatin and a combination of tipranavir + ritonavir or atorvastatin and telaprevir should be avoided. When used in combination with boceprevir, combinations of saquinavir + ritonavir, darunavir + ritonavir, fosamprenavir or a combination of fosamprenavir + ritonavir, the dose of atorvastatin should be limited to 20 mg / day. The increase in atorvastatin exposure when using clinical doses is likely to be higher, therefore caution should be exercised and atorvastatin should be used at the minimum required dose. The combined use of atorvastatin and the combination of grazoprevir + elbasvir should be carried out with appropriate clinical supervision and the minimum required dose of atorvastatin should be used. The combined use of atorvastatin at a dose of 20-40 mg and itraconazole at a dose of 200 mg / day led to an increase in atorvastatin exposure (the ratio of AUC and max'>Cmax atorvastatin 3.3 and 1.2, respectively, compared with the use of atorvastatin alone, for a dose of atorvastatin 40 mg). The dose of atorvastatin in combination with itraconazole should not exceed 20 mg / day. The dose of atorvastatin in combination with letermovir should not exceed 20 mg / day. When atorvastatin and efavirenz are prescribed simultaneously, a decrease in atorvastatin exposure should be considered. Co-administration: the ratio of AUC and max '>Cmax of atorvastatin is 1.12 and 2.9, respectively, with simultaneous use of atorvastatin at a single dose of 40 mg and rifampicin at a dose of 600 mg / day for 7 days compared with a single dose of atorvastatin 40 mg. As a result of the dual mechanism of action of rifampicin (induction of CYP3A4 and inhibition of the OATP1B1 transporter), simultaneous co-administration of atorvastatin and rifampicin, etc. is recommended; delayed intake of atorvastatin after administration of rifampicin was associated with a significant decrease in the concentration of atorvastatin in blood plasma. Simultaneous use of atorvastatin and fusidic acid should be avoided. Studies on the interaction of atorvastatin and colchicine have not been conducted, however, there are reports of cases of myopathy with simultaneous use of atorvastatin and colchicine. Caution should be exercised when prescribing atorvastatin with colchicine (see 'Precautions'). Simultaneous intake of grapefruit juice may increase the concentration of HMG-CoA reductase inhibitors, including atorvastatin, in blood plasma. Consumption of 1.2 liters of juice per day led to an increase in AUC (AUC ratio to 2.5) and max'>Cmax (ratio max'>Cmax to 1.71) of atorvastatin. The interaction of atorvastatin and herbal medicines has not been established. Atorvastatin already included in the drug: For: Atorvastatin.. drugs: Atorvastatin and Atorvastatin available common active substance : Atorvastatin. Pay attention to the dosage.. According to post-registration observations, gemfibrozil, fenofibrate, other fibrates and lipid-modifying doses of niacin (nicotinic acid) may increase the risk of myopathy when used concomitantly with HMG-CoA reductase inhibitors. Atorvastatin calcium and Atorvastatin belong to the same pharmaceutical group: Statins. -
No interactions
Atorvastatin did not have a clinically significant effect on PV when used in patients receiving long-term warfarin treatment. In healthy subjects, there was no significant change in the pharmacokinetics of digoxin at steady state with the combined use of digoxin at a dose of 0.25 mg and atorvastatin at a dose of 10 mg / day. The use of quinapril at a dose of 80 mg 1 time per day in a state of equilibrium did not significantly affect the pharmacokinetic profile of atorvastatin at a dose of 10 mg 1 time per day. Atorvastatin did not affect the pharmacokinetics of phenazone. In healthy adult volunteers, the simultaneous use of atorvastatin (10 mg 1 time per day) and azithromycin (500 mg 1 time per day) slightly changed the concentration of atorvastatin in blood plasma. With simultaneous use of atorvastatin (10 mg 1 time per day) and erythromycin (500 mg 4 times per day) and atorvastatin monotherapy, the ratio of AUC and max'>Cmax atorvastatin was 1.33 and 1.38, respectively. With simultaneous use of atorvastatin (10 mg 1 time per day) and clarithromycin (500 mg 2 times per day) and atorvastatin monotherapy, the ratio of AUC and max'>Cmax atorvastatin was 1.82 and 1.56, respectively. With simultaneous use of atorvastatin at a dose of 20 mg 1 time per day and a combination of lopinavir + ritonavir (400 + 100 mg 2 times per day) and atorvastatin monotherapy, the ratio of AUC and max '>Cmax atorvastatin was 5.9 and 4.7, respectively. With simultaneous use of atorvastatin at a dose of 10 mg once and a combination of tipranavir + ritonavir (500 + 200 mg 2 times a day) and atorvastatin monotherapy, the ratio of AUC and max'>Cmax atorvastatin was 9.4 and 8.6, respectively. Atorvastatin at a dose of 10 mg once did not affect the pharmacokinetics of the combination tipranavir + ritonavir. With simultaneous use of atorvastatin at a dose of 20 mg once and telaprevir at a dose of 750 mg every 8 hours for 10 days and monotherapy with atorvastatin, the ratio of AUC and max'>Cmax atorvastatin was 7.9 and 10.6, respectively. With simultaneous use of atorvastatin at a dose of 40 mg once and boceprevir at a dose of 800 mg 3 times a day for 7 days and monotherapy with atorvastatin, the ratio of AUC and max'>Cmax atorvastatin was 2.3 and 2.7, respectively. With simultaneous use of atorvastatin at a dose of 40 mg once a day and ritonavir at a dose of 400 mg 2 times a day for 15 days and saquinavir at a dose of 400 mg 2 times a day, the ratio of AUC and max'>Cmax atorvastatin was 3.9 and 4.3 accordingly, compared with the use of atorvastatin alone. With simultaneous use of atorvastatin at a dose of 10 mg 1 time per day for 4 days and darunavir at a dose of 300 mg 2 times a day and ritonavir at a dose of 100 mg 2 times a day for 9 days, the ratio of AUC and max '>Cmax atorvastatin It was 3.4 and 2.2, respectively, compared with the use of atorvastatin alone. With simultaneous use of atorvastatin at a dose of 10 mg 1 time per day for 4 days and fosamprenavir at a dose of 700 mg 2 times a day and ritonavir at a dose of 100 mg 2 times a day for 14 days, the ratio of AUC and max '>Cmax atorvastatin It was 2.5 and 2.8, respectively, compared with the use of atorvastatin alone. With simultaneous use of atorvastatin at a dose of 10 mg 1 time per day for 4 days and fosamprenavir at a dose of 1400 mg 2 times per day for 14 days and atorvastatin monotherapy, the ratio of AUC and max'>Cmax atorvastatin was 2.3 and 4, respectively. The use of atorvastatin at a dose of 10 mg once a day for 4 days did not affect the pharmacokinetics of fosamprenavir at a dose of 700 mg 2 times a day and ritonavir at a dose of 100 mg 2 times a day for 14 days (the ratio of AUC and max'>Cmax atorvastatin: 0.99 and 0.94, respectively, compared with the use of atorvastatin alone). With simultaneous use of atorvastatin at a dose of 10 mg 1 time per day for 7 days and glecaprevir at a dose of 400 mg 1 time per day and pibrentasvir at a dose of 120 mg 1 time per day for 7 days, the ratio of AUC and max '>Cmax atorvastatin It was 8.3 and 22, respectively, compared with the use of atorvastatin alone. With simultaneous use of atorvastatin at a dose of 10 mg once and a combination of grazoprevir + elbasvir (200 + 50 mg 1 time per day for 13 days) and atorvastatin monotherapy, the ratio of AUC and max '>Cmax atorvastatin was 1.95 and 4.3, respectively. With simultaneous use of atorvastatin at a dose of 40 mg/day and simeprevir at a dose of 150 mg 1 time per day for 10 days and atorvastatin monotherapy, the ratio of AUC and max'>Cmax atorvastatin was 2.12 and 1.7, respectively. The ratio of AUC and max'>Cmax of atorvastatin is 0.59 and 1.01 with simultaneous use of atorvastatin at a dose of 10 mg and efavirenz at a dose of 600 mg daily compared with the use of atorvastatin alone. -
Positive interactions
Atorvastatin can increase serum levels of transaminases and creatine kinase (from skeletal muscles). -
Unclear interactions
Atorvastatin is metabolized with the participation of the CYP3A4 isoenzyme. Atorvastatin is a substrate of liver transporters. Elbasvir and grazoprevir are inhibitors of OATP1B1, OATP1B3, MDR1 and BCRP, so they can increase the exposure of atorvastatin. The ratio of AUC and max'>Cmax of phenazone is 1.03 and 0.89, respectively, when taking a dose of atorvastatin 80 mg once a day and phenazone 600 mg once. The ratio of AUC and max'>Cmax of atorvastatin was 1.74 and 2.2, respectively, compared with the use of atorvastatin alone. Separate use: the ratio of AUC and max'>Cmax of atorvastatin is 0.2 and 0.6, respectively, with a single dose of atorvastatin 40 mg and a dose of rifampicin 600 mg / day (doses are divided). Excessive consumption of grapefruit juice is not recommended when using atorvastatin. For 240 ml of grapefruit juice, the ratio of AUC and max'>Cmax was 1.37 and 1.16, respectively, for a dose of atorvastatin 40 mg. In the differential diagnosis of chest pain in a patient receiving atorvastatin, it is necessary to determine the cardiac and extra-cardiac fractions of these enzymes. Atorvastatin calcium + Atorvastatin analgin and citramon are used together in 14 preparations.
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Dangerous interactions
Decoding the colors of interactions and contraindications
Dangerous | — | a pronounced negative interaction or contraindication. |
Negative | — | negative interaction or side effect that may reduce effectiveness. |
Positive | — | the interaction can SOMETIMES be used as a positive (often a dose adjustment is needed), or it is an indication of the drug. |
No | — | the drugs do NOT interact, which is separately indicated in the instructions. |
Unclear | — | the system failed to pre-assess the danger. |
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Additional information
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- Why do I need to
- Avoid dangerous prescriptions for your patients.
- Check the contraindications.
- Evaluate the safety of therapy in the treatment of children.
- See the compatibility of drugs with alcohol (enter it as a drug).
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- The use of information about interactions is only possible as an introduction. This information should not be used to adjust therapy without consulting a specialist.
- The article is written: artificial intelligence Kiberis
- Sources: official instructions for medicines and their active substances, as well as inter-group interactions described in medical studies and textbooks.
- Total analyzed: 169,974,420 possible combinations of drugs and their components were found 412,510 interacting combinations.
- Medicine section: Standard evidence-based medicine
- The date of the last update of the interaction database: 2024-05-02
Category - medicine