Atorvastatin and Cyclosporine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 15, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atorvastatin
Cyclosporine
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased atorvastatin exposure, an increased risk of myopathy or rhabdomyolysis and an increased cycloSPORINE exposure
Interaction Deep Dive
Avoid concomitant use of atorvastatin with cycloSPORINE as it may increase atorvastatin exposure, which may also increase the risk of myopathy/rhabdomyolysis12. Also, coadministration of cycloSPORINE (a P-gp substrate) with atorvastatin (a P-gp inhibitor) may increase the plasma concentrations of cycloSPORINE. Adjust cycloSPORINE dosage to achieve the desired cycloSPORINE concentrations when these drugs are administered concomitantly 34.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of atorvastatin; inhibition of OATP1B1-mediated efflux transport of atorvastatin; inhibition of OATP1B3-mediated efflux transport of atorvastatin; inhibition of P-gp-mediated efflux transport of cycloSPORINE; inhibition of CYP3A4-mediated metabolism of atorvastatin
Literature reports
3 reports — tap to read
a) Coadministration of atorvastatin 10 mg once daily for 28 days and cycloSPORINE 5.2 mg/kg/day led to an 8.7-fold increase in atorvastatin AUC and a 10.7-fold increase in Cmax 21.
b) A 40-year-old Asian woman with a history of a cadaveric renal transplant and systemic lupus erythematosus (SLE) presented with increased levels of creatine kinase (1846 units/L), aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and alkaline phosphatase. She also had bilateral lower extremity weakness, resulting in her inability to walk. Medications included a two-month history of concomitant therapy with atorvastatin 10 mg daily and cycloSPORINE 125 mg daily. Her cycloSPORINE level was measured at 124 nanogram/mL (103.1 nanomol/L). After discontinuation of atorvastatin, her creatine kinase concentrations dramatically declined and symptoms resolved. This suggests that atorvastatin, similar to other members of the HMG-CoA reductase class, may in fact interact with cycloSPORINE and potentially result in rhabdomyolysis 5.
c) A randomized, open-arm study was conducted involving 30 renal transplant patients under an immunosuppressive regimen with corticosteroids and cycloSPORINE. The patients were randomly allocated into three groups. Patients in group A were administered 10 mg atorvastatin once daily in the evening for 3 months, group B 0.2 mg cerivastatin once daily in the evening for 3 months, group C was the control group with no drug treatment. Total serum cholesterol (-30%), LDL cholesterol (-42%) and triglycerides (-23%) were significantly lower after atorvastatin therapy (p less than or equal to 0.05). An increase in HDL cholesterol (+10%) was also observed. CycloSPORINE blood trough levels greater than or equal to 25% of baseline values occurred in four of ten patients, requiring a decrease in cycloSPORINE daily dose (from 211 +/- 40 mg before to 177 +/- 333 mg after atorvastatin therapy). CycloSPORINE dosage per kg body weight was lowered from 3.1 +/- 0.8 mg/kg before to 2.7 +/- 0.7 mg/kg after starting therapy. No relevant increase in cycloSPORINE blood trough levels were observed in the other six patients. No significant changes in liver enzymes, CPK, or serum creatinine levels occurred. Myalgia or myopathy was not observed. Renal transplant patients treated with cycloSPORINE have an increased risk of drug-interaction-induced variations in cycloSPORINE blood trough levels. Long-term effects of atorvastatin with cycloSPORINE should be investigated in a larger population of kidney transplant patients 6.
Common questions
Can I take Atorvastatin and Cyclosporine together?
Increased atorvastatin exposure, an increased risk of myopathy or rhabdomyolysis and an increased cycloSPORINE exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atorvastatin and Cyclosporine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Atorvastatin or Cyclosporine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (6)
- Product Information: ATORVALIQ(R) oral suspension, atorvastatin calcium oral suspension. CMP Pharma Inc (per FDA), Farmville, NC, 2023. DailyMed
- Product Information: LIPITOR(R) oral tablets, atorvastatin calcium oral tablets. Viatris Specialty LLC (per FDA), Morgantown, WV, 2022. DailyMed
- Product Information: NEORAL(R) oral soft gelatin capsules oral solution, cyclosporine modified oral soft gelatin capsules oral solution. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
- Product Information: SANDIMMUNE(R) oral capsules, oral solution, intravenous injection, cyclosporine oral capsules, oral solution, intravenous injection. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
- Maltz HC, Balog DL, & Cheigh JS: Rhabdomyolysis associated with concomitant use of atorvastatin and cyclosporine. Ann Pharmacother 1999; 33:1176-1179. PubMed
- Renders L, Mayer-Kadner I, Koch C, et al: Efficacy and drug interactions of the new HMG-CoA reductase inhibitors cerivastatin and atorvastatin in CsA-treated renal transplant recipients. Nephrol Dial Transplant 2001; 16:141-146. PubMed
Keep reading about Atorvastatin
Keep reading about Cyclosporine
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