Atorvastatin and Diltiazem: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 15, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atorvastatin
Diltiazem
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 rhabdomyolysis and an increased dilTIAZem exposure
Interaction Deep Dive
Concomitant use of dilTIAZem and atorvastatin (CYP3A4 substrate, P-gp and CYP3A4 inhibitor) may increase the exposure of both the drugs and may increase the risk of myopathy and rhabdomyolysis with statins metabolized by CYP3A4. When possible, use a non-CYP3A4-metabolized statin together with dilTIAZem; otherwise, adjust the dose for both dilTIAZem and the statin along with close monitoring for signs and symptoms of any statin-related adverse events1. Atorvastatin is metabolized primarily by the CYP3A4 isoenzyme system, and dilTIAZem competes for this same metabolic pathway 345. Coadministration of atorvastatin and dilTIAZem resulted in rhabdomyolysis and subsequent renal failure in one case report 2.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of atorvastatin; inhibition of CYP3A4-mediated metabolism of dilTIAZem; inhibition of P-gp-mediated efflux transport of dilTIAZem
Literature reports
2 reports — tap to read
a) One case report describes a 60-year old man who developed acute renal failure secondary to rhabdomyolysis, which was diagnosed 3 weeks after the addition of dilTIAZem XL 180 mg twice a day to his drug regimen. The patient had been maintained on atorvastatin 20 mg/day, metoprolol 100 mg twice a day, digoxin 1.25 mg/day, benazepril 40 mg/day, furosemide 40 mg twice a day, warfarin 7.5 mg/day, aspirin 325 mg/day, insulin 70/30 twice a day, and sublingual nitroglycerin as needed. Upon admission, relevant laboratory values were as follows: creatinine kinase (CK) 1898 units/L with MB fraction 1.3%, troponin-I less than 1.0 nanogram/mL, serum myoglobin 674.7 mg/mL, urine myoglobin negative, sodium 131 mEq/L, potassium 6.3 mEq/L (6.3 mmol/L), phosphorus 8.2 mg/dL, blood urea nitrogen (BUN) 48 mg/dL, serum creatinine (SCr) 3.4 mg/dL, prothrombin time (PT) 46.5 seconds, INR 19.7, total bilirubin 0.7 mg/dL, direct bilirubin 0.4 mg/dL, AST 1236 units/L, ALT 1610 units/L, alkaline phosphatase (ALP) 287 units/mL, and digoxin 1.3 nanogram/mL. Acute hepatitis was added to the diagnosis; all medications except aspirin, digoxin and furosemide were discontinued. With appropriate treatment, gradually the patient's renal function returned to baseline, CK decreased to 623 units/L, and liver function tests normalized. He did denied any muscle fatigue or weakness during his hospitalization. DilTIAZem was reinstated to control his heart rate, and he was treated as an outpatient for his hypercholesterolemia 2.
b) Atorvastatin is metabolized primarily by the CYP3A4 isoenzyme system, and dilTIAZem competes for this same metabolic pathway 345.
Common questions
Can I take Atorvastatin and Diltiazem together?
Increased atorvastatin exposure, an increased risk of rhabdomyolysis and an increased dilTIAZem exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atorvastatin and Diltiazem 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 "probable". Good supporting evidence, though not definitively proven.
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 Diltiazem 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 (5)
- Product Information: CARDIZEM(R) oral tablets, diltiazem hydrochloride oral tablets. Bausch Health US LLC (per FDA), Bridgewater, NJ, 2025. DailyMed
- Lewin JJ, Nappi JM, & Taylor MH: Rhabdomyolysis with concurrent atorvastatin and diltiazem. Ann Pharmacother 2002; 36(10):1546-1549. PubMed
- Product Information: Lipitor oral tablets, atorvastatin oral tablets. Parke-Davis, New York, NY, 2005. DailyMed
- Product Information: Cardizem (R) LA, diltiazem hydrochloride extended release tablets. Biovail Pharmaceuticals, Inc, Bridgewater, NJ, 2004. DailyMed
- Jacobson TA: Comparative pharmacokinetic interaction profiles of pravastatin, simvastatin, and atorvastatin when coadministered with cytochrome P450 inhibitors. Am J Cardiol 2004; 94(9):1140-1146. PubMed
Keep reading about Atorvastatin
Keep reading about Diltiazem
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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