Atorvastatin and Fluconazole: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 15, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atorvastatin
Fluconazole
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 and an increased risk of myopathy and rhabdomyolysis
Interaction Deep Dive
Concomitant use of atorvastatin and fluconazole may increase atorvastatin exposure and increase risk for myopathy and rhabdomyolysis . Fluconazole inhibits P-gp and is a moderate inhibitor of CYP3A42; atorvastatin is a substrate of CYP3A4 and P-gp. Discontinue atorvastatin if markedly elevated creatine kinase (CK) occurs or if myopathy is diagnosed or suspected. Muscle symptoms and CK increases may resolve if atorvastatin is discontinued. Temporarily discontinue atorvastatin in patients experiencing an acute or serious condition at high risk of developing renal failure secondary to rhabdomyolysis 1. Dose reduction of atorvastatin may be needed. Fluconazole enzyme inhibitory effects may persist for 4 to 5 days after discontinuation due to its long half-life 2. A case report of acute muscle pain followed by an ICU stay for acute renal failure was reported 1 week following fluconazole initiation in a patient that had been stable on atorvastatin 3.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of atorvastatin; inhibition of P-gp-mediated efflux transport of atorvastatin by fluconazole
Literature reports
1 report — tap to read
a) A 70-year-old woman developed muscle pain and weakness 1 week after initiating fluconazole for Candida tropicalis fungemia. She had been taking atorvastatin 20 mg daily for the preceding 4 years without issue. Serum LDL levels decreased from a baseline of 166 mg/dL to 56 mg/dL with a concomitant change in urine to an orange-red color, and the atorvastatin dosage interval was increased to once every other day due to suspicion of drug-drug interaction. A 10-day ICU stay was required after 2 weeks of combination therapy when acute renal failure and reduced consciousness developed. Atorvastatin was immediately discontinued. Significantly elevated laboratory values were as follows: phosphate 6.4 mg/dL, BUN 143 mg/dL, serum creatinine 4.57 mg/dL, creatine kinase 2948 units/L, AST 421 units/L, ALT 559 units/L, lactate dehydrogenase 619 units/L, serum myoglobin 25,350 nanograms/mL, and urine myoglobin 1522 nanograms/mL. Fluconazole was administered for a total of 4 weeks, and atorvastatin was not reinitiated; liver function and creatine kinase levels returned to normal within 2 months. A Drug Interaction Probability Scale (DIPS) calculation indicated that the interaction between fluconazole and atorvastatin was probable 3.
Common questions
Can I take Atorvastatin and Fluconazole together?
Increased atorvastatin exposure and an increased risk of myopathy and rhabdomyolysis Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atorvastatin and Fluconazole 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:
- Can I Take MacuShield Gold With Edoxaban, Atorvastatin, and Bisoprolol?
- Can I Take Ginkgo With Apixaban (Eliquis) and Atorvastatin?
- Is It Safe to Drink Motherwort Tea While Taking Atorvastatin?
- Fluconazole Dosing For 'Intestinal Candida'
- Eliquis With Fluconazole Drug Interaction
- Can You Cut Or Split Fluconazole In Half?
Questions for your pharmacist
- Does my dose of Atorvastatin or Fluconazole 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 (3)
- Product Information: LIPITOR(R) oral tablets, atorvastatin calcium oral tablets. Parke-Davis (per FDA), New York, NY, 2020. DailyMed
- Product Information: DIFLUCAN(R) oral tablets, suspension, fluconazole oral tablets, suspension. Roerig (per FDA), New York, NY, 2023. DailyMed
- Hsiao SH, Chang HJ, Hsieh TH, et al: Rhabdomyolysis caused by the moderate CYP3A4 inhibitor fluconazole in a patient on stable atorvastatin therapy: a case report and literature review. J Clin Pharm Ther 2016; 41(5):575-578. PubMed
Keep reading about Atorvastatin
Keep reading about Fluconazole
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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