Atorvastatin and Levoketoconazole: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 15, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atorvastatin
Levoketoconazole
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 atorvastatin-related adverse effects
Interaction Deep Dive
Coadministration of levoketoconazole (a strong CYP3A4 inhibitor) and atorvastatin (a CYP3A4 substrate) may increase the exposure of atorvastatin, which may increase the risk of atorvastatin-associated myopathy and rhabdomyolysis. Coadministration of levoketoconazole 400 mg once daily with atorvastatin increased atorvastatin AUC and Cmax by 318% and 97%, respectively, compared with administration of atorvastatin alone. If concomitant use is necessary, use the lowest atorvastatin dose necessary and closely monitor patients for adverse reactions when atorvastatin dosage exceeds 20 mg daily1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of atorvastatin
Literature reports
1 report — tap to read
a) Coadministration of levoketoconazole 400 mg once daily with atorvastatin was associated with increased atorvastatin AUC and Cmax by 318% and 97%, respectively, compared with administration of atorvastatin alone (N=23) 1.
Common questions
Can I take Atorvastatin and Levoketoconazole together?
Increased atorvastatin exposure and an increased risk of atorvastatin-related adverse effects Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atorvastatin and Levoketoconazole interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
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 Levoketoconazole 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 (1)
- Product Information: RECORLEV(R) oral tablets, levoketoconazole oral tablets. Xeris Pharmaceuticals Inc (per FDA), Chicago, IL, 2023. DailyMed
Keep reading about Atorvastatin
Keep reading about Levoketoconazole
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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