Drug Interaction Report

Atorvastatin and Lopinavir: Interaction Details

A pharmacist-reviewed analysis of the Atorvastatin and Lopinavir interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Jul 15, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Atorvastatin

Atorvaliq Lipitor Lipitor®
+

Lopinavir

No brand names on record
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Jul 15, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
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.

Of 159 documented Atorvastatin interactions, 114 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
unspecified
Evidence
established
Severity
Major

What happens

Increased atorvastatin exposure with increased risk of myopathy or rhabdomyolysis

Interaction Deep Dive

Concomitant use of atorvastatin with lopinavir/ritonavir may increase atorvastatin exposure and may result in increased risk of myopathy/rhabdomyolysis. In patients taking lopinavir plus ritonavir consider the risk/benefit of concomitant use with atorvastatin. Monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness), particularly during the initial months of therapy and during upward dosage titration of either drug1. After concomitant administration of lopinavir/ritonavir and atorvastatin, the atorvastatin AUC increased 488% 2.

Why it happens (mechanism)

Inhibition of CYP3A4-mediated metabolism of atorvastatin

Literature reports

1 report — tap to read

a) Concomitant use of lopinavir/ritonavir (CYP3A inhibitors) and atorvastatin (a CYP3A4 substrate) may cause significant increases in the plasma concentrations of atorvastatin and increase the risk of myopathy and rhabdomyolysis. After concomitant administration of lopinavir/ritonavir and atorvastatin, the atorvastatin AUC increased 488% 2.

Common questions

Can I take Atorvastatin and Lopinavir together?

Increased atorvastatin exposure with increased risk of myopathy or rhabdomyolysis Always confirm with your pharmacist or prescriber before making any change.

How serious is the Atorvastatin and Lopinavir 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 "established". Well documented — supported by controlled studies or strong clinical data.

Questions for your pharmacist

  • Does my dose of Atorvastatin or Lopinavir 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 (2)

  1. Product Information: LIPITOR(R) oral tablets, atorvastatin calcium oral tablets. Viatris Specialty LLC (per FDA), Morgantown, WV, 2022. DailyMed
  2. Panel on Antiretroviral Guidelines for Adults and Adolescents: Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. AIDSinfo, U.S. Department of Health and Human Services. Rockville, MD. 2013.
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Atorvastatin

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All Atorvastatin interactions (159) Atorvastatin drug information
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Lopinavir

Keep reading about Lopinavir

All Lopinavir interactions (94)
Also serious with: Ketoconazole Topical Lovastatin Dihydroergotamine Injection Methylergonovine
Beyond drug–drug

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:

Atorvastatin + Activated Charcoal Apple Beer Grapefruit Green Tea Siberian Cocklebur St. John's Wort Sweet Orange + 173 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.