Atorvastatin and Ritonavir: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 15, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atorvastatin
Ritonavir
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, including rhabdomyolysis
Interaction Deep Dive
Concomitant use of atorvastatin and dasabuvir/ombitasvir/paritaprevir/ritonavir is contraindicated4. Coadministration of atorvastatin and ritonavir may increase atorvastatin exposure and increase the risk of myopathy, including rhabdomyolysis. If concurrent therapy is required, initiate with the lowest possible dose of atorvastatin and carefully titrate. Additionally, monitor for atorvastatin adverse effects during therapy (e.g., muscle pain, tenderness, or weakness) 56. Avoid concomitant use of atorvastatin with tipranavir/ritonavir. In patients taking lopinavir plus ritonavir, consider the risk/benefit of concomitant use with atorvastatin. If atorvastatin is used concomitantly in patients taking saquinavir plus ritonavir, darunavir plus ritonavir or fosamprenavir plus ritonavir, do not exceed a atorvastatin dose of 20 mg/day 1. Concomitant use of atorvastatin with tipranavir plus ritonavir is not recommended 2.
Why it happens (mechanism)
Inhibition of BCRP-mediated efflux transport 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 atorvastatin; inhibition of CYP3A4-mediated metabolism of atorvastatin
Literature reports
5 reports — tap to read
a) In a pharmacokinetic study (n=16), concomitant use of fosamprenavir and atorvastatin significantly increased the Cmax and AUC of atorvastatin. When fosamprenavir 1400 mg twice daily for 2 weeks was coadministered with atorvastatin 10 mg once daily for 4 days, the Cmax and AUC of atorvastatin were increased by 304% and 130%, respectively. The Cmax and AUC of amprenavir were decreased by 18% and 27%, respectively. When fosamprenavir 700 mg twice daily plus ritonavir 100 mg twice daily for 2 weeks were coadministered with atorvastatin 10 mg once daily for 4 days, the Cmax and AUC of atorvastatin were increased by 184% and 153%, respectively. The Cmax and AUC of amprenavir did not change (increased or decreased less than or equal to 10%) 3.
b) Coadministration of tipranavir 500 mg/ritonavir 200 mg twice daily with atorvastatin 10 mg once daily for 7 days increased the atorvastatin AUC by 9.36-fold and Cmax by 8.58-fold compared with atorvastatin alone 1.
c) Coadministration of fosamprenavir 700 mg/ritonavir 100 mg twice daily with atorvastatin 10 mg once daily for 4 days increased the atorvastatin AUC by 2.53-fold and Cmax by 2.84-fold compared with atorvastatin alone 1.
d) Coadministration of atorvastatin 40 mg once daily for 4 days with ritonavir-boosted saquinavir 400 mg twice daily for 15 days led to a 3.93-fold increase in atorvastatin AUC and a 4.31-fold increase in Cmax 21.
e) Subjects receiving atorvastatin 10 mg daily for 4 days who were coadministered darunavir 300 mg/ritonavir 100 mg twice daily for 9 days had a 3.45-fold increase in atorvastatin AUC and a 2.25-fold increase in Cmax 21.
Common questions
Can I take Atorvastatin and Ritonavir together?
Increased atorvastatin exposure and an increased risk of myopathy, including rhabdomyolysis Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atorvastatin and Ritonavir interaction?
It is rated contraindicated. These should generally not be used together.
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 Ritonavir 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: LEXIVA(R) oral tablets, oral suspension, fosamprenavir calcium oral tablets, oral suspension. ViiV Healthcare and Vertex Pharmaceuticals Incorporated (per FDA), Research Triangle Park, NC, 2012. DailyMed
- Product Information: VIEKIRA PAK oral tablets, ombitasvir, paritaprevir, ritonavir, dasabuvir oral tablets. AbbVie Inc (per FDA), North Chicago, IL, 2017.
- Product Information: NORVIR(R) oral tablets, oral solution, ritonavir oral tablets, oral solution. Abbott Laboratories (per Manufacturer), North Chicago, IL, 2012. DailyMed
- Product Information: NORVIR(R) oral capsules, oral solution, ritonavir oral capsules, oral solution. Abbott Laboratories (per manufacturer), North Chicago, IL, 2012. DailyMed
Keep reading about Atorvastatin
Keep reading about Ritonavir
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.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist