Atorvastatin and Ticagrelor: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 15, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atorvastatin
Ticagrelor
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 (CYP3A4 substrate) and ticagrelor (weak CYP3A4 inhibitor) increases atorvastatin exposure1 and coadministration has been associated with increased incidence of rhabdomyolysis 2. In a pharmacokinetic study, coadministration of atorvastatin and ticagrelor resulted in an approximately 1.4-fold increase in AUC. The manufacturer of ticagrelor does not recommend dose adjustments when used concomitantly 1. If risk factors for rhabdomyolysis are present (eg, renal impairment, older age, hypertension, diabetes), consider using a lower dose of atorvastatin therapy or an alternative antiplatelet if appropriate. Monitor closely, especially during the first few months of coadministration. If rhabdomyolysis occurs during coadministration, switch to another P2Y12 inhibitor if possible 2.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of atorvastatin
Literature reports
3 reports — tap to read
a) Increased incidence of rhabdomyolysis was associated with coadministration of ticagrelor and atorvastatin in an analysis of the World Health Organization pharmacovigilance database (N=9489 cases of statin use, including 2464 also treated with antiplatelets). Concomitant use of ticagrelor and atorvastatin was associated with significantly increased risk of rhabdomyolysis in the univariate analysis (reporting OR [ROR], 1.48; 95% CI, 1.17 to 1.88) compared with use of atorvastatin alone; the results were also significant in the multivariate analysis (ROR, 1.3; 95% CI, 1.02 to 1.65). No significant differences in risk of rhabdomyolysis were noted when atorvastatin was coadministered with other antiplatelets (including aspirin, clopidogrel, or prasugrel) compared with use of atorvastatin alone. Most cases of rhabdomyolysis associated with a combination of antiplatelet and statin therapy occurred in male patients (62.5%) over 65 years (66.5%), and most occurred during the first 6 months of coadministration 2.
b) In a case series, coadministration of ticagrelor with high-intensity statin therapy following percutaneous transluminal coronary angioplasty was associated with statin-induced rhabdomyolysis in 4 patients over a 1-year period. All patients were receiving ticagrelor 90 mg twice daily with a high-intensity statin (rosuvastatin or atorvastatin) when diagnosed with rhabdomyolysis and acute kidney injury. In case 1, a 48-year-old male patient developed weakness, limb pain, and stiffness 13 weeks after initiation of ticagrelor and rosuvastatin 40 mg (peak creatine kinase [CK], 18,970 units/L; peak SCr, 9.96 mg/dL [baseline, 1.1]). In case 2, a 70-year-old female patient developed generalized myalgias 1 week after initiation of ticagrelor and rosuvastatin 40 mg (peak CK, 10,850 units/L; peak SCr, 3.28 mg/dL [baseline, 1.2]; previously on atorvastatin 10 mg [moderate intensity]). In case 3, a 67-year-old male patient developed shortness of breath and anasarca 2 weeks after initiation ticagrelor and atorvastatin 80 mg (peak CK, 36,011 units/L; peak SCr, 8.62 mg/dL [baseline, 0.9]; previously on atorvastatin 10 mg). In case 4, a 74-year-old female patient developed generalized myalgia and decreased urine output 4 weeks after initiation of ticagrelor and rosuvastatin 40 mg (peak CK, 40,205 units/L; peak SCr, 6.28 mg/dL [baseline, 1]). Statins were discontinued in all cases, however 2 patients (cases 2 and 4) eventually died. High doses of statins, polypharmacy, older age, and vitamin D deficiency were probable risk factors for rhabdomyolysis and associated mortality in this 3.
c) In a pharmacokinetic study, coadministration of atorvastatin 80 mg and ticagrelor 180 mg twice daily resulted in an approximately 1.4-fold increase in AUC and a nonsignificant change in Cmax of atorvastatin 1.
Common questions
Can I take Atorvastatin and Ticagrelor 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 Ticagrelor interaction?
It is rated moderate. Can be significant — usually manageable with 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 "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 Ticagrelor 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 anything you'd monitor while I'm on both?
References (3)
- Product Information: BRILINTA(R) oral tablets, ticagrelor oral tablets. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2024. DailyMed
- Roule V, Alexandre J, Lemaitre A, et al: Rhabdomyolysis with co-administration of statins and antiplatelet therapies-analysis of the WHO pharmacovigilance database. Cardiovasc Drugs Ther 2024; 38(6):1191-1199. PubMed
- Patel R, Sharma JB, & Rajput S: Statins ticagrelor and rhabdomyolysis: a coincidence or a drug interaction. J Lipid Atheroscler 2024; 13(1):61-68. PubMed
Keep reading about Atorvastatin
Keep reading about Ticagrelor
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