Atorvastatin with Verapamil Interaction Details

Brand Names Associated with Atorvastatin

Brand Names Associated with Verapamil

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Mar 04, 2024

Interaction Effect

Increased exposure to atorvastatin and an increased risk of myopathy or rhabdomyolysis

Interaction Summary

Concomitant administration of atorvastatin and verapamil may result in elevated atorvastatin levels, and an increased risk of myopathy/rhabdomyolysis. The mechanism may involve inhibition of CYP3A4-mediated atorvastatin metabolism by verapamil. Other CYP3A4 substrates (eg, simvastatin) have demonstrated increased exposure when coadministered with verapamil, and reports of myopathy/rhabdomyolysis have been noted. If concomitant therapy of atorvastatin and verapamil is necessary, lower doses of atorvastatin may be required[1][2][3]. Periodic creatine kinase (CK) determinations may be considered in patients receiving atorvastatin; discontinue use with markedly elevated CK levels, or if severe myopathy/rhabdomyolysis is diagnosed or suspected [4]. If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness).

Severity

Major

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Concomitant administration of atorvastatin and verapamil may result in elevated atorvastatin levels, leading to an increased risk of myopathy/rhabdomyolysis. If coadministration is necessary, lower starting and maintenance doses of atorvastatin may be required[1][2][3]. Periodic creatine kinase (CK) determinations may be considered in patients receiving atorvastatin, although such monitoring does not assure severe myopathy can be avoided. . Discontinue atorvastatin with markedly elevated CPK levels or if severe myopathy/rhabdomyolysis is diagnosed or suspected [4]. If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness).

Mechanism Of Interaction

Inhibition of CYP3A4-mediated atorvastatin metabolism by verapamil

Literature Reports

A) Coadministration of simvastatin 80 mg (a CYP3A4 substrate) and verapamil 10 mg (a CYP3A4 inhibitor) resulted in 2.5-fold greater simvastatin exposure compared with administration of simvastatin alone. In addition to the available pharmacokinetic data, reports of myopathy/rhabdomyolysis have occurred in association with the use of HMG-CoA reductase inhibitors that are CYP3A4 substrates in combination with verapamil. Lower starting and maintenance doses of atorvastatin (another CYP3A4 substrate) may be required [1][2][3].

References

1 ) Product Information: CALAN(R) oral tablets, verapamil HCl oral tablets. G.D. Searle (per FDA), New York, NY, 2011.

2 ) Product Information: COVERA-HS(R) oral extended-release controlled-onset tablets, verapamil HCl oral extended-release controlled-onset tablets. G.D. Searle (per FDA), New York, NY, 2011.

3 ) Product Information: CALAN(R) intravenous injection, verapamil HCl intravenous injection. G.D. Searle (per FDA), New York, NY, 2011.

4 ) Product Information: LIPITOR(R) oral tablets, atorvastatin calcium oral tablets. Pfizer Ireland Pharmaceuticals, Dublin, Ireland, 2009.

Atorvastatin Overview

• Atorvastatin is used together with diet, weight loss, and exercise to reduce the risk of heart attack and stroke and to decrease the chance that heart surgery will be needed in people who have heart disease or who are at risk of developing heart disease. Atorvastatin is also used to decrease the amount of fatty substances such as low-density lipoprotein (LDL) cholesterol ('bad cholesterol') and triglycerides in the blood and to increase the amount of high-density lipoprotein (HDL) cholesterol ('good cholesterol') in the blood. Atorvastatin may also be used to decrease the amount of cholesterol and other fatty substances in the blood in children and teenagers 10 to 17 years of age who have familial heterozygous hypercholesterolemia (an inherited condition in which cholesterol cannot be removed from the body normally). Atorvastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body.

• Accumulation of cholesterol and fats along the walls of your arteries (a process known as atherosclerosis) decreases blood flow and, therefore, the oxygen supply to your heart, brain, and other parts of your body. Lowering your blood level of cholesterol and fats with atorvastatin has been shown to prevent heart disease, angina (chest pain), strokes, and heart attacks.

Verapamil Overview

• Verapamil is used to treat high blood pressure and to control angina (chest pain). The immediate-release tablets are also used alone or with other medications to prevent and treat irregular heartbeats. Verapamil is in a class of medications called calcium-channel blockers. It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart and slows electrical activity in the heart to control the heart rate.

• High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.