Clarithromycin and Atorvastatin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 15, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atorvastatin
Clarithromycin
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 or rhabdomyolysis
Interaction Deep Dive
Coadministration of atorvastatin and clarithromycin may increase atorvastatin exposure. Evaluate the benefit/risk of concomitant use of atorvastatin with clarithromycin1. Use caution if coadministered and do not exceed atorvastatin doses of 20 mg daily due to an increased risk of myopathy/rhabdomyolysis 7. Monitor all patients for signs and symptoms of myopathy particularly during initiation of therapy and during upward dose titration of either drug 1. When possible, substitute atorvastatin for a statin that is not dependent on CYP3A metabolism, such as fluvastatin 8. Clinically significant rhabdomyolysis has been cited in case reports of patients treated concomitantly with atorvastatin and clarithromycin 5.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of atorvastatin
Literature reports
5 reports — tap to read
a) In a retrospective, population-based cohort study of adults older than 65 years taking a statin metabolized by CYP3A (atorvastatin, 73%; simvastatin, 24%; lovastatin, 3%), concomitant administration with clarithromycin (n=72,591) or erythromycin (n=3267) was associated a rate of hospitalization for rhabdomyolysis of 0.03% and a rate of hospitalization for acute kidney injury of 0.46%. Corresponding rates with concomitant administration of azithromycin (n=68,478) were 0.01% and 0.26%, respectively. The all-cause mortality rate was 0.7% in the clarithromycin/erythromycin group and 0.45% in the azithromycin group 3.
b) Subjects receiving atorvastatin 80 mg daily for 8 days who were coadministered clarithromycin 500 mg twice daily for 9 days had a 4.4-fold increase in atorvastatin AUC and a 5.4-fold increase in Cmax 2.
c) The coadministration of clarithromycin with atorvastatin significantly increased atorvastatin exposure. In a randomized study, healthy subjects (N=36) received atorvastatin 10 mg daily for 8 days. On study days 6 through 8, subjects received one of 3 concomitant treatments: clarithromycin 500 mg twice daily, azithromycin 500 mg once daily, or placebo. Coadministration of clarithromycin with atorvastatin significantly increased atorvastatin mean Cmax and AUC (by 56% and 82%, respectively). No significant changes from baseline were observed during placebo or azithromycin co-treatment 6.
d) Severe rhabdomyolysis associated with 3rd degree heart block developed in a 51-year-old woman receiving a multidrug regimen comprising atorvastatin, esomeprazole, and clarithromycin. The patient had previously taken atorvastatin 10 mg daily without incident for over a year, prior to presenting with symptoms of severe weakness, dyspnea, chest pain, and bradycardia. Electrocardiographic exam revealed a 3rd degree heart block pattern and serum creatine kinase (CK) was 7348 units/L, with a CK-MB (muscle-brain) concentration of 186 units/L. Urinalysis confirmed the presence of myoglobinuria. The patient reported having symptoms of increasing fatigue, mild chest pain and dyspnea that began with the coadministration of esomeprazole, approximately 6 weeks prior to admission. Clarithromycin 500 mg twice daily was added to her therapy regimen 2 days before admission (3 dose total) for treatment of respiratory symptoms. Despite the withdrawal of all medications, CK and CK-MB continued to rise, peaking above 40,000 units/L and 396 units/L, respectively. Electrolyte hydration and forced diuresis was initiated and a permanent cardiac pacemaker was eventually required. Although the authors determined esomeprazole had the highest probability of causing increased atorvastatin exposure, they also suggested clarithromycin contributed to the event 4.
e) Rhabdomyolysis developed in a 35-year-old man with HIV after clarithromycin was added to a longstanding regimen of atorvastatin and HIV protease inhibitors. The patient had previously tolerated chronic use of the combination of atorvastatin 40 mg with lopinavir/ritonavir. Approximately 8 days after starting clarithromycin 500 mg twice daily for treatment of pneumonia (at which time his liver enzymes were within normal range), the patient developed continuous sharp muscle pain in both lower limbs. Physical examination revealed bilateral hip flexor/extensor weakness, and laboratory analysis revealed a serum creatine kinase (CK) concentration of 10,298 units/L accompanied by elevations in serum ALT (281 units/L) and alkaline phosphatase (850 units/L). Urinalysis confirmed the presence of myoglobin. Atorvastatin and clarithromycin were discontinued, an alkaline diuresis was initiated, and the CK concentration declined to within normal limits by day 7 of treatment 5.
Common questions
Can I take Clarithromycin and Atorvastatin together?
Increased atorvastatin exposure and an increased risk of myopathy or rhabdomyolysis Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clarithromycin and Atorvastatin 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.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Clarithromycin or Atorvastatin 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 (8)
- Product Information: LIPITOR(R) oral tablets, atorvastatin calcium oral tablets. Viatris Specialty LLC (per FDA), Morgantown, WV, 2022. DailyMed
- Product Information: LIPITOR(R) oral tablets, atorvastatin calcium oral tablets. Pfizer (Per FDA), New York, NY, 2012. DailyMed
- Patel AM, Shariff S, Bailey DG, et al: Statin toxicity from macrolide antibiotic coprescription: a population-based cohort study. Ann Intern Med 2013; 158(12):869-876. PubMed
- Sipe BE, Jones RJ, & Bokhart GH: Rhabdomyolysis causing AV blockade due to possible atorvastatin, esomeprazole, and clarithromycin interaction. Ann Pharmacother 2003; 37:808-811. PubMed
- Ming JB & Gill MJ: Drug-induced rhabdomyolysis after concomitant use of clarithromycin, atorvastatin, and lopinavir/ritonavir in a patient with HIV. AIDS Patient Care and STDs 2003; 17(5):207-210.
- Amsden GW, Kuye O, & Wei GC: A study of the interaction potential of azithromycin and clarithromycin with atorvastatin in healthy volunteers. J Clin Pharmacol 2002; 42:444-449. DOI
- Product Information: VOQUEZNA(TM) TRIPLE PAK(TM) oral kit, vonoprazan oral tablets, amoxicillin oral capsules, clarithromycin oral tablets kit. Phathom Pharmaceuticals (per FDA), Buffalo Grove, IL, 2023. DailyMed
- Product Information: BIAXIN(R) Filmtab(R) oral tablets, clarithromycin oral tablets. Abbott Laboratories (per manufacturer), North Chicago, IL, 2011. DailyMed
Keep reading about Atorvastatin
Keep reading about Clarithromycin
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