Drug Interaction Report

Erythromycin and Atorvastatin: Interaction Details

A pharmacist-reviewed analysis of the Erythromycin and Atorvastatin 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®
+

Erythromycin

Erythrocin Stearate
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
Contraindicated
These should generally not be used together.
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 186 documented Erythromycin interactions, 7 are rated contraindicated — 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
delayed
Evidence
probable
Severity
Contraindicated

What happens

Increased atorvastatin exposure, an increased risk of atorvastatin-related adverse reaction and an increased risk of myopathy or rhabdomyolysis

Interaction Deep Dive

Concomitant use of erythromycin and atorvastatin (CYP3A4 substrate and HMG CoA reductase inhibitor) is contraindicated due to the potential for serious reactions such as myopathy and rhabdomyolysis and cause serious adverse reactions456. Concomitant use of atorvastatin with erythromycin may increase atorvastatin exposure. Evaluate the risk/benefit and risk of coadministration. 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 drug 1. Clinically significant rhabdomyolysis has been cited in case reports of patients treated concomitantly with atorvastatin and clarithromycin 78.

Why it happens (mechanism)

Inhibition of CYP3A4-mediated metabolism of atorvastatin; inhibition of P-gp-mediated efflux transport of atorvastatin

Literature reports

3 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 a single dose of atorvastatin 10 mg who were coadministered erythromycin 500 mg 4 times daily for 7 days had a 33% increase in atorvastatin AUC and a 38% increase in Cmax 2.

c) Clinically significant rhabdomyolysis has been cited in case reports of patients treated concomitantly with atorvastatin and clarithromycin 78.

Common questions

Can I take Erythromycin and Atorvastatin together?

Increased atorvastatin exposure, an increased risk of atorvastatin-related adverse reaction and an increased risk of myopathy or rhabdomyolysis Always confirm with your pharmacist or prescriber before making any change.

How serious is the Erythromycin and Atorvastatin 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 "probable". Good supporting evidence, though not definitively proven.

Questions for your pharmacist

  • Does my dose of Erythromycin 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)

  1. Product Information: LIPITOR(R) oral tablets, atorvastatin calcium oral tablets. Viatris Specialty LLC (per FDA), Morgantown, WV, 2022. DailyMed
  2. Product Information: LIPITOR(R) oral tablets, atorvastatin calcium oral tablets. Pfizer (Per FDA), New York, NY, 2012. DailyMed
  3. 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
  4. Product Information: Erythromycin Lactobionate IV injection lyophilized powder for solution, erythromycin lactobionate IV injection lyophilized powder for solution. Nexus Pharmaceuticals (per DailyMed), Lincolnshire, IL, 2024.
  5. Product Information: Erythromycin oral delayed-release capsules, erythromycin oral delayed-release capsules. Dr. Reddy's Laboratories Inc. (per DailyMed), Princeton, NJ, 2025. DailyMed
  6. Product Information: ERYTHROMYCIN ETHYLSUCCINATE oral suspension granule, erythromycin ethylsuccinate oral suspension granule. ANI Pharmaceuticals, Inc (per DailyMed), Baudette, MN, 2025. DailyMed
  7. 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
  8. 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.
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Atorvastatin

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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
Erythromycin + Activated Charcoal American Hellebore Arsenic Beer Cesium Ephedra Grapefruit Oleander + 196 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.