Gemfibrozil and Atorvastatin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atorvastatin
Gemfibrozil
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
Avoid coadministration of atorvastatin (an OATP1B1, OATP1B3 and BCRP substrate) with gemfibrozil (an OATP1B1, OATP1B3 and BCRP inhibitor)2, as it may significantly increase atorvastatin exposure, which may also increase the risk of myopathy/rhabdomyolysis 3. Coadministration of atorvastatin and gemfibrozil (an OATP1B1 transporter inhibitor) significantly increased the exposure of the atorvastatin metabolites 1, and clinically significant rhabdomyolysis has been reported in a case report of a patient treated concomitantly with both drugs 5.
Why it happens (mechanism)
Inhibition of OATP1B1-mediated atorvastatin transport; inhibition of OATP1B3-mediated efflux transport of atorvastatin; inhibition of BCRP-mediated efflux transport of atorvastatin
Literature reports
5 reports — tap to read
a) Concomitant use of atorvastatin and gemfibrozil resulted in a significant increase in enantiomers of 2- and 4-hydroxy metabolites of atorvastatin related to gemfibrozil inhibition of the OATP1B1 transporter 1.
b) I a drug interaction study, subjects receiving a single dose of atorvastatin 40 mg who were coadministered gemfibrozil 600 mg twice daily for 7 days resulted in increased AUC and Cmax by 1.35-fold and 1-fold, respectively 3.
c) Coadministration of single dose atorvastatin 40 mg with gemfibrozil 600 mg twice daily for 7 days led to a 1.35-fold increase in atorvastatin AUC and a 1-fold increase in Cmax 2.
d) A study involving 10 healthy volunteers found gemfibrozil given 600 mg twice a day for 5 days and a single atorvastatin 20 mg dose on day 3 increased atorvastatin exposure when compared with atorvastatin plus placebo. Gemfibrozil raised the plasma concentrations of atorvastatin and of both the acid and lactone forms of the 2-hydroxy and 4-hydroxy metabolites, but had no effect on the concentration of atorvastatin lactone. The AUC of atorvastatin, 2-hydroxyatorvastatin acid, and 4-hydroxyatorvastatin acid increased 24%, 51% and 82% respectively. The respective lactone forms of the atorvastatin metabolites were increased by 29% and 28%. The maximum concentration (Cmax) of 2-hydroxyatorvastatin lactone increased by 36% and of 4-hydroxyatorvastatin acid by 173%. This was attributed to the possible inhibition of OATP1B1-mediated hepatic uptake of atorvastatin and its hydroxylated metabolites 4.
e) A 43-year-old female with pancreatitis, chylomicronemia, dehydration, uncontrolled diabetes, a thrombotic diathesis, and arterial thromboses associated with foot ischemia was admitted to the hospital with a serum creatine kinase concentration of 4633 units/L. Prior to admission, she had been taking gemfibrozil 600 mg twice daily, cimetidine 400 mg twice daily, fluoxetine 20 mg once daily, medroxyprogesterone 10 mg twice daily, and furosemide on an as-needed basis. Three weeks before admission, atorvastatin 10 mg twice daily was added to her medication regimen. When no evidence of myocardial infarction or stroke was present, the atorvastatin and gemfibrozil were discontinued during the first day of her hospital stay. Her serum creatine kinase levels dropped steadily during the first two weeks, and continued to decrease when gemfibrozil was reinstituted on day 9. The rhabdomyolysis was attributed to an interaction between atorvastatin and gemfibrozil, and may have been potentiated by dehydration and pancreatitis 5.
Common questions
Can I take Gemfibrozil 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 Gemfibrozil 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 "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 Gemfibrozil 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 (5)
- Tornio A, Neuvonen PJ, Niemi M, et al: Role of gemfibrozil as an inhibitor of CYP2C8 and membrane transporters. Expert Opin Drug Metab Toxicol 2017; 13(1):83-95. PubMed
- 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
- Backman J, Luurila H, Neuvonen M, et al: Rifampin markedly decreases and gemfibrozil increases the plasma concentrations of atorvastatin and its metabolites. Clin Pharmacol Ther 2005; 78:154-167. PubMed
- Duell PB, Connor WE, & Illingworth DR: Rhabdomyolysis after taking atorvastatin with gemfibrozil. Am J Cardiol 1998; 81:368-369. PubMed
Keep reading about Atorvastatin
Keep reading about Gemfibrozil
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
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