Lovastatin and Azithromycin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Lovastatin
Azithromycin
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
An increased risk of rhabdomyolysis
Interaction Deep Dive
Although pharmacokinetic study revealed azithromycin had no significant effect on atorvastatin Cmax and AUC, concomitant use of azithromycin and lovastatin may increase the risk of rhabdomyolysis. In one review, rhabdomyolysis was reported within 10 days of azithromycin initiation during statin use. Of all cases (n=53) except 1 (cerivastatin), the reported statin doses were within recommended daily doses23. Monitor the patient for signs and symptoms of rhabdomyolysis (dark-colored urine, muscle pain) when azithromycin is coadministered with lovastatin.
Why it happens (mechanism)
Unknown
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 1.
b) A systematic review of the World Heath Organization Adverse Drug Reaction database revealed concomitant use of statins and azithromycin may increase the risk of rhabdomyolysis. The statins reported included atorvastatin, cerivastatin, lovastatin, pravastatin, rosuvastatin and simvastatin. Of reported cases (n=53; median age 60 years), 26% of patients were using a statin 3 months or more before the onset of rhabdomyolysis. In 23% of cases, rhabdomyolysis occurred within 10 days of azithromycin initiation. In all cases except 1 (cerivastatin), the reported statin doses were within recommended daily doses 2.
c) In a pharmacokinetic study (n=12), coadministration of azithromycin 500 mg orally daily on days 6 to 8 with atorvastatin 10 mg/day for 8 days revealed no significant effects to atorvastatin Cmax and AUC 3.
Common questions
Can I take Lovastatin and Azithromycin together?
An increased risk of rhabdomyolysis Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lovastatin and Azithromycin 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 Lovastatin or Azithromycin 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)
- 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. DOI
- Strandell J, Bate A, Hagg S, et al: Rhabdomyolysis a result of azithromycin and statins: an unrecognized interaction. Br J Clin Pharmacol 2009; 68(3):427-434. PubMed
- Product Information: ZITHROMAX(R) oral suspension, oral tablets, azithromycin oral suspension, oral tablets. Pfizer Labs, New York, NY, 2009. DailyMed
Keep reading about Lovastatin
Keep reading about Azithromycin
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:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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