Verapamil and Atorvastatin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 15, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atorvastatin
Verapamil
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 exposure to atorvastatin and an increased risk of myopathy or rhabdomyolysis
Interaction Deep Dive
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 required234. 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 1. If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness).
Why it happens (mechanism)
Inhibition of CYP3A4-mediated atorvastatin metabolism by verapamil
Literature reports
1 report — tap to read
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 234.
Common questions
Can I take Verapamil and Atorvastatin together?
Increased exposure to atorvastatin and an increased risk of myopathy or rhabdomyolysis Always confirm with your pharmacist or prescriber before making any change.
How serious is the Verapamil 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 "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Verapamil 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 (4)
- Product Information: LIPITOR(R) oral tablets, atorvastatin calcium oral tablets. Pfizer Ireland Pharmaceuticals, Dublin, Ireland, 2009. DailyMed
- Product Information: CALAN(R) oral tablets, verapamil HCl oral tablets. G.D. Searle (per FDA), New York, NY, 2011. DailyMed
- 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. DailyMed
- Product Information: CALAN(R) intravenous injection, verapamil HCl intravenous injection. G.D. Searle (per FDA), New York, NY, 2011. DailyMed
Keep reading about Atorvastatin
Keep reading about Verapamil
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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