Voriconazole and Atorvastatin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 15, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atorvastatin
Voriconazole
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, an increased risk of myopathy, an increased voriconazole exposure and an increased risk of voriconazole-related adverse reactions
Interaction Deep Dive
Concomitant use of atorvastatin and voriconazole may increase atorvastatin exposure2 and increase risk for myopathy. If concomitant use is necessary, use the lowest atorvastatin dose necessary and closely monitor patients for signs or symptoms of muscle pain, tenderness, and weakness, particularly during initial months of therapy or during periods of titration of either drug. Consider periodic creatine phosphokinase (CPK) levels, however there is no assurance such monitoring will prevent severe myopathy 1. Coadministration of voriconazole is coadministered with atorvastatin (CYP3A4 inhibitor) may increase voriconazole exposure. Adjust voriconazole dosage and frequently monitor for adverse reactions 3.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of atorvastatin; inhibition of CYP3A4-mediated metabolism of voriconazole
Literature reports
4 reports — tap to read
a) In a drug interaction study, concurrent administration of oral voriconazole (400 mg every 12 hours for 1 day, then 200 mg every 12 hours for 2.5 days) and oral fluconazole (CYP3A4 inhibitor) (400 mg on day 1, then 200 mg every 24 hours for 4 days) to 6 healthy male subjects resulted in an increase in Cmax and AUC(tau) of voriconazole by an average of 57% (90% CI: 20%, 107%) and 79% (90% CI: 40%, 128%), respectively 3.
b) In an independent published study, concomitant use of voriconazole (400 mg every 12 hours on Day 1, then 200 mg every 12 hours on Day 2) with a single intravenous dose of fentaNYL (CYP3A4 substrate) (5 microgram/kg) resulted in an increase in the mean AUC (0 to inf) of fentaNYL by 1.4-fold (range 0.81- to 2.04-fold) 3.
c) In another independent published study, coadministration of multiple doses of oral voriconazole (400 mg every 12 hours, on Day 1 followed by five doses of 200 mg every 12 hours on Days 2 to 4) with a single 10 mg oral dose of oxyCODONE (CYP3A4 substrate) on Day 3 resulted in an increase in the mean Cmax and AUC (0 to inf) of oxyCODONE by 1.7-fold (range 1.4- to 2.2-fold) and 3.6- fold (range 2.7- to 5.6-fold), respectively. The mean elimination half-life of oxyCODONE was also increased by 2.0-fold (range 1.4- to 2.5-fold) 3.
d) In stable renal transplant recipients receiving chronic cycloSPORINE (CYP3A4 substrate) therapy, concomitant administration of oral voriconazole (200 mg every 12 hours for 8 days) increased cycloSPORINE Cmax and AUC (tau) an average of 1.1 times (90% CI: 0.9, 1.41) and 1.7 times (90% CI: 1.5, 2.0), respectively, as compared to when cycloSPORINE was administered without voriconazole 3.
Common questions
Can I take Voriconazole and Atorvastatin together?
Increased atorvastatin exposure, an increased risk of myopathy, an increased voriconazole exposure and an increased risk of voriconazole-related adverse reactions Always confirm with your pharmacist or prescriber before making any change.
How serious is the Voriconazole 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 "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 Voriconazole 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 (3)
- 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
- Product Information: VFEND(R) oral tablets, oral suspension, intravenous injection, voriconazole oral tablets, oral suspension, intravenous injection. Roerig (per FDA), New York, NY, 2025. DailyMed
Keep reading about Atorvastatin
Keep reading about Voriconazole
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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:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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