MajorHMG-CoA reductase inhibitors (statins)×Macrolide antibiotic
Updated · Methodology
Mechanism
Clarithromycin is a strong inhibitor of CYP3A4 and P-glycoprotein. Atorvastatin plasma levels rise 4–5-fold, and so does the risk of rhabdomyolysis with acute kidney injury. The labels do not ban the pair. The FDA caps atorvastatin at 20 mg/day while clarithromycin is taken. The AEMPS label advises avoiding the combination where possible and, if it cannot be avoided, using lower starting and maximum statin doses.
Symptoms
Within 5–10 days: muscle pain, especially thighs and shoulder girdle, dark urine, creatine kinase above 10× ULN, rising creatinine.
Management
Hold atorvastatin or reduce it to 10–20 mg/day for the duration of clarithromycin (typically 7–14 days). Alternative: switch clarithromycin to azithromycin, which does not inhibit CYP3A4.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
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Sources
- FDA: Lipitor (atorvastatin) prescribing information (2017)– ; DailyMed setid a60cc18b-0631-4cf0-b021-9f52224ece65
- FDA: Lipitor (atorvastatin) prescribing information, Section 7 Drug Interactions (2017)
- AEMPS: Ficha técnica: Atorvastatina (nº registro 69536), sección 4.5 (2024)– AEMPS, CIMA, nº registro 69536, sección 4.5
- AEMPS: Ficha técnica: Claritromicina (nº registro 75638), sección 4.5 (2025)– AEMPS, CIMA, nº registro 75638, sección 4.5