ModerateHMG-CoA reductase inhibitors (statins)×Antifungals, triazole derivatives
Updated · Methodology
Mechanism
Fluconazole moderately inhibits CYP3A4, the enzyme that metabolises atorvastatin (fluconazole and atorvastatin SmPCs). Atorvastatin blood levels can rise, and with them the risk of muscle damage up to rhabdomyolysis (fluconazole SmPC).
Symptoms
Pain and weakness in large muscle groups (thighs, shoulders, calves), dark urine, elevated creatine kinase. Severe cases progress to rhabdomyolysis with acute kidney injury.
Management
The combination is not contraindicated. The atorvastatin SmPC classes fluconazole as a moderate CYP3A4 inhibitor: consider a lower maximum atorvastatin dose while the drugs are combined, and monitor the patient, especially after fluconazole is started or its dose changed (atorvastatin SmPC). While both drugs are taken, watch for muscle pain and weakness and check creatine kinase. If creatine kinase rises markedly or myopathy or rhabdomyolysis is suspected, stop atorvastatin (fluconazole SmPC).
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
- PubMed: Rhabdomyolysis associated with concomitant use of atorvastatin and fluconazole (2008)
- AEMPS: Ficha técnica: Atorvastatina (nº registro 69536), sección 4.5 (2024)– AEMPS, CIMA, nº registro 69536, sección 4.5
- AEMPS: Ficha técnica: Fluconazol (nº registro 67929), sección 4.5 (2026)– AEMPS, CIMA, nº registro 67929, revisión 10/2026, sección 4.5
- FDA: Diflucan (fluconazole) prescribing information (2026)– FDA Diflucan label, DailyMed setid f694c617-3383-416c-91b6-b94fda371204, revised 04/2026, Contraindications and Drug Interactions
- AEMPS: Ficha técnica: Atorvastatina (Cardyl 10 mg) (nº registro 61716), secciones 4.4 y 4.5 (2024)– AEMPS, CIMA, nº registro 61716, revisión 11/2024, secciones 4.4 y 4.5
- AEMPS: Ficha técnica: Fluconazol (Diflucan 100 mg) (nº registro 58804), sección 4.5 (2024)– AEMPS, CIMA, nº registro 58804, revisión 07/2024, sección 4.5