Atorvastatin × Linezolid

Linezolid does not inhibit the CYP3A4 enzyme and is not expected to change the levels of drugs cleared through it (linezolid SmPC), so atorvastatin levels are not expected to rise. The risk lies elsewhere: rhabdomyolysis has been reported with linezolid (linezolid SmPC), and atorvastatin itself can damage muscle, up to rhabdomyolysis (atorvastatin SmPC). The labels give no data on the combination itself.

Muscle pain, tenderness, cramps or weakness, sometimes with fever and malaise, dark urine and raised creatine kinase in blood tests (linezolid and atorvastatin labels).

The linezolid SmPC asks for caution in patients with risk factors for rhabdomyolysis (linezolid SmPC), and atorvastatin can itself cause rhabdomyolysis (atorvastatin SmPC). Linezolid does not inhibit CYP3A4, so the atorvastatin label's lower maximum dose for drugs that raise atorvastatin levels does not apply to it (linezolid and atorvastatin labels). Ask the patient to report muscle pain, cramps or weakness at once, especially with fever or malaise. If they occur, measure creatine kinase; stop atorvastatin if it is more than 5 times the upper limit of normal or if rhabdomyolysis is suspected (atorvastatin SmPC). At signs of rhabdomyolysis, stop linezolid as well and start appropriate treatment (linezolid SmPC).