Major
Atorvastatin × Voriconazole
HMG-CoA reductase inhibitors (statins)×Triazole derivatives, systemic antifungals
Mechanism
Voriconazole inhibits CYP3A4. Atorvastatin rises 3-4 fold.
Symptoms
Myalgia, weakness, dark urine, rising CK within 5-10 days.
Management
Cap atorvastatin at 20 mg/day.
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.