MAJOR — Use With Caution
DANGEROUS — statin therapy becomes ineffective
Evidence level: STRONG
Rifampin makes atorvastatin nearly useless for cholesterol control.
Rifampin induces CYP3A4 and P-glycoprotein. Atorvastatin is a CYP3A4 substrate. Rifampin reduces atorvastatin levels by up to 80%.
Statin dose may need significant increase during rifampin therapy. Consider pravastatin (less CYP3A4 dependent). Monitor lipids.
Some antibiotics (erythromycin, clarithromycin) strongly inhibit CYP3A4 and can dramatically increase statin levels, raising rhabdomyolysis risk. Take Atorvastatin in the evening as usual. Your prescriber may temporarily pause or reduce the statin during short antibiotic courses.
Pre-existing cardiovascular disease, concurrent CYP inducers
Loss of cholesterol control, cardiovascular risk
Discuss alternative statin or dose adjustment. Monitor lipid panel.
Statin interactions often involve liver enzyme competition. Ask your doctor about alternative statins (rosuvastatin and pravastatin have fewer CYP interactions) or spacing doses 12 hours apart. CoQ10 supplementation may help with statin-related muscle discomfort.
Rifampin makes atorvastatin nearly useless for cholesterol control.
Some antibiotics (erythromycin, clarithromycin) strongly inhibit CYP3A4 and can dramatically increase statin levels, raising rhabdomyolysis risk. Take Atorvastatin in the evening as usual. Your prescriber may temporarily pause or reduce the statin during short antibiotic courses.
Loss of cholesterol control, cardiovascular risk
Statin interactions often involve liver enzyme competition. Ask your doctor about alternative statins (rosuvastatin and pravastatin have fewer CYP interactions) or spacing doses 12 hours apart. CoQ10 supplementation may help with statin-related muscle discomfort.
Discuss alternative statin or dose adjustment. Monitor lipid panel.
Or browse the full interaction database (121,000+ pairs).