Fluconazole Atorvastatin

Kahri J, Valkonen M, Backlund T, Vuoristo M, Kivisto KT. Rhabdomyolysis in a patient receiving atorvastatin and fluconazole. Eur J Clin Pharmacol 2005 60(12) 905-7. 

Clinically important, potentially hazardous interactions with alfentanil, aminophylline, amisulpride, amoxicillin, ampicillin, anticonvulsants, astemizole, atorvastatin, benzodiazepines, bromocriptine, buprenorphine, bupropion, carbamazepine, cilostazol, ciprofloxacin, cisapride, clindamycin, colchicine, cyclosporine, dasatinib, digoxin, dihydroergotamine, diltiazem, disopyramide, enoxacin, eplerenone, ergotamine, eszopiclone, everolimus, fluconazole, fluoxetine, fluvastatin, gatifloxacin, HMG-CoA reductase inhibitors, imatinib, itraconazole, ketoconazole, lomefloxacin, lorazepam, lovastatin, methadone, methylprednisolone, methysergide, midazolam, mizolastine, moxifloxacin, nitrazepam, norfloxacin, ofloxacin, paroxetine, pimozide, pravastatin, quinolones, ranolazine, repaglinide, rupatadine, sertraline, sildenafil, simvastatin, sparfloxacin, sulpiride, tacrolimus, terfenadine, triazolam, troleandomycin, vardenafil, verapamil, vinblastine, warfarin, zaleplon, zolpidem, zuclopenthixol... 

Fluconazole modestly increases the levels of fluvastatin and rosuvastatin, but not pravastatin. Miconazoie wouid be expected to interact simiiariy. Itraconazoie causes a marked rise in the serum ieveis of atorvastatin, iovastatin, pravastatin and simvastatin, but no change in fluvastatin or rosuvastatin ieveis. Ketoconazole wouid be expected to interact simiiariy. Rhabdomyolysis has been reported in some cases. Due to the risk of myopathy, the manufacturers of voriconazoie caution, and the manufacturers of posaco-nazoie contraindicate, concurrent use with atorvastatin, iovastatin and simvastatin. 

A case report describes a 76-year-old man taking multiple medications, including pravastatin 80 mg daily with fluconazole 150 mg daily, uneventfully for about 18 months. Due to an inadequate response to the pravastatin he was changed to atorvastatin 40 mg daily. Within one week he developed dyspnoea, myopathy, rhabdomyolysis and renal failure. Although both drugs were stopped he later died of multi-organ failure. The authors considered an interaction between atorvastatin and fluconazole as the most likely explanation for the rhabdomyolysis. ... 

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