Azole antifungals with statins

The evidence suggests that all the azole antifungals can raise ciclosporin levels to a greater or lesser degree. Ketoconazole may cause five- to tenfold rises, while itraconazole, fluconazole and voriconazole may cause two- to threefold rises. A case report suggests that intravenous miconazole interacts similarly and in theory, miconazole oral gel may also interact. Posaconazole may also modestly raise ciclosporin levels. Rhabdomyolysis has been reported with the combination of ciclosporin and itraconazole, but four of these cases were complicated by the presence of statins. 

Pravastatin. The clinical relevance of the modest changes in pravastatin levels with different azole antifungals seems likely to be small, and a clinically significant interaction would not be expected. Note that in a review of the FDA spontaneous reports of statin-associated rhabdomyolysis for the period November 1997 to March 2000, azole antifungals were not identified as a potentially interacting drug in any of the reports for pravastatin. ... 

The antifungal azoles inhibit CYP isozymes and can therefore interact with some statins. 

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