Atorvastatin and Tolsura

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Talk to your doctor before using atorvastatin together with itraconazole. Combining these medications may significantly increase the blood levels of atorvastatin. This can increase the risk of side effects such as liver damage and a rare but serious condition called rhabdomyolysis that involves the breakdown of skeletal muscle tissue. In some cases, rhabdomyolysis can cause kidney damage and even death. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications, or your doctor may prescribe alternative medications that do not interact. Let your doctor know immediately if you have unexplained muscle pain, tenderness, or weakness during treatment with atorvastatin or similar medications, especially if these symptoms are accompanied by fever or dark colored urine. You should also seek immediate medical attention if you develop fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, dark colored urine, and/or yellowing of the skin or eyes, as these may be signs and symptoms of liver damage. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

ADJUST DOSE: Coadministration with itraconazole may significantly increase the plasma concentrations of atorvastatin and potentiate the risk of statin-induced myopathy. The proposed mechanism is itraconazole inhibition of atorvastatin metabolism via intestinal and hepatic CYP450 3A4. When single doses of atorvastatin 20 mg and 40 mg were coadministered with itraconazole 200 mg daily for 4 days, atorvastatin systemic exposure (AUC) increased by 2.5- and 3.3-fold, respectively, compared to atorvastatin administered alone. High levels of statin or HMG-CoA reductase inhibitory activity in plasma is associated with an increased risk of musculoskeletal toxicity. Myopathy manifested as muscle pain and/or weakness associated with grossly elevated creatine kinase exceeding ten times the upper limit of normal has been reported occasionally. Rhabdomyolysis has also occurred rarely, which may be accompanied by acute renal failure secondary to myoglobinuria and may result in death.

MANAGEMENT: The benefits of using atorvastatin in combination with itraconazole should be carefully weighed against the potentially increased risk of myopathy including rhabdomyolysis. The lowest effective dosage of atorvastatin should be used, and should not exceed 20 mg/day when prescribed with itraconazole. Fluvastatin, pitavastatin, pravastatin, and rosuvastatin may be safer alternatives, since they are not metabolized by CYP450 3A4. All patients receiving statin therapy should be advised to promptly report any unexplained muscle pain, tenderness or weakness, particularly if accompanied by fever, malaise and/or dark colored urine. Therapy should be discontinued if creatine kinase is markedly elevated in the absence of strenuous exercise or if myopathy is otherwise suspected or diagnosed.

Atorvastatin

Generic Name: atorvastatin

Brand name: Lipitor

Synonyms: AtorvaSTATin

What is Atorvastatin?

Tolsura

Generic Name: itraconazole

Brand name: Onmel, Sporanox, Sporanox PulsePak, Tolsura

Synonyms: n.a.

What is Tolsura?