Nonstatin drug/substanceStatins affectedRecommendation
CYP3A4 inhibitors
Azole antifungals
  • Atorvastatin (Lipitor)

  • Lovastatin (Mevacor)

  • Simvastatin (Zocor)

  • Avoid lovastatin and simvastatin11,21,22

  • Use caution when exceeding 20 mg per day of atorvastatin23

Itraconazole (Sporanox)
Ketoconazole
Calcium channel blockers
Diltiazem (Cardizem)
  • Do not exceed 20 mg per day of lovastatin or 10 mg per day of simvastatin11,17,18,22,24

Verapamil
  • Do not exceed 40 mg per day of lovastatin or 20 mg per day of simvastatin11,17,18,22,24,25

Other
Grapefruit juice (more than 1 quart per day)
  • Avoid atorvastatin, lovastatin, and simvastatin11,22,26

CYP3A4/organic anion transporting polypeptide inhibitors
Cyclosporine (Sandimmune)
  • All statins

  • Do not exceed 10 mg per day of atorvastatin, 20 mg per day of lovastatin, or 5 mg per day of rosuvastatin (Crestor)22,27,28

  • Use caution with fluvastatin (Lescol)29

  • Avoid pitavastatin (Livalo)30 and pravastatin (Pravachol)27

Macrolide antibiotics
  • Atorvastatin

  • Lovastatin

  • Pitavastatin

  • Simvastatin

  • Avoid lovastatin and simvastatin11,17,18,22,24,25

  • Do not exceed 1 mg per day of pitavastatin30

  • Use caution when exceeding 20 mg per day of atorvastatin17,23,27,31

Clarithromycin (Biaxin)
Erythromycin
Protease inhibitors
  • All statins

  • Avoid lovastatin, pitavastatin, and simvastatin11,17,18,22,24

  • Do not exceed 20 mg per day of atorvastatin or 10 mg per day of rosuvastatin11,23,28

Atazanavir (Reyataz)
Ritonavir (Norvir)
Lopinavir/ritonavir (Kaletra)
CYP3A4/CYP2C9 inhibitor
Amiodarone (Cordarone)
  • Atorvastatin

  • Fluvastatin

  • Lovastatin

  • Simvastatin

  • Consider limiting atorvastatin dose17,18,23,24

  • Do not exceed 40 mg per day of lovastatin or 20 mg per day of simvastatin11,17,22,24

  • Use caution with fluvastatin29

CYP2C9, CYP2C19, glucuronidation, and organic anion transporting polypeptide inhibitors
Gemfibrozil (Lopid)
  • All statins

  • Avoid pravastatin unless benefits outweigh risks32

  • Consider limiting atorvastatin dose

  • Do not exceed 10 mg per day of rosuvastatin or simvastatin11,28,32

  • Do not exceed 20 mg per day of lovastatin22

  • Use caution with fluvastatin29 and pitavastatin30

CYP2C9 inhibitor
Fluconazole (Diflucan)
  • Fluvastatin

  • Use caution29