atorvastatin

fenofibrate
Paracetamol (acetaminophen)
Vitamin B1 (thiamine)
Vitamin B12 (cyanocobalamin)
Vitamin B6 (pyridoxine)
Consumer
Professional

Major

Moderate

Minor

Food

Therapeutic Duplication

Interactions between your selected drugs

Major

atorvastatin fenofibrate
Applies to: atorvastatin, fenofibrate

Using fenofibrate together with atorvastatin 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. Talk to your doctor if you
have any questions or concerns. Your doctor may already be aware of the risks, but
has determined that this is the best course of treatment for you and has taken
appropriate precautions and is monitoring you closely for any potential complications.
Let your doctor know immediately if you have unexplained muscle pain, tenderness,
or weakness while taking these 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.
Switch to professional interaction data

No other interactions were found between your selected drugs.

Note: this does not necessarily mean no interactions exist. ALWAYS consult with your
doctor or pharmacist.

Other drugs and diseases that your selected drugs

interact with

atorvastatin interacts with more than 200 other drugs and 2 diseases.

fenofibrate interacts with more than 60 other drugs and 5 diseases.

Paracetamol (acetaminophen) interacts with more than 80 other

drugs and 3 diseases.

Vitamin B12 (cyanocobalamin) interacts with more than 10 other drugs.

Vitamin B6 (pyridoxine) interacts with more than 10 other drugs.

Interactions between your selected drugs and food

Moderate

atorvastatin food
Applies to: atorvastatin

Grapefruit juice can 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 should limit
your consumption of grapefruit juice to no more than 1 quart per day during
treatment with atorvastatin. Let your doctor know immediately if you have
unexplained muscle pain, tenderness, or weakness during treatment, 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.
Switch to professional interaction data

Therapeutic duplication warnings

No therapeutic duplications were found for your selected drugs.

See also...

Go to interactions checker

Print this page

Email these results to a friend/patient

Ask questions/find answers in the Drugs.com Community

Drug Interaction Classification

The classifications below are a guideline only. The relevance of a particular drug interaction to a
specific patient is difficult to determine using this tool alone given the large number of variables
that may apply.

Major

Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit

Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumsta
Minor

Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take
to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.
Disclaimer: Every effort has been made to ensure that the information provided by Multum is
accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug
information contained herein may be time sensitive and should not be utilized as a reference
resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or
recommend therapy. Multum's information is a reference resource designed as supplement to,
and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners
in patient care. The absence of a warning for a given drug or combination thereof in no way
should be construed to indicate that the drug or combination is safe, effective, or appropriate for
any given patient. Multum Information Services, Inc. does not assume any responsibility for any
aspect of healthcare administered with the aid of information Multum provides. Copyright 20002016 Multum Information Services, Inc. The information contained herein is not intended to cover
all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or
adverse effects. If you have questions about the drugs you are taking, check with your doctor,
nurse, or pharmacist.

PROFESIONAL Drug Interaction

Report
Drug interactions for the following 6 drug(s):

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atorvastatin
fenofibrate
Paracetamol (acetaminophen)
Vitamin B1 (thiamine)
Vitamin B12 (cyanocobalamin)
Vitamin B6 (pyridoxine)

Consumer
Professional

Major

Moderate

Minor

Food

Therapeutic Duplication

Interactions between your selected drugs

Major

atorvastatin fenofibrate

Applies to: atorvastatin, fenofibrate

GENERALLY AVOID: Severe myopathy and rhabdomyolysis have been reported

during concomitant use of HMG-CoA reductase inhibitors and fibric acid derivatives,
especially gemfibrozil. Gemfibrozil has been reported to significantly increase the
plasma concentrations of some HMG-CoA reductase inhibitors and/or their active
metabolites, including lovastatin, simvastatin, pravastatin, cerivastatin, and
rosuvastatin (but not fluvastatin). High levels of 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. Other fibrates have not been shown to significantly affect the
pharmacokinetics of HMG-CoA reductase inhibitors. However, the use of fibrates
alone has also been associated with development of myopathy, thus a
pharmacodynamic interaction could conceivably occur.
MANAGEMENT: Concurrent use of fibric acid derivatives and HMG-CoA reductase
inhibitors should generally be avoided unless the benefit of further alterations in lipid
levels is anticipated to outweigh the potential risks. Addition of fibrates to HMG-CoA
reductase inhibitor therapy typically provides little additional reduction in LDL
cholesterol, but further reductions of triglycerides and increases in HDL cholesterol
may be attained. If the combination is prescribed, a fibrate other than gemfibrozil
may be preferable, along with lower initial dosages of the HMG-CoA reductase
inhibitor. If gemfibrozil is used, rosuvastatin daily dosage should not exceed 10 mg.
Lovastatin labeling recommends that the dosage not exceed 20 mg daily when
prescribed with gemfibrozil or other fibrates. All patients treated with HMG-CoA
reductase inhibitors and/or fibrates 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. In addition, patients should be closely monitored
for hepatotoxicity.
References
1.

Duell PB, Connor WE, Illingworth DR "Rhabdomyolysis after taking atorvastatin with gemfibrozil."
Am J Cardiol 81 (1998): 368-9

2.

Mastroianni CM, dEttorre G, Forcina G, Lichtner M, Corpolongo A, Coletta S, Vullo V

"Rhabdomyolysis after cerivastatin-gemfibrozil therapy in an HIV-infected patient with protease
inhibitor-related hyperlipidemia." AIDS 15 (2001): 820-1

3.

Bermingham RP, Whitsitt TB, Smart ML, Nowak DP, Scalley RD "Rhabdomyolysis in a patient
receiving the combination of cerivastatin and gemfibrozil." Am J Health Syst Pharm 57 (2000): 461-4

View all 42 references

Switch to consumer interaction data

No other interactions were found between your selected drugs.

Note: this does not necessarily mean no interactions exist. ALWAYS consult with your
doctor or pharmacist.

Other drugs and diseases that your selected drugs

interact with

atorvastatin interacts with more than 200 other drugs and 2 diseases.

fenofibrate interacts with more than 60 other drugs and 5 diseases.

Paracetamol (acetaminophen) interacts with more than 80 other drugs and 3

diseases.

Vitamin B12 (cyanocobalamin) interacts with more than 10 other drugs.

Vitamin B6 (pyridoxine) interacts with more than 10 other drugs.

Interactions between your selected drugs and food

Moderate

atorvastatin food
Applies to: atorvastatin

GENERALLY AVOID: Coadministration with grapefruit juice may increase the plasma
concentrations of atorvastatin. The proposed mechanism is inhibition of CYP450
3A4-mediated first-pass metabolism in the gut wall by certain compounds present in
grapefruit. When a single 40 mg dose of atorvastatin was coadministered with 240
mL of grapefruit juice, atorvastatin peak plasma concentration (Cmax) and systemic
exposure (AUC) increased by 16% and 37%, respectively. Greater increases in
Cmax (up to 71%) and/or AUC (up to 2.5 fold) have been reported with excessive
consumption of grapefruit juice (>=750 mL to 1.2 liters per day). Clinically, high levels
of 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.

ADJUST DOSING INTERVAL: Fibres such as oat bran and pectin may diminish the
pharmacologic effects of HMG-CoA reductase inhibitors by interfering with their
absorption from the gastrointestinal tract.
MANAGEMENT: Patients receiving therapy with atorvastatin should limit their
consumption of grapefruit juice to no more than 1 liter per day. Patients 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. In addition,
patients should either refrain from the use of oat bran and pectin or, if concurrent use
cannot be avoided, to separate the administration times by at least 2 to 4 hours.
References
1.

Richter WO, Jacob BG, Schwandt P "Interaction between fibre and lovastatin." Lancet 338 (1991):
706

2.

McMillan K "Considerations in the formulary selection of hydroxymethylglutaryl coenzyme a

reductase inhibitors." Am J Health Syst Pharm 53 (1996): 2206-14

3.

Boberg M, Angerbauer R, Fey P, Kanhai WK, Karl W, Kern A, Ploschke J, Radtke M "Metabolism
of cerivastatin by human liver microsomes in vitro. Characterization of primary metabolic pathways and
of cytochrome P45 isozymes involved." Drug Metab Dispos 25 (1997): 321-31

View all 7 references

Switch to consumer interaction data

Therapeutic duplication warnings

No therapeutic duplications were found for your selected drugs.

See also...

Go to interactions checker

Print this page

Email these results to a friend/patient

Ask questions/find answers in the Drugs.com Community

Drug Interaction Classification

The classifications below are a guideline only. The relevance of a particular drug interaction to a
specific patient is difficult to determine using this tool alone given the large number of variables
that may apply.

Major

Highly clinically significant. Avoid combinations; the risk of the interaction outweighs t
benefit.

Moder
ate

Moderately clinically significant. Usually avoid combinations; use it only under special
circumstances.

Minor

Minimally clinically significant. Minimize risk; assess risk and consider an alternative d
take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.
Disclaimer: Every effort has been made to ensure that the information provided by Multum is
accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug
information contained herein may be time sensitive and should not be utilized as a reference
resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or
recommend therapy. Multum's information is a reference resource designed as supplement to,
and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners
in patient care. The absence of a warning for a given drug or combination thereof in no way
should be construed to indicate that the drug or combination is safe, effective, or appropriate for
any given patient. Multum Information Services, Inc. does not assume any responsibility for any
aspect of healthcare administered with the aid of information Multum provides. Copyright 20002016 Multum Information Services, Inc. The information contained herein is not intended to cover
all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or
adverse effects. If you have questions about the drugs you are taking, check with your doctor,
nurse, or pharmacist.