From the FDA Drug Label
When used in therapeutic doses, azithromycin had a modest effect on the pharmacokinetics of atorvastatin
- Lipitor (Atorvastatin) and azithromycin can be coadministered, but no dosage adjustment of either drug is recommended.
- There is no information about the interaction between Lipitor (Atorvastatin) and vancomycin in the provided drug label. The FDA drug label does not answer the question about the interaction with vancomycin.
From the Research
Lipitor (atorvastatin) can potentially interact with azithromycin, but not significantly with vancomycin, and it is crucial to monitor and adjust dosing as necessary to minimize risks of adverse effects, particularly muscle pain or rhabdomyolysis, when taking these medications together. The interaction between atorvastatin and azithromycin is of greater concern because azithromycin can inhibit the metabolism of atorvastatin, potentially increasing statin levels in the bloodstream 1. This occurs due to azithromycin's inhibition of certain liver enzymes (CYP3A4) that normally break down atorvastatin.
When considering the use of these medications together, it's essential to weigh the benefits against the potential harms. The precautionary principle suggests taking reasonable measures to avoid threats that are serious and plausible, even if all cause-and-effect relationships are not fully established scientifically 2, 3. However, in the context of atorvastatin and vancomycin, the direct interactions are less significant, though both can affect kidney function, suggesting a need for monitoring when used together.
Key considerations include:
- Informing healthcare providers about all medications being taken to assess potential interactions and adjust dosing if necessary.
- Avoiding the cessation of prescribed medications without consulting a healthcare provider first.
- Recognizing that statins, like atorvastatin, are essential for managing cardiovascular disease and have a good safety record, with transient elevations in liver enzymes being a potential but generally manageable side effect 4, 5, 1.
Given the potential for azithromycin to increase atorvastatin levels, temporarily reducing the atorvastatin dose during azithromycin treatment may be necessary, and healthcare providers should be vigilant about monitoring for signs of adverse effects, particularly those related to muscle toxicity. The most recent and highest quality evidence supports the careful management of these potential interactions to prioritize patient safety and minimize morbidity and mortality risks 1.