Atorvastatin × Ciclosporin

Cyclosporine blocks the OATP1B1 transporter and CYP3A4 – two atorvastatin clearance routes. Atorvastatin plasma levels rise 8- to 15-fold, with high myopathy and rhabdomyolysis risk, particularly in transplant patients.

Pain and weakness in large muscle groups (thighs, shoulders, calves), dark urine, elevated creatine kinase. Severe cases progress to rhabdomyolysis with acute kidney injury. Symptoms appear within 1–4 weeks of co-administration.

For transplant patients needing a statin, use pravastatin up to 20 mg/day or fluvastatin (minimal cyclosporine interaction). Use atorvastatin only when no alternative exists, capped at 10 mg/day, with creatine kinase every 4 weeks.