Atorvastatin × Fluconazole

Fluconazole at 200 mg/day or above moderately inhibits CYP3A4; at 400 mg/day, strongly. Atorvastatin plasma levels rise 2- to 4-fold depending on fluconazole dose.

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 short fluconazole courses (up to 7 days), halve atorvastatin or hold it. For prolonged systemic therapy, alternative antifungals: echinocandins (micafungin, caspofungin); or switch to pravastatin/rosuvastatin.