Atorvastatin × fluvoxamine

Fluvoxamine blocks CYP3A4 – a partial atorvastatin metabolic route. Atorvastatin plasma levels may rise modestly, raising myalgia risk.

Pain and weakness in large muscle groups (thighs, shoulders, calves), dark urine, elevated creatine kinase. Symptoms usually appear 2–6 weeks after starting the combination.

When combined, cap atorvastatin at 40 mg/day if needed. Check creatine kinase on muscle symptoms. Alternative antidepressants without CYP3A4 effect: sertraline or escitalopram.