Atorvastatin × Linezolid

Linezolid is associated with rhabdomyolysis in combination with statins (rare post-marketing cases; mechanism not fully established).

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.

For short linezolid courses (10–14 days), no special adjustment. In patients with myopathy risk factors, check creatine kinase before start and on muscle symptoms. In severe gram-positive infections on statins: alternative antibiotics (daptomycin with its own myopathy risk, vancomycin, ceftaroline).