Interactions between Atorvastatin and Daraxonrasib
1 drug interaction and 14 additional warnings found for the following 2 drugs:
- atorvastatin
- daraxonrasib
Drug interactions
Major drug interactions
Major:
atorvastatin daraxonrasib
Applies to: atorvastatin and daraxonrasib
Adjust dosing interval
Coadministration with daraxonrasib may increase the plasma concentrations and effects of drugs that are substrates of the P-glycoprotein (P-gp) efflux transporter. The proposed mechanism is inhibition of P-gp-mediated transport by daraxonrasib. Free dabigatran peak plasma concentration (Cmax) and systemic exposure (AUC) are predicted to increase 2.5-fold and 2.1-fold, respectively, during concomitant use with daraxonrasib 300 mg once daily. No clinically significant difference in free dabigatran pharmacokinetics is predicted when daraxonrasib is administered 4 hours apart from dabigatran etexilate.
Management
P-gp substrates should be administered at least 4 hours apart from daraxonrasib. Patients should be monitored for adverse reactions associated with the P-gp substrate, particularly when the substrate has a narrow therapeutic range or when increased exposure could result in serious toxicity. Consultation with individual product labeling may be advisable for additional guidance.
References (1)
- (2026) "Product Information. Rasonque (daraxonrasib)." Revolution Medicines, Inc, FDA 1
Food/lifestyle interactions
Major food/lifestyle interactions
Major:
daraxonrasib Food/Lifestyle
Applies to: daraxonrasib
Generally avoid
Grapefruit juice may increase the plasma concentrations of daraxonrasib, which is primarily metabolized by CYP450 3A. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Inhibition of hepatic CYP450 3A4 may also contribute. The interaction has not been studied with grapefruit juice but has been reported for other CYP450 3A4 inhibitors. Daraxonrasib systemic exposure (AUC) is predicted to increase 2-fold during concomitant use with voriconazole 200 mg twice daily, a potent CYP450 3A inhibitor. Additionally, daraxonrasib systemic exposure (AUC) is predicted to increase 1.5-fold during concomitant use with fluconazole 200 mg once daily, a moderate CYP450 3A inhibitor. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Increased daraxonrasib exposure has been associated with a greater incidence of dose interruption, reduction or discontinuation due to increased adverse reactions (e.g., rash, diarrhea, stomatitis, nausea, fatigue, vomiting, abdominal pain, edema, decreased appetite, and hemorrhage), including those that are Grade 3 or greater.
Management
Patients should avoid consumption of grapefruit, grapefruit juice, or supplements that contain grapefruit during treatment with daraxonrasib. Because the CYP450 3A inhibitory strength of grapefruit cannot be reliably categorized as moderate or strong, a specific daraxonrasib dosage reduction should not be selected solely on the basis of grapefruit exposure.
References (1)
- (2026) "Product Information. Rasonque (daraxonrasib)." Revolution Medicines, Inc, FDA 1
Moderate food/lifestyle interactions
Moderate:
atorvastatin Food/Lifestyle
Applies to: atorvastatin
Generally avoid
Coadministration with grapefruit juice may increase the plasma concentrations of atorvastatin. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. When a single 40 mg dose of atorvastatin was coadministered with 240 mL of grapefruit juice, atorvastatin peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 16% and 37%, respectively. Greater increases in Cmax (up to 71%) and/or AUC (up to 2.5 fold) have been reported with excessive consumption of grapefruit juice (>=750 mL to 1.2 liters per day). Clinically, high levels of HMG-CoA reductase inhibitory activity in plasma is associated with an increased risk of musculoskeletal toxicity. Myopathy manifested as muscle pain and/or weakness associated with grossly elevated creatine kinase exceeding ten times the upper limit of normal has been reported occasionally. Rhabdomyolysis has also occurred rarely, which may be accompanied by acute renal failure secondary to myoglobinuria and may result in death.
Adjust dosing interval
Fibres such as oat bran and pectin may diminish the pharmacologic effects of HMG-CoA reductase inhibitors by interfering with their absorption from the gastrointestinal tract.
Management
Patients receiving therapy with atorvastatin should limit their consumption of grapefruit juice to no more than 1 liter per day. Patients should be advised to promptly report any unexplained muscle pain, tenderness or weakness, particularly if accompanied by fever, malaise and/or dark colored urine. Therapy should be discontinued if creatine kinase is markedly elevated in the absence of strenuous exercise or if myopathy is otherwise suspected or diagnosed. In addition, patients should either refrain from the use of oat bran and pectin or, if concurrent use cannot be avoided, to separate the administration times by at least 2 to 4 hours.
References (7)
- Richter WO, Jacob BG, Schwandt P (1991) "Interaction between fibre and lovastatin." Lancet, 338, p. 706
- McMillan K (1996) "Considerations in the formulary selection of hydroxymethylglutaryl coenzyme a reductase inhibitors." Am J Health Syst Pharm, 53, p. 2206-14
- (2001) "Product Information. Lipitor (atorvastatin)." Parke-Davis
- Boberg M, Angerbauer R, Fey P, Kanhai WK, Karl W, Kern A, Ploschke J, Radtke M (1997) "Metabolism of cerivastatin by human liver microsomes in vitro. Characterization of primary metabolic pathways and of cytochrome P45 isozymes involved." Drug Metab Dispos, 25, p. 321-31
- Bailey DG, Malcolm J, Arnold O, Spence JD (1998) "Grapefruit juice-drug interactions." Br J Clin Pharmacol, 46, p. 101-10
- Lilja JJ, Kivisto KT, Neuvonen PJ (1999) "Grapefruit juice increases serum concentrations of atorvastatin and has no effect on pravastatin." Clin Pharmacol Ther, 66, p. 118-27
- Neuvonen PJ, Backman JT, Niemi M (2008) "Pharmacokinetic comparison of the potential over-the-counter statins simvastatin, lovastatin, fluvastatin and pravastatin." Clin Pharmacokinet, 47, p. 463-74
Disease interactions
12 potential interactions Applies to: 9 conditions, including Underactive Thyroid, Diabetes Mellitus, Liver Disease, Alcoholism, and Renal Dysfunction.
Alcoholism
Major:
atorvastatin
Atorvastatin has a major potential interaction with Alcoholism.
The use of most HMG-CoA reductase inhibitors is contraindicated in patients with active liver disease, decompensated cirrhosis, or unexplained persistent elevations of serum transaminases. HMG-CoA reductase inhibitors are extensively metabolized by the liver. Decreased drug metabolism may lead to accumulation and increased risk of toxicity, including biochemical abnormalities of liver function and, rarely, jaundice, hepatitis, cirrhosis, fatty change in the liver, and fulminant hepatic necrosis. Therapy with HMG-CoA reductase inhibitors should be administered cautiously in patients with a history of liver disease and/or heavy alcohol use. A lower initial dosage may be appropriate, and clinical monitoring of liver transaminase levels according to the individual manufacturer product information is recommended. Patients who develop elevated ALT or AST levels during therapy should be monitored until abnormalities resolve. If an increase above 3 times the upper limit of normal persists, consideration should be given to a reduction in dosage or withdrawal of therapy.
Central Nervous System Disorders
Moderate:
atorvastatin
Atorvastatin has a moderate potential interaction with Central Nervous System Disorders.
Cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) have been observed in patients receiving statins. The reports are usually not serious, and reversible upon statin discontinuation. Caution is recommended when using these agents in patients with cognitive impairment.
Diabetes Mellitus
Moderate:
atorvastatin
Atorvastatin has a moderate potential interaction with Diabetes Mellitus.
Increases in hemoglobin A1c and fasting serum glucose levels have been reported with the use of certain HMG-CoA reductase inhibitors. Caution should be exercised when using these agents in diabetic patients and close monitoring is recommended.
Liver Disease
Major:
atorvastatin
Atorvastatin has a major potential interaction with Liver Disease.
The use of most HMG-CoA reductase inhibitors is contraindicated in patients with active liver disease, decompensated cirrhosis, or unexplained persistent elevations of serum transaminases. HMG-CoA reductase inhibitors are extensively metabolized by the liver. Decreased drug metabolism may lead to accumulation and increased risk of toxicity, including biochemical abnormalities of liver function and, rarely, jaundice, hepatitis, cirrhosis, fatty change in the liver, and fulminant hepatic necrosis. Therapy with HMG-CoA reductase inhibitors should be administered cautiously in patients with a history of liver disease and/or heavy alcohol use. A lower initial dosage may be appropriate, and clinical monitoring of liver transaminase levels according to the individual manufacturer product information is recommended. Patients who develop elevated ALT or AST levels during therapy should be monitored until abnormalities resolve. If an increase above 3 times the upper limit of normal persists, consideration should be given to a reduction in dosage or withdrawal of therapy.
Moderate:
daraxonrasib
Daraxonrasib has a moderate potential interaction with Liver Disease.
The effects of severe liver dysfunction (total bilirubin greater than 3 to 10 times the upper limit of normal, with any AST level) on the pharmacokinetics of daraxonrasib are unknown. No clinically significant differences in daraxonrasib pharmacokinetics were observed in patients with mild or moderate liver dysfunction.
Myoneural Disorder
Moderate:
atorvastatin
Atorvastatin has a moderate potential interaction with Myoneural Disorder.
HMG-CoA reductase inhibitors may cause myopathy and rhabdomyolysis; acute renal failure secondary to myoglobinuria and rare fatalities have occurred due to rhabdomyolysis in patients treated with statins. The myopathy may be dose-related and is characterized by unexplained muscle weakness, pain, or tenderness accompanied by increases in creatine phosphokinase (CPK) values exceeding 10 times the upper limit of normal. Therapy with HMG-CoA reductase inhibitors should be administered cautiously in patients with preexisting myopathy, in those with predisposing factors for myopathy, or with a history of myoneural disorder, since it may delay the recognition or confound the diagnosis of a drug-induced musculoskeletal effect. Patients should be advised to report promptly any unusual muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever. Periodic CPK determinations may be considered in some patients, although the value of such monitoring is uncertain. HMG-CoA reductase inhibitor therapy should be withdrawn if markedly elevated CPK levels occur or if drug-related myopathy is diagnosed or suspected.
Myopathy
Moderate:
atorvastatin
Atorvastatin has a moderate potential interaction with Myopathy.
HMG-CoA reductase inhibitors may cause myopathy and rhabdomyolysis; acute renal failure secondary to myoglobinuria and rare fatalities have occurred due to rhabdomyolysis in patients treated with statins. The myopathy may be dose-related and is characterized by unexplained muscle weakness, pain, or tenderness accompanied by increases in creatine phosphokinase (CPK) values exceeding 10 times the upper limit of normal. Therapy with HMG-CoA reductase inhibitors should be administered cautiously in patients with preexisting myopathy, in those with predisposing factors for myopathy, or with a history of myoneural disorder, since it may delay the recognition or confound the diagnosis of a drug-induced musculoskeletal effect. Patients should be advised to report promptly any unusual muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever. Periodic CPK determinations may be considered in some patients, although the value of such monitoring is uncertain. HMG-CoA reductase inhibitor therapy should be withdrawn if markedly elevated CPK levels occur or if drug-related myopathy is diagnosed or suspected.
Pulmonary Impairment
Moderate:
daraxonrasib
Daraxonrasib has a moderate potential interaction with Pulmonary Impairment.
Daraxonrasib can cause interstitial lung disease (ILD) or pneumonitis; at least 1 fatal event has been reported. Patients should be monitored for new or worsening pulmonary symptoms and daraxonrasib should be withheld if ILD/pneumonitis is suspected. The dose should be reduced or permanently discontinued if no other potential causes of ILD/pneumonitis are identified.
Renal Dysfunction
Moderate:
atorvastatin
Atorvastatin has a moderate potential interaction with Renal Dysfunction.
HMG-CoA reductase inhibitors may cause myopathy and rhabdomyolysis; acute renal failure secondary to myoglobinuria and rare fatalities have occurred due to rhabdomyolysis in patients treated with statins. The myopathy may be dose-related and is characterized by unexplained muscle weakness, pain, or tenderness accompanied by increases in creatine phosphokinase (CPK) values exceeding 10 times the upper limit of normal. Therapy with HMG-CoA reductase inhibitors should be administered cautiously in patients with preexisting myopathy, in those with predisposing factors for myopathy, or with a history of myoneural disorder, since it may delay the recognition or confound the diagnosis of a drug-induced musculoskeletal effect. Patients should be advised to report promptly any unusual muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever. Periodic CPK determinations may be considered in some patients, although the value of such monitoring is uncertain. HMG-CoA reductase inhibitor therapy should be withdrawn if markedly elevated CPK levels occur or if drug-related myopathy is diagnosed or suspected.
Moderate:
atorvastatin
Atorvastatin has a moderate potential interaction with Renal Dysfunction.
Some HMG-CoA reductase inhibitors (e.g., fluvastatin) have not been studied in patients with severe renal dysfunction or end-stage renal disease. Some others (e.g., pitavastatin, simvastatin) require a dose reduction when used in this group of patients. Caution and close monitoring are advised when using these drugs in patients with renal dysfunction.
Moderate:
daraxonrasib
Daraxonrasib has a moderate potential interaction with Renal Dysfunction.
The effects of severe renal dysfunction (CrCl less than 30 mL/min) on the pharmacokinetics of daraxonrasib are unknown. No clinically significant differences in daraxonrasib pharmacokinetics were observed in patients with CrCl 30 to 89 mL/min.
Underactive Thyroid
Moderate:
atorvastatin
Atorvastatin has a moderate potential interaction with Underactive Thyroid.
HMG-CoA reductase inhibitors may cause myopathy and rhabdomyolysis; acute renal failure secondary to myoglobinuria and rare fatalities have occurred due to rhabdomyolysis in patients treated with statins. The myopathy may be dose-related and is characterized by unexplained muscle weakness, pain, or tenderness accompanied by increases in creatine phosphokinase (CPK) values exceeding 10 times the upper limit of normal. Therapy with HMG-CoA reductase inhibitors should be administered cautiously in patients with preexisting myopathy, in those with predisposing factors for myopathy, or with a history of myoneural disorder, since it may delay the recognition or confound the diagnosis of a drug-induced musculoskeletal effect. Patients should be advised to report promptly any unusual muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever. Periodic CPK determinations may be considered in some patients, although the value of such monitoring is uncertain. HMG-CoA reductase inhibitor therapy should be withdrawn if markedly elevated CPK levels occur or if drug-related myopathy is diagnosed or suspected.
More resources
atorvastatin
A total of 437 drugs are known to interact with atorvastatin.
- Atorvastatin is in the drug class statins.
-
Atorvastatin is used to treat the following conditions:
- High Cholesterol
- High Cholesterol - Familial Heterozygous
- High Cholesterol - Familial Homozygous
- Hyperlipoproteinemia
- Hyperlipoproteinemia Type IIa, Elevated LDL
- Hyperlipoproteinemia Type IIb, Elevated LDL VLDL
- Hyperlipoproteinemia Type III, Elevated beta-VLDL IDL
- Hyperlipoproteinemia Type IV, Elevated VLDL
- Prevention of Cardiovascular Disease
daraxonrasib
A total of 254 drugs are known to interact with daraxonrasib.
- Daraxonrasib is in the drug class miscellaneous antineoplastics.
- Daraxonrasib is used to treat Pancreatic Cancer.
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
| No interaction information available. |
Further information
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