# A 64-year-old client takes atorvastatin 40 mg orally each evening. The provider writes a new order for clarithromycin 500 mg orally twice daily for 10 days for a community-acquired respiratory infection. Which action by the nurse is most appropriate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374919&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 64-year-old client takes atorvastatin 40 mg orally each evening. The provider writes a new order for clarithromycin 500 mg orally twice daily for 10 days for a community-acquired respiratory infection. Which action by the nurse is most appropriate?

## Option

1. Withhold the atorvastatin for the entire 10-day antibiotic course and resume it 3 days after the clarithromycin is finished, documenting the decision in the medical record without contacting the prescriber.
2. Administer the atorvastatin concurrently with the clarithromycin, scheduling them at separate times to minimize potential gastrointestinal upset but taking no additional action regarding the drug interaction.
3. Contact the prescriber and suggest switching the antibiotic to azithromycin because it lacks significant CYP3A4 inhibition, while continuing to administer atorvastatin and the first dose of clarithromycin.
4. Notify the prescriber about the atorvastatin–clarithromycin CYP3A4 interaction and ask whether atorvastatin should be temporarily held during the antibiotic course or whether the antibiotic should be changed. **✔ Correct answer**

**Correct answer: 4**

## Explanation

Atorvastatin + clarithromycin — CYP3A4 interaction
Atorvastatin (also simvastatin·lovastatin) is a CYP3A4 substrate. Clarithromycin is a strong CYP3A4 inhibitor, and concurrent use raises atorvastatin plasma levels several-fold, increasing the risk of myopathy and rhabdomyolysis. Per FDA labeling and clinical guidelines, options are: (1) avoid the combination and use a non-CYP3A4 statin (pravastatin·rosuvastatin·pitavastatin) or non-interacting macrolide (azithromycin), (2) temporarily hold atorvastatin during the short antibiotic course, or (3) reduce atorvastatin dose with close monitoring. The nurse must notify the prescriber for clarification before administering — never assume, never permanently discontinue without an order, never double the dose. Other CYP3A4 inhibitors to remember with statins: erythromycin·diltiazem·verapamil·azole antifungals (ketoconazole·itraconazole·fluconazole)·protease inhibitors·cyclosporine·grapefruit juice. Azithromycin is the macrolide of choice when concurrent use is needed.

## In-depth explanation

Clinical reasoning summary
Atorvastatin + clarithromycin — CYP3A4 interaction
Atorvastatin (also simvastatin·lovastatin) is a CYP3A4 substrate. Clarithromycin is a strong CYP3A4 inhibitor, and concurrent use raises atorvastatin plasma levels several-fold, increasing the risk of myopathy and rhabdomyolysis. Per FDA labeling and clinical guidelines, options are: (1) avoid the combination and use a non-CYP3A4 statin (pravastatin·rosuvastatin·pitavastatin) or non-interacting macrolide (azithromycin), (2) temporarily hold atorvastatin during the short antibiotic course, or (3) reduce atorvastatin dose with close monitoring. The nurse must notify the prescriber for clarification before administering — never assume, never permanently discontinue without an order, never double the dose. Other CYP3A4 inhibitors to remember with statins: erythromycin·diltiazem·verapamil·azole antifungals (ketoconazole·itraconazole·fluconazole)·protease inhibitors·cyclosporine·grapefruit juice. Azithromycin is the macrolide of choice when concurrent use is needed.

## Related questions

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en)
- [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=en)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en)
- [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en)
- [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=en)
- [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=374919&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=374919&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=374919&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=374919&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=374919&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._