Rosuvastatin interactions

Concomitant administration of clarithromycin tablets with HMG-CoA reductase inhibitors (statins) that are extensively metabolized by CYP3A4 (lovastatin or simvastatin) is contraindicated, due to the increased risk of myopathy, including rhabdomyolysis [see Warnings and Precautions ( 5.4 ) and Drug Interactions ( 7 )]. (Clarithromycin label, Contraindications)

Steps to Prevent or Reduce the Risk of Myopathy and Rhabdomyolysis The concomitant use of CRESTOR with cyclosporine or gemfibrozil is not recommended. (Rosuvastatin label, Warnings and precautions)

• Statins: Avoid statins metabolized by CYP3A4. (Diltiazem label, Drug interactions)

• Statins: Avoid simvastatin doses greater than 10 mg daily. (Dronedarone label, Drug interactions)

Do not use erythromycin concomitantly with HMG CoA reductase inhibitors (statins) that are extensively metabolized by CYP 3A4 (lovastatin or simvastatin), due to the increased risk of myopathy, including rhabdomyolysis (see PRECAUTIONS - Drug Interactions ). (Erythromycin label, Contraindications)

When used in combination with a statin, fenofibrate, or other LDL-C lowering therapy, ZETIA is contraindicated in patients for whom a statin, fenofibrate, or other LDL-C lowering therapy are contraindicated. (Ezetimibe label, Contraindications)

Steps to Prevent or Reduce the Risk of Myopathy and Rhabdomyolysis The concomitant use of CRESTOR with cyclosporine or gemfibrozil is not recommended. (Rosuvastatin label, Warnings and precautions)

Myopathy Coadministration of CYP3A4 metabolized HMG-CoA reductase inhibitors such as simvastatin, and lovastatin is contraindicated with ketoconazole tablets (see PRECAUTIONS: Drug Interactions ). (Ketoconazole label, Contraindications)

…lurasidone, pimozide • Benign prostatic hyperplasia agents: silodosin • Cardiovascular agents: eplerenone, ivabradine • Ergot derivatives: dihydroergotamine, ergotamine, methylergonovine • HMG-CoA reductase inhibitors: lovastatin, simvastatin (these drugs can be temporarily discontinued to allow PAXLOVID use [see Table 2 , Drug Interactions (7.3) ] ) • Immunosuppressants:… (Nirmatrelvir and ritonavir label, Contraindications)

HMG-CoA Reductase Inhibitors Primarily Metabolized through CYP3A4 ( 4.4 , 7.2 ) (Posaconazole label, Contraindications)

…Antifungal: voriconazole ○ Anti-gout: colchicine ○ Antipsychotics: lurasidone, pimozide ○ Ergot Derivatives: dihydroergotamine, ergotamine, methylergonovine ○ GI Motility Agent: cisapride ○ HMG-CoA Reductase Inhibitors: lovastatin, simvastatin ○ Microsomal triglyceride transfer protein (MTTP) Inhibitor: lomitapide ○ Non-opioid Analgesic (selective blocker of Na v 1.8 sodium… (Ritonavir label, Contraindications)

Table 5: Drug Interactions that Increase the Risk of Myopathy and Rhabdomyolysis with CRESTOR Sofosbuvir/velpatasvir/voxilaprevir or Ledipasvir/sofosbuvir Prevention or Management: Avoid concomitant use with CRESTOR. (Rosuvastatin label, Drug interactions)

Patients who consume substantial quantities of alcohol and/or have a history of liver disease may be at increased risk for hepatic injury [see Use in Specific Populations (8.7) ] . (Rosuvastatin label, Warnings and precautions)

Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. (Rosuvastatin label, Drug interactions)

Table 6: Drug Interactions that Decrease the Efficacy of CRESTOR Antacids Prevention or Management: In patients taking an antacid, administer CRESTOR at least 2 hours before the antacid . (Rosuvastatin label, Drug interactions)

HMG-CoA Reductase Inhibitors: lovastatin simvastatin ↑ lovastatin ↑ simvastatin Initiate lovastatin and simvastatin with the lowest starting dose and titrate carefully while monitoring for safety (e.g., myopathy). (Bictegravir, emtricitabine, and tenofovir alafenamide label, Drug interactions)

Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. (Rosuvastatin label, Drug interactions)

Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. (Rosuvastatin label, Drug interactions)

Niacin, fibrates, and colchicine may also increase the risk of myopathy and rhabdomyolysis [see Drug Interactions (7.1) ] . (Rosuvastatin label, Warnings and precautions)

Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. (Rosuvastatin label, Drug interactions)

Concomitant use of TRIKAFTA may increase exposures of medicinal products that are substrates of these transporters, such as statins, glyburide, nateglinide and repaglinide. (Elexacaftor, tezacaftor, and ivacaftor label, Drug interactions)

Increased exposure to rosuvastatin when co-administered with VIBERZI with a potential for increased risk of myopathy/rhabdomyolysis [ see Clinical Pharmacology ( 12.3 ) ] Intervention: Use the lowest effective dose of rosuvastatin (see prescribing information of rosuvastatin for additional information on recommended dosing). (Eluxadoline label, Drug interactions)

During Zortress therapy with cyclosporine, patients administered an HMG-CoA reductase inhibitor and/or fibrate should be monitored for the possible development of rhabdomyolysis and other adverse effects, as described in the respective labeling for these agents [ see Drug Interactions (7 . (Everolimus label, Warnings and precautions)

The risk is also greater in patients taking VYTORIN 80 mg daily compared with patients taking lower VYTORIN dosages and compared with patients using other statins with similar or greater LDL-C-lowering efficacy [see Adverse Reactions (6.1) ] . (Ezetimibe and simvastatin label, Warnings and precautions)

Febuxostat Prevention or Management: In patients taking febuxostat, do not exceed a dosage of CRESTOR 20 mg once daily . (Rosuvastatin label, Drug interactions)

Fenofibrates (e.g., fenofibrate and fenofibric acid) Prevention or Management: Consider if the benefit of using fibrates concomitantly with CRESTOR outweighs the increased risk of myopathy and rhabdomyolysis. (Rosuvastatin label, Drug interactions)

Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. (Rosuvastatin label, Drug interactions)

Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. (Rosuvastatin label, Drug interactions)

In a double-blind, placebo-controlled trial of 8,179 statin-treated subjects with established cardiovascular disease (CVD) or diabetes plus an additional risk factor for CVD, adjudicated atrial fibrillation or atrial flutter requiring hospitalization for 24 or more hours occurred in 127 (3%) patients treated with VASCEPA compared to 84 (2%) patients receiving… (Icosapent ethyl label, Warnings and precautions)

Interactions With Drugs Metabolized by CYP3A4 Gleevec will increase plasma concentration of CYP3A4 metabolized drugs (e.g., triazolo-benzodiazepines, dihydropyridine calcium channel blockers, certain HMG-CoA reductase inhibitors, etc.). Use caution when administering Gleevec with CYP3A4 substrates that have a narrow therapeutic window. (Imatinib label, Drug interactions)

Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. (Rosuvastatin label, Drug interactions)

Rosuvastatin: The dose of rosuvastatin should not exceed 10 mg once daily in patients taking ARAVA. (Leflunomide label, Drug interactions)

Substances increasing the systemic exposure of CHCs: Co-administration of atorvastatin or rosuvastatin and CHCs containing ethinyl estradiol increase systemic exposure of ethinyl estradiol by approximately 20 to 25 percent. (Levonorgestrel and ethinyl estradiol label, Drug interactions)

However, another HMG-CoA reductase inhibitor has been found to produce a less than two-second increase in prothrombin time in healthy volunteers receiving low doses of warfarin. (Lovastatin label, Drug interactions)

Mechanism and Clinical Effect(s): Concomitant aluminum and magnesium hydroxide combination antacid administration decreased the mean exposure of rosuvastatin 50% [see Clinical Pharmacology (12.3) ]. (Rosuvastatin label, Drug interactions)

Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. (Rosuvastatin label, Drug interactions)

Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. (Rosuvastatin label, Drug interactions)

Niacin, fibrates, and colchicine may also increase the risk of myopathy and rhabdomyolysis [see Drug Interactions (7.1) ] . (Rosuvastatin label, Warnings and precautions)

Substances increasing the plasma concentrations of COCs Co-administration of atorvastatin or rosuvastatin and certain COCs containing ethinyl estradiol (EE) increase AUC values for EE by approximately 20-25%. (Norgestimate and ethinyl estradiol label, Drug interactions)

Decrease exposure Selective 5-HT3 Receptor Antagonists Ondansetron Decrease exposure Statins Metabolized by CYP3A4 Simvastatin Decrease exposure Thiazolidinediones Rosiglitazone Decrease AUC by 66% Tricyclic Antidepressants Nortriptyline A tuberculosis treatment regimen including rifampin (600 mg/day), isoniazid (300 mg/day), pyrazinamide (500 mg 3× per day),… (Rifampin label, Drug interactions)

The risk is also greater in patients taking an 80 mg daily dosage of ZOCOR compared with patients taking lower ZOCOR dosages and compared with patients using other statins with similar or greater LDL-C-lowering efficacy [see Adverse Reactions (6.1) ] . (Simvastatin label, Warnings and precautions)

During sirolimus therapy with or without cyclosporine, patients should be monitored for elevated lipids, and patients administered an HMG-CoA reductase inhibitor and/or fibrate should be monitored for the possible development of rhabdomyolysis and other adverse effects, as described in the respective labeling for these agents. (Sirolimus label, Warnings and precautions)

Table 6: Drug Interactions that Decrease the Efficacy of CRESTOR Antacids Prevention or Management: In patients taking an antacid, administer CRESTOR at least 2 hours before the antacid . (Rosuvastatin label, Drug interactions)

Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. (Rosuvastatin label, Drug interactions)

Teriflunomide Prevention or Management: In patients taking teriflunomide, do not exceed a dosage of CRESTOR 10 mg once daily . (Rosuvastatin label, Drug interactions)

Ticagrelor Prevention or Management: In patients taking ticagrelor, do not exceed a dosage of CRESTOR 20 mg once daily. (Rosuvastatin label, Drug interactions)

Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. (Rosuvastatin label, Drug interactions)

Elevations in LDL cholesterol decreased to pre-treatment levels in response to statin therapy. (Upadacitinib label, Warnings and precautions)

Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. (Rosuvastatin label, Drug interactions)

Table 7: CRESTOR Effects on Other Drugs Warfarin Prevention or Management: In patients taking warfarin, obtain an INR before starting CRESTOR and frequently enough after initiation, dosage titration or discontinuation to ensure that no significant alteration in INR occurs. (Rosuvastatin label, Drug interactions)

Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. (Rosuvastatin label, Drug interactions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

…acid, α-blockers, angiotensin-converting enzyme (ACE) inhibitors, analgesics, anti-convulsants, beta-adrenergic blocking agents, diuretics, calcium channel blockers, cardiac nitrates, HMG-CoA reductase inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, H 2 antagonists and quinolone anti-infectives without evidence of clinically significant… (Finasteride label, Drug interactions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

Effient can be administered with aspirin (75 mg to 325 mg per day), heparin, GPIIb/IIIa inhibitors, statins, digoxin, and drugs that elevate gastric pH, including proton pump inhibitors and H 2 blockers [see Clinical Pharmacology (12.3) ] . (Prasugrel label, Drug interactions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)

HMG-CoA Reductase Inhibitors The use of HMG-CoA reductase inhibitors that are CYP3A4 substrates in combination with verapamil has been associated with reports of myopathy/rhabdomyolysis. (Verapamil label, Drug interactions)

Additionally, no dosage adjustment for substrates of CYP2D6 (e.g., dextromethorphan), CYP3A4 (e.g., lovastatin), CYP2B6 (e.g., bupropion), BCRP (e.g., rosuvastatin), or P-gp (e.g., fexofenadine) is required when administered concomitantly with REXULTI. (Brexpiprazole label, Drug interactions)