9 Rosuvastatin Interactions to Watch Out for

Rosuvastatin (Crestor) is a common statin medication used to treat high cholesterol. It works in the liver to lower the amount of low-density lipoprotein (LDL, or “bad cholesterol”). This can help lower your risk of heart-related complications, like heart attacks or strokes.

As with all medications, there are a few things to keep in mind about rosuvastatin if you’re taking it. For instance, there are several medications that have interactions with rosuvastatin. This can lead to a greater chance of side effects, as well as either rosuvastatin or the other medication not working as well. Here, we’ll discuss nine of the most notable rosuvastatin interactions.

1. Paxlovid

Paxlovid (nirmaterlvir/ritonavir) is an antiviral medication authorized to treat COVID-19. However, Paxlovid can slow the body’s breakdown of rosuvastatin. This can make rosuvastatin side effects, such as muscle pain or weakness, more likely. In severe cases, this interaction may lead to rhabdomyolysis (muscle breakdown that’s harmful to the kidneys).

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Your healthcare provider will likely have you stop taking your rosuvastatin while taking Paxlovid. You should be able to resume it once you finish taking this antiviral medication.

2. Other antiviral medications

Similar to Paxlovid, other antiviral medications also slow rosuvastatin’s breakdown. This can raise your risk of muscle pain. These medications are often prescribed for people living with HIV or hepatitis C. For some antivirals, a lower dosage of rosuvastatin will help limit this interaction. But there are others that shouldn’t be combined with rosuvastatin at all.

Some antivirals that interact with rosuvastatin include:

• Epclusa (sofosbuvir/velpatasvir)

• Harvoni (ledipasvir/sofosbuvir)

• Kaletra (lopinavir/ritonavir)

• Mavyret (glecaprevir/pibrentasvir)

• Reyataz (atazanavir), when combined with Norvir (ritonavir)

• Viekira Pak (dasabuvir/ombitasvir/paritaprevir/ritonavir)

• Vosevi (sofosbuvir/velpatasvir/voxilaprevir)

• Zepatier (elbasvir/grazoprevir)

3. Gemfibrozil and fenofibrate

Fibrates are another group of cholesterol medications. Two fibrates that interact with rosuvastatin are gemfibrozil (Lopid) and fenofibrate (Tricor). These two medications also carry a risk of muscle pain and rhabdomyolysis. Combining them with rosuvastatin raises this risk even further.

Of the two, gemfibrozil is more likely to cause problems with rosuvastatin. So it’s best to avoid taking them together. For people who need to take both, it’s recommended to take no more than 10 mg of rosuvastatin per day.

Fenofibrate has a lower risk of issues when taken with rosuvastatin. If you take both fenofibrate and rosuvastatin, let your healthcare provider know if you start experiencing any new or unexplained muscle pain.

4. Cyclosporine

Cyclosporine (Sandimmune) is a medication taken after receiving an organ transplant to prevent rejection. This medication is known to raise the levels of rosuvastatin in the body. This can increase your risk of side effects.

If your healthcare provider determines you should take both cyclosporine and rosuvastatin, they’ll likely prescribe a low dosage (5 mg per day) of rosuvastatin. But they may also prefer you take a different cholesterol medication and avoid this interaction altogether.

5. Colchicine

Colchicine (Colcrys) is a medication used to treat and prevent gout attacks. People have reported experiencing muscle pain and rhabdomyolysis when combining colchicine and rosuvastatin. If you’re taking both of these medications, watch out for and immediately report any feelings of muscle pain to your healthcare provider.

6. Niacin

Niacin (Niacor) is a B vitamin — also known as vitamin B3 — that’s sometimes taken to help lower cholesterol. However, it can interact with rosuvastatin. This is especially true if you’re taking more than 1,000 mg of niacin daily. Taking these medications together can raise your risk of muscle pain or weakness.

Your healthcare provider may have you avoid this combination, or recommend a lower dose of niacin. Let them know if you’re taking both medications and start to notice any muscle pain.

7. Warfarin

Warfarin (Coumadin, Jantoven) is a blood thinner used to treat and prevent blood clots. Rosuvastatin causes warfarin to stay in the body longer. This interaction can cause your international normalized ratio (INR) to go up. This raises your risk of serious bleeding with warfarin. Your INR is a lab test that represents how long it takes your blood to clot. A higher INR means your blood takes longer to clot (your blood is “thinner”), and you may bleed easier.

You may be able to take both rosuvastatin and warfarin. But you may need more frequent INR checks while taking them. Warfarin dosage adjustments may also be needed. Be sure to go for all recommended INR tests if you’re taking both warfarin and rosuvastatin. Contact your healthcare provider immediately if you start noticing any bleeding or increased bruising.

8. Darolutamide

Darolutamide (Nubeqa) is a medication used to treat prostate cancer. When darolutamide and rosuvastatin are combined, the amount of rosuvastatin in the body rises dramatically. This can raise the risk of side effects.

It’s recommended to limit the dosage of rosuvastatin to 5 mg per day if a person needs to take both medications. Otherwise, another cholesterol medication may be needed to avoid this interaction.

9. Regorafenib

Regorafenib (Stivarga) is a medication used for certain types of cancer. When taken with rosuvastatin, it can increase your risk of muscle pain.

It’s recommended to take no more than 10 mg per day of rosuvastatin if you’re also taking regorafenib. This can help manage the interaction. But your healthcare provider may prefer to have you take a different cholesterol medication instead.

When should I contact my healthcare provider about a rosuvastatin interaction?

In our list above, we only discussed some of the possible rosuvastatin interactions. So before starting this medication, you should share an up-to-date medication list with your healthcare provider and pharmacist. Make sure your list also includes any over-the-counter medications, vitamins, and supplements you may take. This can help them spot any possible interactions.

Similarly, if you start any new medications while taking rosuvastatin, you should check with your healthcare provider first. Ask them if any medication changes are needed to manage or avoid interactions.

It’s important to let your provider know if you start developing muscle pain or weakness for no explainable reason while taking rosuvastatin. This is especially the case if you’ve recently changed or added other medications to your routine. Muscle-related side effects can be a sign of a potential rosuvastatin interaction.

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Written by:

Timothy Aungst, PharmD

Timothy Aungst, PharmD, has worked in pharmacy practice for the past decade with different roles and responsibilities. He has served as an associate professor of pharmacy practice for almost a decade, a clinical pharmacist in outpatient cardiology management, and now in home healthcare.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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