Key takeaways:
Rosuvastatin (Crestor) is a statin medication commonly used to treat high cholesterol. It has a number of interactions to be aware of.
Examples of medications that interact with rosuvastatin include Paxlovid (nirmatrelvir / ritonavir), some medications used to treat HIV, and warfarin (Coumadin, Jantoven). Rosuvastatin also interacts with certain other cholesterol medications. These include gemfibrozil (Lopid), fenofibrate (Tricor), and niacin (Niacor).
There are no foods that directly interact with rosuvastatin. But you may want to limit dietary items that can raise cholesterol. Examples of foods and drinks to avoid include fatty or fried foods, high-sugar foods and drinks, and alcohol.
Save on related medications
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 reduce your risk of heart-related complications, such as 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 interact with rosuvastatin. Interactions may change how this cholesterol medication works in your body. And while no dietary items interact with rosuvastatin, limiting certain foods and drinks can help promote healthy cholesterol levels.
Good to know: Unlike some statins, rosuvastatin does not interact with grapefruit (the fruit and its juice). So if you like this citrus fruit, you’re in luck.
Rosuvastatin (Crestor) interactions at a glance
Rosuvastatin interacts with:
Paxlovid (nirmatrelvir / ritonavir)
Other antiviral medications
Fibrate cholesterol medications, such as gemfibrozil (Lopid)
Cyclosporine (Sandimmune, Gengraf, Neoral)
Colchicine (Colcrys, Lodoco, Mitigare, Gloperba)
Niacin (Niacor)
Warfarin (Coumadin, Jantoven)
Darolutamide (Nubeqa)
Regorafenib (Stivarga)
Other cancer medications, including enasidenib (Idhifa) and capmatinib (Tabrecta)
Teriflunomide (Aubagio)
Febuxostat (Uloric)
Tafamidis (Vyndamax, Vyndaqel)
Antacids that contain aluminum and magnesium
This isn’t a complete list of all possible rosuvastatin interactions. Be sure to discuss the medications you take with your prescriber and pharmacist before starting rosuvastatin. You should also review possible interactions any time you start a new medication while taking rosuvastatin. This includes prescription and over-the-counter (OTC) medications, as well as vitamins and supplements.
Here, we’ll discuss 10 notable rosuvastatin interactions and how to manage them.
1. Paxlovid
Paxlovid is an antiviral medication that can treat COVID-19. Paxlovid can slow the body’s breakdown of rosuvastatin. This can raise the risk of rosuvastatin side effects, such as muscle pain or weakness. In severe cases, this interaction may lead to rhabdomyolysis (muscle breakdown that’s harmful to the kidneys).
Most people only take Paxlovid for 5 days. Because of this short time frame, your prescriber will likely have you temporarily stop taking 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 and other rosuvastatin side effects. These interacting antivirals 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 you shouldn’t combine 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)
Some of these antivirals are long-term medications. It’s unlikely that you’d stop antiviral treatment to manage this interaction. It’s more likely that your prescriber would lower your rosuvastatin dosage to account for it. They may also recommend switching to a cholesterol medication that doesn’t interact with your antiviral.
3. Gemfibrozil and fenofibrate
Fibrates are a group of non-statin cholesterol medications. Two fibrates that interact with rosuvastatin are gemfibrozil 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.
Side effects to watch for: Many rosuvastatin (Crestor) interactions raise the risk of side effects, such as muscle pain or weakness.
Taking the right dose: In some cases, your prescriber may adjust your rosuvastatin dosage to help manage interactions.
What if you can’t take rosuvastatin? Read about statin alternatives your prescriber may consider.
Fenofibrate has a lower risk of issues when taken with rosuvastatin. If you take both fenofibrate and rosuvastatin, let your healthcare professional know if you start experiencing any new or unexplained muscle pain.
4. Cyclosporine
Cyclosporine 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, including muscle pain and rhabdomyolysis.
If your healthcare team determines you should take both medications, it’s not recommended to take more than 5 mg of rosuvastatin per day. Your prescriber may also prefer you take a different cholesterol medication and avoid this interaction altogether.
5. Colchicine
Colchicine 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 team.
6. Niacin
Niacin is a B vitamin — also known as vitamin B3 — that’s sometimes taken to help lower cholesterol. But it can interact with rosuvastatin. This is especially true if you’re taking 1,000 mg or more of niacin daily. Taking these medications together can raise your risk of muscle pain or weakness.
Your prescriber 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 is a blood thinner used to treat and prevent blood clots. Rosuvastatin causes warfarin to stay in the body longer. This interaction raises your risk of serious bleeding with warfarin. It can also cause your international normalized ratio (INR) to go up. 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 team immediately if you start noticing unusual or more frequent bleeding or increased bruising.
8. Darolutamide (Nubeqa)
Darolutamide 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 rosuvastatin side effects.
If you need to take both medications, it’s recommended to limit the dosage of rosuvastatin to no more than 5 mg per day. Otherwise, another cholesterol medication may be needed to avoid this interaction.
9. Regorafenib (Stivarga)
Regorafenib 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 prescriber may prefer to have you take a different cholesterol medication instead.
10. Antacids
Many people use antacids for quick heartburn relief. But certain ones interact with rosuvastatin.
Check the active ingredient section of your antacid’s OTC label for aluminum and magnesium hydroxide. They can prevent your body from fully absorbing rosuvastatin. And this means your cholesterol medication may not work as well.
Examples of antacids that interact with rosuvastatin include:
Mylanta (aluminum hydroxide / magnesium hydroxide / simethicone)
Rolaids (calcium carbonate / magnesium hydroxide)
Milk of Magnesia (magnesium hydroxide)
You don’t need to completely avoid these antacids while taking rosuvastatin. Just make sure you separate them from each other by at least 2 hours.
What foods should you avoid when taking rosuvastatin (Crestor)?
There aren’t any foods that you need to completely avoid while taking rosuvastatin. But there are things that you may want to limit. These foods and drinks can contribute to higher cholesterol. So rosuvastatin may not work as well if you’re also consuming them regularly or in large quantities.
Limit or avoid these foods and drinks while taking rosuvastatin:
Fatty cuts of red meat, such as marbled steak and lamb
Processed meats, such as deli meats and sausage
Fast food
Fried foods
Solid fats, such as lard and butter
High-fat dairy products, such as whole milk
High-sugar foods and sweetened beverages
Alcohol (can also raise the risk of serious rosuvastatin side effects)
Consider including foods and drinks in your diet that help lower cholesterol. Examples include:
Fatty fish, such as salmon and mackerel
Certain nuts, such as almonds and hazelnuts
Whole grains, such as oats and wheat
Certain fruits, such as blueberries and cherries
Vegetables, such as broccoli and carrots
Avocado
Dark chocolate
Frequently asked questions
There aren’t any restrictions on what you can drink with rosuvastatin. But try to limit drinks that are high in fat, such as whole milk, or high in sugar, such as soda. It’s also a good idea to avoid or limit drinking alcohol while taking rosuvastatin. Alcohol can also raise cholesterol, as well as make serious rosuvastatin side effects more likely to happen.
Rosuvastatin can affect your bowels. Constipation is a common rosuvastatin side effect. But it’s usually mild and manageable if you make lifestyle changes or take OTC medications. If rosuvastatin causes constipation, make sure you’re drinking plenty of fluids. You should also slowly increase your daily fiber intake. Exercise, too, can help get things moving. If these tips don’t help, ask your prescriber or pharmacist about OTC constipation medications. They can recommend a medication that’s safe for you to take.
Your liver is the primary organ responsible for breaking down rosuvastatin. In rare cases, rosuvastatin can cause liver damage. Your prescriber should have you go for blood tests from time to time while taking this medication. This test helps your prescriber watch for signs of liver damage. If you have certain liver problems, you may not be able to take rosuvastatin.
There aren’t any restrictions on what you can drink with rosuvastatin. But try to limit drinks that are high in fat, such as whole milk, or high in sugar, such as soda. It’s also a good idea to avoid or limit drinking alcohol while taking rosuvastatin. Alcohol can also raise cholesterol, as well as make serious rosuvastatin side effects more likely to happen.
Rosuvastatin can affect your bowels. Constipation is a common rosuvastatin side effect. But it’s usually mild and manageable if you make lifestyle changes or take OTC medications. If rosuvastatin causes constipation, make sure you’re drinking plenty of fluids. You should also slowly increase your daily fiber intake. Exercise, too, can help get things moving. If these tips don’t help, ask your prescriber or pharmacist about OTC constipation medications. They can recommend a medication that’s safe for you to take.
Your liver is the primary organ responsible for breaking down rosuvastatin. In rare cases, rosuvastatin can cause liver damage. Your prescriber should have you go for blood tests from time to time while taking this medication. This test helps your prescriber watch for signs of liver damage. If you have certain liver problems, you may not be able to take rosuvastatin.
The bottom line
Rosuvastatin (Crestor) is a medication that can help lower cholesterol. But it does have some interactions to know about. Rosuvastatin interacts with Paxlovid (nirmatrelvir / ritonavir), some medications used to treat HIV, and warfarin (Coumadin, Jantoven). It also interacts with other cholesterol medications, such as gemfibrozil (Lopid), fenofibrate (Tricor), and niacin (Niacor).
There are no foods that directly interact with rosuvastatin. But certain dietary items can contribute to high cholesterol. Foods and drinks to limit while taking rosuvastatin include fatty or fried foods, high-sugar foods and drinks, and alcohol.
Certain interactions can be managed with a lower rosuvastatin dosage. But others may require you to stop taking rosuvastatin altogether. Let your prescriber and pharmacist know all medications you’re currently taking. This can help them check for potential interactions.
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References
Bajaj, T., et al. (2022). Rosuvastatin. StatPearls.
NuCare Pharmaceuticals. (2023). Rosuvastatin- rosuvastatin tablet, film coated [package insert].
U.S. Food and Drug Administration. (2016). FDA drug safety communication: Interactions between certain HIV or hepatitis C drugs and cholesterol-lowering statin drugs can increase the risk of muscle injury.
