7.1Drug
Interactions that Increase the Risk of Myopathy and Rhabdomyolysis with Rosuvastatin calcium Rosuvastatin is a substrate of CYP2C9 and transporters (such as OATP1B1, BCRP). Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. Table 5 includes a list of drugs that increase the risk of myopathy and rhabdomyolysis when used concomitantly with rosuvastatin calcium and instructions for preventing or managing them [ see Warnings and Precautions (5.1) and Clinical Pharmacology (12.3) ].
Table 5: Drug Interactions that Increase the Risk of Myopathy and Rhabdomyolysis with Rosuvastatin calcium Cyclosporine Clinical Impact: Cyclosporine increased rosuvastatin exposure 7-fold. The risk of myopathy and rhabdomyolysis is increased with concomitant use of cyclosporine or gemfibrozil with rosuvastatin calcium. Intervention: If used concomitantly, do not exceed a dose of rosuvastatin calcium 5 mg once daily .
Teriflunomide Clinical Impact: Teriflunomide increased rosuvastatin exposure more than 2.5-fold. The risk of myopathy and rhabdomyolysis is increased with concomitant use. Intervention: In patients taking teriflunomide, do not exceed a dose of rosuvastatin calcium 10 mg once daily . Capmatinib Clinical Impact: Capmatinib increased rosuvastatin exposure more than 2.1-fold. The risk of myopathy and rhabdomyolysis is increased with concomitant use.
Intervention: In patients taking capmatinib, do not exceed a dose of rosuvastatin calcium 10 mg once daily . Fostamatinib Clinical Impact: Fostamatinib increased rosuvastatin exposure more than 2.0-fold. The risk of myopathy and rhabdomyolysis is increased with concomitant use. Intervention: In patients taking fostamatinib, do not exceed a dose of rosuvastatin calcium 20 mg once daily . Febuxostat Clinical Impact: Febuxostat increased rosuvastatin exposure more than 1.9-fold.
The risk of myopathy and rhabdomyolysis is increased with concomitant use. Intervention: In patients taking febuxostat, do not exceed a dose of rosuvastatin calcium 20 mg once daily . Gemfibrozil Clinical Impact: Gemfibrozil significantly increased rosuvastatin exposure and gemfibrozil may cause myopathy when given alone. The risk of myopathy and rhabdomyolysis is increased with concomitant use of gemfibrozil with rosuvastatin calcium.
Intervention: Avoid concomitant use of gemfibrozil with rosuvastatin calcium. If used concomitantly, initiate rosuvastatin calcium at 5 mg once daily and do not exceed a dose of rosuvastatin calcium 10 mg once daily . Tafamidis Clinical Impact: Tafamidis significantly increased rosuvastatin exposure and tafamidis may cause myopathy when given alone. The risk of myopathy and rhabdomyolysis is increased with concomitant use of tafamidis with rosuvastatin calcium.
Intervention: Avoid concomitant use of tafamidis with rosuvastatin calcium. If used concomitantly, initiate rosuvastatin calcium at 5 mg once daily and do not exceed a dose of rosuvastatin calcium 10 mg once daily. Monitor for signs of myopathy and rhabdomyolysis if used concomitantly with rosuvastatin calcium . Anti-Viral Medications Clinical Impact: Rosuvastatin plasma levels were significantly increased with concomitant administration of many anti-viral drugs, which increases the risk of myopathy and rhabdomyolysis.
Intervention: · Sofosbuvir/velpatasvir/voxilaprevir · Ledipasvir/sofosbuvir Avoid concomitant use with rosuvastatin calcium. · Simeprevir · Dasabuvir/ombitasvir/paritaprevir/ritonavir · Elbasvir/grazoprevir · Sofosbuvir/velpatasvir · Glecaprevir/pibrentasvir · Atazanavir/ritonavir · Lopinavir/ritonavir Initiate with rosuvastatin calcium 5 mg once daily, and do not exceed a dose of rosuvastatin calcium 10 mg once daily.
Darolutamide Clinical Impact: Darolutamide increased rosuvastatin exposure more than 5-fold. The risk of myopathy and rhabdomyolysis is increased with concomitant use . Intervention: In patients taking darolutamide, do not exceed a dose of rosuvastatin calcium 5 mg once daily . Regorafenib Clinical Impact: Regorafenib increased rosuvastatin exposure and may increase the risk of myopathy. Intervention: In patients taking regorafenib, do not exceed a dose of rosuvastatin calcium 10 mg once daily .
Fenofibrates (e.g., fenofibrate and fenofibric acid) Clinical Impact: Fibrates may cause myopathy when given alone. The risk of myopathy and rhabdomyolysis is increased with concomitant use of fibrates with rosuvastatin calcium. Intervention: Consider if the benefit of using fibrates concomitantly with rosuvastatin calcium outweighs the increased risk of myopathy and rhabdomyolysis. If concomitant use is decided, monitor patients for signs and symptoms of myopathy, particularly during initiation of therapy and during upward dose titration of either drug.
Niacin Clinical Impact: Cases of myopathy and rhabdomyolysis have occurred with concomitant use of lipid-modifying doses (≥1 g/day) of niacin with rosuvastatin calcium. Intervention: Consider if the benefit of using lipid-modifying doses (≥1 g/day) of niacin concomitantly with rosuvastatin calcium outweighs the increased risk of myopathy and rhabdomyolysis. If concomitant use is decided, monitor patients for signs and symptoms of myopathy, particularly during initiation of therapy and during upward dose titration of either drug.
Colchicine Clinical Impact: Cases of myopathy and rhabdomyolysis have been reported with concomitant use of colchicine with rosuvastatin calcium. Intervention: Consider if the benefit of using colchicine concomitantly with rosuvastatin calcium outweighs the increased risk of myopathy and rhabdomyolysis. If concomitant use is decided, monitor patients for signs and symptoms of myopathy, particularly during initiation of therapy and during upward dose titration of either drug.