The most serious consequence of drug interactions with rosuvastatin and other statins is the development of myopathy or rhabdomyolysis. Drugs that can cause myopathy when given alone increase the risk of myopathy with all statins; these drugs include fibric acid derivatives (fibrates or gemfibrozil), and nicotinic acid. Rosuvastatin undergoes limited metabolism, principally by the cytochrome P450 isoenzyme CYP2C9, and may not have the same interactions with enzyme inhibitors as simvastatin. However, increased plasma-rosuvastatin concentrations have been reported with ciclosporin, HIV-protease inhibitors, and to a lesser extent, with gemfibrozil, and such combinations should be avoided. If they must be given together, lower doses of rosuvastatin should be used.
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