Zyrova Drug Interactions

Cyclosporine: Cyclosporine significantly increased rosuvastatin exposure. Therefore in patients taking cyclosporine, therapy should be limited to Rosuvastatin 5 mg once daily.
Gemfibrozil: Gemfibrozil significantly increased rosuvastatin exposure. Therefore, combination therapy with rosuvastatin and gemfibrozil should be avoided. If used, do not exceed Rosuvastatin 10 mg once daily.
Coumarin Anticoagulants: Rosuvastatin significantly increased INR in patients receiving coumarin anticoagulants. Therefore, caution should be exercised when coumarin anticoagulants are given in conjunction with Rosuvastatin. In patients taking coumarin anticoagulants and Rosuvastatin concomitantly, INR should be determined before starting Rosuvastatin and frequently enough during early therapy to ensure that no significant alteration of INR occurs.
Niacin: The risk of skeletal muscle effects may be enhanced when Rosuvastatin is used in combination with niacin; a reduction in Rosuvastatin dosage should be considered in this setting.
Fenofibrate: When Rosuvastatin was co-administered with fenofibrate no clinically significant increase in the AUC of rosuvastatin of fenofibrate was observed. The benefit of further alterations in lipid levels by the combined use of Rosuvastatin with fibrates should be carefully weighed against the potential risk of this combination.
5 mg: Lopinavir/Ritonavir: The combination of lopinavir and ritonavir significantly increased rosuvastatin exposure. Therefore, in patients taking a combinations of lopinavir and ritonavir, the dose of Rosuvastatin should not be limited to 10 mg once daily. The effect of other protease inhibitors on rosuvastatin pharmacokinetics has not been examined
10 mg & 20 mg: Rosuvastatin levels were increased 7-folds, 2-folds and by 28% when it was administered concomitantly with cyclosporine, gemfibrozil and itraconazole, respectively. Patients on concomitant rosuvastatin and warfarin may have an increase in the International Normalized Ratio (INR). Hence, appropriate monitoring of INR is recommended in such patients. Simultaneous administration of rosuvastatin with an antacid preparation containing albumin and magnesium hydroxide resulted in a decrease in rosuvastatin plasma concentration by approximately 50%. This effect was mitigated when the antacid was dosed 2 hrs after rosuvastatin. Concomitant use of rosuvastatin and erythromycin resulted in a 20% decrease in AUC and 31% decrease in C_max of rosuvastatin. Concomitant use of rosuvastatin and an oral contraceptive resulted in an increase in ethinylestradiol and norgestrel AUC of 26% and 34%, respectively.
40 mg: Protease Inhibitors: Co-administration of rosuvastatin with certain protease inhibitors given in combination with ritonavir has differing effects on rosuvastatin exposure. The protease inhibitor combinations lopinavir/ritonavir and atazanavir/ritonavir increase rosuvastatin exposure. For these combinations the dose of Rosuvastatin should not exceed 10 mg once daily. The combinations of tipranavir/ritonavir or fosamprenavir/ritonavir produce little or no change in rosuvastatin exposure. Caution should be exercised when rosuvastatin is co-administered with protease inhibitors given in combination with ritonavir.
Colchicine: Cases of myopathy, including rhabdomyolysis, have been reported with HMG-CoA reductase inhibitors, including rosuvastatin, co-administered with colchicine, and caution should be exercised when prescribing Rosuvastatin with colchicine.