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.
Lopinavir/Ritonavir: The combination of lopinavir and ritonavir significantly increased exposure. Therefore, in patients taking a combination of lopinavir and ritonavir, the dose of rosuvastatin should be limited to 10 mg once daily. The effect of the other protease inhibitors on rosuvastatin pharmacokinetics has not been examined.
Coumarin Anticoagulants: Rosuvastatin significantly increased International Normalized Ratio (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 or 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 risks of this combination.