Roszet Drug Interactions You Need to Know About

Roszet (Ezetimibe/Rosuvastatin) is a combination cholesterol medication that interacts with several other drugs, supplements, and even some foods. Some of these interactions are dangerous — they can increase your risk of serious muscle damage or change how well Roszet works.

This guide covers the most important interactions so you know what to avoid and what to discuss with your doctor before starting Roszet.

How Drug Interactions Work

A drug interaction happens when another substance changes how a medication behaves in your body. With Roszet, interactions typically fall into two categories:

1. Increased drug levels. Some medications slow down how your body processes Rosuvastatin, causing it to build up in your blood. Higher levels mean a higher risk of side effects — especially muscle problems like rhabdomyolysis.
2. Increased side effect risk. Some drugs don't change Roszet's blood levels but independently raise the risk of the same side effects, creating an additive danger.

Not every interaction is equally serious. Some are absolute contraindications (never combine), while others just require dose adjustments or careful monitoring.

Medications That Interact with Roszet

Major Interactions (Contraindicated or Not Recommended)

These combinations should be avoided entirely:

• Cyclosporine (Neoral, Sandimmune, Gengraf) — Contraindicated. Cyclosporine increases Rosuvastatin levels in the blood by approximately 7-fold, dramatically raising the risk of rhabdomyolysis (severe muscle breakdown). If you take Cyclosporine, Roszet should not be prescribed.
• Gemfibrozil (Lopid) — Contraindicated. This fibrate medication significantly increases statin exposure and myopathy risk. The combination is considered too dangerous.
• Danazol — Not recommended with Roszet due to increased risk of muscle problems.

Moderate Interactions (Dose Adjustment or Monitoring Required)

These medications can be used with Roszet in some cases, but require precautions:

• Other fibrates — Fenofibrate (Tricor, Fenoglide), Bezafibrate — While safer than Gemfibrozil, other fibrates still increase the risk of myopathy when combined with statins. Your doctor will weigh the benefits against the risks and monitor you closely.
• Niacin (Niaspan, Slo-Niacin) — At doses of 1 gram per day or more, Niacin increases the risk of muscle problems when combined with statins. Lower doses used in supplements are generally less concerning, but tell your doctor about any Niacin you take.
• Colchicine (Colcrys, Mitigare) — Used for gout, Colchicine independently increases myopathy risk. Taking it with Roszet compounds that danger. Your doctor may need to adjust doses of one or both medications.
• Warfarin (Coumadin, Jantoven) and other anticoagulants — Rosuvastatin can increase the effect of Warfarin, raising your INR and increasing bleeding risk. If you take a blood thinner, your doctor will monitor your INR more frequently when starting or adjusting Roszet.
• Certain HIV antivirals — Atazanavir (Reyataz), Darunavir (Prezista), Ritonavir (Norvir) combinations — These protease inhibitors can increase Rosuvastatin levels. Dose adjustments for Roszet may be needed.
• Darolutamide (Nubeqa) — Used for prostate cancer. When taken with Darolutamide, the Rosuvastatin dose should be limited to 5 mg (meaning only the lowest-strength Roszet tablet).
• Regorafenib (Stivarga) — An oncology medication. Rosuvastatin dose should be limited to 10 mg when combined with Regorafenib.
• Bile acid sequestrants — Cholestyramine (Questran), Colesevelam (Welchol) — These cholesterol medications bind to other drugs in the gut, reducing absorption. Take Roszet at least 2 hours before or 4 hours after a bile acid sequestrant.

Supplements and Over-the-Counter Products to Watch

It's not just prescription drugs that interact with Roszet. Tell your doctor if you take any of the following:

• Red yeast rice — This supplement naturally contains monacolin K, which is chemically identical to the statin Lovastatin. Taking it with Roszet is essentially stacking two statins, increasing the risk of muscle problems.
• High-dose Niacin (Vitamin B3) — As noted above, Niacin at doses over 1 gram per day increases myopathy risk.
• St. John's Wort — May reduce the effectiveness of some statins by speeding up their metabolism. The interaction with Rosuvastatin is less studied than with other statins, but it's worth mentioning to your doctor.
• Antacids containing aluminum or magnesium — These can reduce the absorption of Rosuvastatin. Take antacids at least 2 hours after your Roszet dose.

Food and Drink Interactions

• Grapefruit juice — Grapefruit is a well-known interaction concern with many statins because it inhibits an enzyme (CYP3A4) that breaks them down. The good news: Rosuvastatin is minimally affected by grapefruit compared to statins like Atorvastatin or Simvastatin. Occasional grapefruit consumption is generally fine, but check with your doctor if you consume large amounts daily.
• Alcohol — Heavy alcohol use increases the risk of liver damage, and since Roszet is processed by the liver, combining the two raises that risk. Moderate alcohol consumption (one drink per day for women, two for men) is generally acceptable, but discuss your drinking habits with your doctor.

What to Tell Your Doctor

Before starting Roszet, make sure your doctor and pharmacist have a complete picture of everything you take. This includes:

• All prescription medications — Even ones prescribed by other doctors
• Over-the-counter drugs — Pain relievers, cold medicines, antacids
• Vitamins and supplements — Especially Niacin, red yeast rice, and fish oil
• Herbal products — St. John's Wort and others
• Your alcohol intake
• Any history of muscle problems on previous cholesterol medications

If you're prescribed a new medication while already taking Roszet, remind the prescribing doctor that you're on a statin. Interactions can happen at any point during treatment, not just when you start.

Final Thoughts

Roszet is an effective cholesterol-lowering medication, but its interactions with other drugs are real and important. Cyclosporine and Gemfibrozil are the most dangerous — those combinations should never happen. Other interactions like Warfarin and Niacin can be managed with monitoring and dose adjustments.

The key is communication. Make sure every doctor and pharmacist you see knows your complete medication list. And if you notice unexplained muscle pain, weakness, or dark urine after starting a new medication alongside Roszet, contact your doctor immediately.

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