ModerateMacrolides×HMG-CoA reductase inhibitors (statins)
Updated · Methodology
Mechanism
Rosuvastatin undergoes limited metabolism, about 10% of the dose, mainly by the CYP2C9 enzyme (rosuvastatin SmPC). Azithromycin is a weak inhibitor of cytochrome P450 enzymes (azithromycin SmPC). There are no data on higher rosuvastatin levels with this combination, but post-marketing cases of rhabdomyolysis have been reported in patients taking azithromycin with statins (azithromycin SmPC).
Symptoms
Muscle pain, weakness, cramps or tenderness, sometimes with malaise and fever. In rhabdomyolysis, urine turns dark from myoglobin and there is a risk of acute kidney injury (statin SmPCs).
Management
Use the combination with caution: post-marketing cases of rhabdomyolysis have been reported in patients taking azithromycin with statins (azithromycin SmPC). The documents do not require a change in the rosuvastatin dose. Ask the patient to report unexplained muscle pain, weakness or cramps at once, especially with malaise or fever. If these occur, measure creatine kinase (CK): stop rosuvastatin if CK is above 5 times the upper limit of normal or if muscle symptoms are severe (rosuvastatin SmPC).
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- Indiana University: Flockhart Table of Drug Interactions (CYP isoforms) (2023)
- AEMPS: Ficha técnica: Azitromicina (Zitromax 500 mg) (nº registro 61272), secciones 4.4 y 4.5 (2026)– AEMPS, CIMA, nº registro 61272, revisión 08/2026, secciones 4.4 y 4.5
- AEMPS: Ficha técnica: Rosuvastatina (Crestor 10 mg) (nº registro 70243), secciones 4.4 y 5.2 (2025)– AEMPS, CIMA, nº registro 70243, revisión 11/2025, secciones 4.4 y 5.2