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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
We weigh the pros and cons every day in decisions big and small. That cheeseburger is bound to give you heartburn, for example, but it’s worth it because of the taste and the memory you’re making with your friends when you go out together. Healthcare providers prescribing medications use the same process on a more serious level when it comes to statin drugs like Crestor. Some studies have found that Crestor is more effective than several of its competitors at lowering bad cholesterol. However, that benefit has to be weighed against its potential side effects—even if they are relatively rare (Jones, 2003).
Just because your healthcare provider is the one prescribing doesn’t mean you can’t be part of the decision about what’s right for you. If Crestor is part of your health conversation, here’s what you need to know about how it works, the potential side effects, how common they are, and when to get medical advice.
What is Crestor, and how does it work?
Crestor (rosuvastatin calcium) is a statin drug made by AstraZeneca that’s most well-known for lowering low-density lipoprotein (LDL cholesterol) in people with high cholesterol levels (hypercholesterolemia). It does this in two ways: by blocking the production of cholesterol and by encouraging your liver to break down cholesterol that’s already in the blood so it can be shuttled out of the body (Luvai, 2012).
Rosuvastatin belongs to the statin drug class, also known as HMG-CoA reductase inhibitors—they block HMG-CoA reductase, an enzyme that plays a vital role in cholesterol production. This class of prescription drugs reduces elevated cholesterol levels in people with a high risk of developing cardiovascular disease (also called heart disease). Cardiovascular disease (CVD) is a group of medical conditions that can lead to heart attacks, chest pain, and strokes. Lowering cholesterol is important because high cholesterol is one of the key risk factors for developing CVD (CDC, 2019).
But Crestor is approved by the U.S. Food and Drug Administration (FDA) for more than its cholesterol-lowering effects. Crestor may help lower bad cholesterol when diet and exercise alone aren’t enough to get levels to a goal set by a healthcare professional. It may also be given to help lower triglycerides, raise levels of high-density lipoprotein or HDL cholesterol, or slow the buildup of plaque on artery walls (AstraZeneca, 2020).
What you need to know about different classes of statins
There are a couple of differences between individual drugs within the larger group of statins—not all statins are metabolized the same way (Schachter, 2005). Statin drugs such as atorvastatin (brand name Lipitor), simvastatin (brand name Zocor), and lovastatin (brand name Altoprev and Mevacor) are all broken down by an enzyme called CYP3A4. Other statins, including fluvastatin (brand name Lescol), rosuvastatin (brand name Crestor), and pravastatin (brand name Pravachol), are metabolized down by a different enzyme called CYP2C9 (Schachter, 2005).
Statins can also be divided based on whether they are hydrophilic or lipophilic (Schachter, 2005). Lipophilic statins are those medications that get dispersed throughout many tissues in your body. Hydrophilic statins, on the other hand, stay primarily in liver tissue. Lipophilic statins include atorvastatin, simvastatin, lovastatin, fluvastatin, and pitavastatin, while hydrophilic statins include rosuvastatin and pravastatin (Schachter, 2005). Some worry that lipophilic statins have a higher risk of side effects because they can travel outside the liver. However, a review looking at clinical trials involving over 11,000 patients suggests that there is not much of a difference in adverse effects between the two types of statins (Bytyçi, 2017).
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What are the bad side effects of Crestor?
Common side effects of rosuvastatin include headache, nausea, muscle aches, weakness, and abdominal pain. Side effect rates may vary depending on the medication dose, but in clinical trials the average frequency of each symptom was (FDA, 2010):
- Headache: 5.5%
- Nausea: 3.4%
- Myalgia (muscle pain): 2.8%
- Asthenia (weakness or lack of energy): 2.7%
- Constipation: 2.4%
Interestingly, certain side effects are more prevalent at some dosages than others. For example, headaches occur more often at 40 mg, while nausea and unexplained muscle pain are more likely to happen at 20 mg (FDA, 2010). Lastly, some people have also reported confusion and memory loss while taking this drug.
In rare cases, Crestor may cause more severe side effects, including liver problems and muscle problems. In some cases, rosuvastatin may cause rhabdomyolysis, a breakdown of muscle tissue that may also cause kidney problems. You should watch for muscle pain, tenderness, and weakness (myopathy). Rosuvastatin may also elevate blood sugar levels (FDA, 2010).
If these side effects happen and persist, your prescribing healthcare provider may take you off Crestor to see if the symptoms are from statin use. You may need blood tests before starting Crestor, and sometimes during treatment, to check your liver function.
Lately, some medications interfere with how your body breaks down statins. Examples include cyclosporine, gemfibrozil, niacin, fibrates (such as Fenofibrate), and protease inhibitors such as ritonavir. Combining statins with these drugs increases the risk of adverse effects (FDA, 2010).
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When to talk to your healthcare provider
Talk to your healthcare provider immediately if you experience unexplained muscle pain (especially in combination with a fever), unusual weakness or tiredness, upper belly pain, loss of appetite, dark urine, or yellowing of the whites of your eyes or skin—these may be signs of a serious side effect like muscle or liver damage. Seek medical attention right away if you have any allergic reaction symptoms such as swelling of the lips, tongue, or face.
- AstraZeneca. (2020, July). CRESTOR FAQs. Retrieved Aug. 11, 2020 from https://www.crestor.com/cholesterol-medicine/faqs.html
- Bytyçi, I., Bajraktari, G., Bhatt, D. L., Morgan, C. J., Ahmed, A., Aronow, W. S., et al, & Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group. (2017). Hydrophilic vs lipophilic statins in coronary artery disease: A meta-analysis of randomized controlled trials. Journal of Clinical Lipidology, 11(3), 624–637. https://doi.org/10.1016/j.jacl.2017.03.003. Retrieved from https://www.lipidjournal.com/article/S1933-2874(17)30071-5/fulltext
- Centers for Disease Control and Prevention (CDC). (2019). Know Your Risk for Heart Disease. Retrieved Aug. 11, 2020 from https://www.cdc.gov/heartdisease/risk_factors.htm
- Food and Drug Administration (FDA). (2010, February 8). Crestor (rosuvastatin calcium) tablets. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021366s016lbl.pdf
- Fukazawa, I., Uchida, N., Uchida, E., & Yasuhara, H. (2004). Effects of grapefruit juice on pharmacokinetics of atorvastatin and pravastatin in Japanese. British Journal of Clinical Pharmacology, 57(4), 448-455. doi:10.1046/j.1365-2125.2003.02030.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15025743/
- Jones, P. H., Davidson, M. H., Stein, E. A., Bays, H. E., Mckenney, J. M., Miller, E., et al. (2003). Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR**STELLAR = Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin. Trial). The American Journal of Cardiology, 92(2), 152-160. doi:10.1016/s0002-9149(03)00530-7. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12860216/
- Luvai, A., Mbagaya, W., Hall, A. S., & Barth, J. H. (2012). Rosuvastatin: A Review of the Pharmacology and Clinical Effectiveness in Cardiovascular Disease. Clinical Medicine Insights: Cardiology, 6, 17-33. doi:10.4137/cmc.s4324. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22442638/
- Schachter, M. (2005). Chemical, pharmacokinetic and pharmacodynamic properties of statins: An update. Fundamental and Clinical Pharmacology, 19(1), 117-125. doi:10.1111/j.1472-8206.2004.00299.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15660968/
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.