Crestor side effects and how to avoid them

Crestor side effects | Muscle Pain | Serious side effects | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Crestor is the brand name for the lipid-lowering medication rosuvastatin calcium. Crestor is part of a class of medications known as statins. Statins are HMG-CoA reductase inhibitors because they block the activity of the enzyme HMG-CoA in the liver. Individuals taking Crestor should anticipate a reduction in total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides with a concomitant increase in high-density lipoprotein (HDL) cholesterol. 

Crestor should be used under the care of a healthcare professional and part of a healthy lifestyle which may include diet modification and exercise. In the U.S., Crestor is manufactured by AstraZeneca and is available in 5, 10, 20, or 40 mg tablets. 

Lipid-lowering medications like Crestor can be associated with potentially serious adverse effects. In this article, we will discuss some of the side effects, warnings, and interactions associated with Crestor use as well as how to avoid them. 

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Common side effects of Crestor

Statins are generally well-tolerated medications. However, statin use, including the use of Crestor, is associated with some very common side effects. Many side effects associated with Crestor use are self-limiting, meaning they go away on their own. If any of the following adverse effects become bothersome, notify your healthcare provider: 

• Headache, dizziness, insomnia, tiredness, memory loss, and cognitive impairment 
• Myopathy and myalgia (muscle aches and muscle pains) 
• Arthralgia or pain in the joints
• Asthenia or physical weakness with a lack of energy 
• Gastrointestinal symptoms including abdominal pain, nausea, and constipation
• Diabetes 
• Elevated liver enzymes (AST, ALT)
• Elevated creatine kinase (CK)
• Protein or blood in the urine 
• Gynecomastia 

Muscle pain

Statins, including Crestor, are associated with various statin-associated muscle symptoms (SAMS), which can cause statin intolerance in certain individuals. Muscle complaints vary with statin use, ranging from mild to severe symptoms. Mild symptoms include muscle pain, cramping, and perceived muscle weakness. Rhabdomyolysis and statin-induced necrotizing autoimmune myopathy (SINAM) are more serious side effects that need immediate medical attention. 

Individuals who are taking statins and experience severe muscle pain or weakness should speak with their healthcare provider about alternative treatment options. 

Serious side effects of Crestor

Crestor is associated with some serious side effects. If you experience any of the adverse effects listed below, it is important to notify a healthcare professional right away. 

• Hepatotoxicity could lead to liver damage and other liver problems
• Myopathy including statin-induced necrotizing autoimmune myopathy (SINAM)
• Rhabdomyolysis, a breakdown of muscle tissue that can be life-threatening
• Tendon rupture 
• Acute renal failure 
• Pancreatitis 
• Hypersensitivity reaction 
• Angioedema 
• Diabetes 
• Thrombocytopenia or low platelets 
• Interstitial lung disease 

Crestor side effects in women vs. men

There are limited studies available specifically looking at the tolerance of statins in women compared to men. While most side effects associated with Crestor use are the same in women and men, women have been reported to have a higher incidence of statin-induced myopathies. This may be caused by estrogen competing for CYP450 enzymes that metabolize statins in the liver, which could also result in drug-hormone interactions. Additionally, higher estrogen levels, similar to levels occurring during pregnancy, alter lipid metabolism and cause hyperlipidemia. Polymorphisms (genetic variants found in a given population) of the estrogen receptor gene are associated with variations in triglyceride and HDL levels. In combination, all of these factors contribute to an increased side effect profile in women compared to men. 

Men, on the other hand, are more likely to experience the rare side effect of gynecomastia, a benign, progressive enlargement of male breast tissue. This effect usually reverses within a few months of discontinuing statin use.

It is important to note that these associations are for statins in general and may vary depending on which statin is used. 

How long do side effects last?

The duration of potential side effects associated with Crestor will depend on the type of side effect and how long the medication has been used. Mild side effects (headache, nausea, and insomnia) usually go away over a short period of time (days to weeks). More severe side effects range from days to permanent:

• Rhabdomyolysis will usually begin to resolve within days of discontinuing the medication
• Autoimmune myopathy is often severe and may persist long after the discontinuation of medication
• Liver problems may be permanent and unfortunately do not usually appear until an individual has been taking Crestor for several months

Crestor contraindications & warnings

• Abuse and dependence: Crestor is not habit-forming or addictive, and there are no withdrawal symptoms associated with discontinuing Crestor use. 
• Overdose: The maximum dose of Crestor for individuals without kidney problems or liver disease is 40 mg per day. It is important to only take the dosage of medication that was prescribed. While fatal overdose with Crestor is unlikely, if you believe you have taken too much medication or if you have taken too much medication and have kidney or liver disease, contact the Poison Control Centers at 800-222-1222 or seek emergency medical treatment right away. 
• Restrictions: Crestor is absolutely contraindicated for use in the following individuals:
  • Those with a known hypersensitivity to the drug or components in the drug
  • Individuals with acute or active liver disease, which may include anyone with unexplained, persistent elevations in hepatic transaminases
  • Women who are pregnant or who may become pregnant 
  • Nursing mothers 

Hepatic transaminases, enzymes in the liver, may be persistently elevated while taking this medication. Individuals with acute liver disease should not take this medication. Individuals with liver disease from chronic alcohol use are known to have higher levels of rosuvastatin in the blood. Liver enzymes should be monitored before and during treatment. High liver enzymes usually indicate liver impairment or damage. 

Renal impairment and dose adjustment

Individuals with mild to moderate renal impairment do not require dose adjustment when taking Crestor. However, exposure to rosuvastatin is increased to a clinically significant extent in individuals with severe renal impairment who are not receiving hemodialysis. Crestor dosing should be adjusted for individuals with severe renal impairment. 

Teratogenic effects 

Crestor is Pregnancy Category X and is absolutely contraindicated for use in pregnant women. Serum cholesterol and triglycerides increase during pregnancy as cholesterol and lipid products are necessary for the growth of the developing fetus. As such, lipid-lowering agents, including Crestor, should not be used during pregnancy. There is no known clinical benefit of using this medication while pregnant. 

Breastfeeding mothers

Statins have been shown to be in human breast milk. In animal studies, rosuvastatin was shown to be in breast milk at three times higher concentrations than measured in plasma. If Crestor is required to be used in nursing mothers, they should be advised not to nurse their infants. Statins can also cause serious adverse reactions in infants.

Individuals of Asian descent

Laboratory studies have demonstrated almost a two-fold increase of serum rosuvastatin levels in Asian patients when compared to Caucasian patients. Therefore, Crestor dosage should be adjusted for individuals of Asian descent. 

Individuals with hypothyroidism

Hypothyroidism is a well-known cause of lipid abnormalities and is associated with atherosclerosis, cholesterol plaque accumulation on artery walls. Individuals who have thyroid disease are at an increased risk of developing SAMS and rhabdomyolysis while taking statins. If you have known thyroid disease, it is important to speak with your healthcare provider before beginning any lipid-lowering agent, including Crestor.

Crestor interactions

Crestor has several potential drug interactions. It is important to inform your healthcare provider about all of the medicines you are taking prior to taking Crestor as well as any changes you may have to your medications while actively using Crestor. The following medications have significant interactions with Crestor and should be avoided:

• Cyclosporine: Increases rosuvastatin exposure. With this medication, the Crestor dose should be limited to 5 mg once per day. 
• Gemfibrozil: Increases rosuvastatin exposure and risk of myopathy. With this medication, the Crestor dose should be limited to 10 mg once per day. 
• Lopinavir/ritonavir or atazanavir/ritonavir: Increases rosuvastatin exposure. With this medication, the Crestor dose should be limited to 10 mg once per day. 
• Coumarin anticoagulants including warfarin: Prolongs INR (a test used to determine bleeding time and blood coagulation). It is important to monitor the INR frequently until it is stable before initiating or altering Crestor therapy while taking a coumarin anticoagulant. 
• Lipid-lowering therapies: May increase skeletal muscle side effects. Fibrate medications (fenofibrate), niacin, bile acid sequestrants (cholestyramine), and cholesterol absorption inhibitors (ezetimibe) should be used with extreme caution when taking Crestor. 

If you are concerned about any medications you are taking or are not sure if one of your medicines may interact with Crestor, speak with your healthcare provider. 

How to avoid Crestor side effects

1. It is important to follow medical advice while taking this medication 

Take only the dose prescribed by a healthcare professional, taking it how and when prescribed. If there is a missed dose, take the next dose as soon as you remember, but skip it if it is too close to the next scheduled dose. Patients should continue taking the medication as prescribed even if they feel well after the first few doses.

2. Do not discontinue this use of this medication without seeking medical advice

You should not discontinue a statin unless you with your healthcare provider have decided that is the right decision. Most individuals who abruptly discontinue statins re-experience elevated cholesterol levels and potentially cardiovascular side effects.

3. Disclose a full medication list, health history, and allergies before taking Crestor

This includes all medications and supplements, any medical conditions present, or any allergic reactions to medications experienced in the past. 

4. Store the medication correctly and out of the reach of children

Crestor should be stored at room temperature (68 to 77°F). This medication should be stored out of reach of children, as even low doses can be harmful to small children who were not prescribed it.

5. Swallow the tablet whole

Do not crush, break or chew the tablet.

6. Avoid taking this medication with antacids

Antacids and other magnesium salts reduce the amount of Crestor in the systemic circulation by up to 50%. If antacids must be taken, take them at least two hours before or two hours after Crestor administration. 

7. Maintain a healthy weight with a healthful diet and exercise if tolerated 

Many individuals take Crestor daily for many years. Crestor is most effective when it is used in combination with a healthy lifestyle which includes a healthy diet and exercise. With appropriate lifestyle modifications, it is possible to reduce several unwanted side effects and even reduce the need for this medication. 

8. Consider your exercise regimen while taking this medication 

Do not take this medication around the time of day when you exercise and do not “overdo” your exercise while taking this medication. Individuals who aggressively exercise while taking statins are more likely to experience severe muscle problems. 

9. Do not take this medication if you will be unable to have your liver enzymes routinely monitored 

This medication can elevate your liver enzymes which can cause liver damage and even acute hepatitis. It is important that individuals taking this medication have access to facilities that can perform the appropriate blood tests. Seek medical care immediately if you experience any symptoms of liver problems, which may include feeling unusually tired or weak, loss of appetite, upper abdominal pain, dark urine, or yellowing of the skin or eyes. 

10. Women of childbearing age should use reliable contraception while taking this medication 

Crestor is associated with teratogenic effects on developing fetuses. Women who need to take this medication should not become or try to become pregnant while taking Crestor. 

11. Patients should immediately seek medical care if they experience any type of allergic reaction to this medication or unexplained muscle pain 

Allergic responses should be reported and treated as early as possible. Any type of serious adverse effect or potential overdose should receive medical attention immediately.