Rosuvastatin: uses, dosage and side effects
Rosuvastatin is a statin. It is prescription-only in Ireland and is used to lower cholesterol and to reduce the risk of heart attack and stroke in people at raised cardiovascular risk. This page explains what it is used for, how it is taken, its side effects and how an existing prescription is renewed. It is information and does not replace your own doctor's assessment.
What rosuvastatin is used for
Rosuvastatin lowers cholesterol, and it is prescribed for raised cholesterol including the inherited form, for raised blood fats generally, and to reduce the risk of cardiovascular events in people whose overall risk is high. It blocks an enzyme the liver uses to make cholesterol, which lowers LDL cholesterol in the blood and, in people who have already had a heart attack or stroke, reduces the chance of another. Statins are usually prescribed alongside diet, physical activity and stopping smoking, not instead of them, and the target is decided from your overall risk rather than from a cholesterol number in isolation. Cholesterol itself causes no symptoms, so treatment is judged on blood tests and on risk, which is why it is taken for years and why blood tests are part of the treatment. Rosuvastatin is not a treatment for chest pain that is happening now: pain at rest or with sweating and breathlessness needs 112 or 999.
Side effects of rosuvastatin
The effects reported most often are headache, muscle aches, abdominal pain, nausea, constipation and dizziness. Muscle symptoms are what people ask about most: in the usual case mild aching settles or improves with a change of dose or product, and a doctor can test whether the muscles are actually affected. Very rarely a statin sets off an immune reaction in the muscle, called immune-mediated necrotising myopathy, in which weakness in the thighs and upper arms and a raised muscle enzyme in the blood carry on even after the tablet has been stopped; that form does not settle by itself and needs to be investigated rather than waited out. Contact a doctor without delay if you develop unexplained muscle pain, tenderness or weakness that is severe or widespread, especially with fever or feeling generally unwell, or if your urine turns dark. Very rarely a statin can cause serious muscle breakdown that affects the kidneys, and that is the reason for the warning. Seek advice too for yellowing of the eyes or skin, for a severe rash, or for persistent abdominal pain. Statins can also raise blood sugar slightly and may lead to a diagnosis of type 2 diabetes in people already close to the threshold, which is one of the things a doctor weighs against the benefit.
Dosage and how to take rosuvastatin
Rosuvastatin is taken by mouth once a day and, unlike some older statins, it can be taken at any time of day as long as it is roughly the same time each day, with or without food. The prescriber sets the strength, usually starting lower and adjusting after a blood test, because the aim is to reach the cholesterol target rather than to use the highest dose. Blood tests are part of treatment: lipids are normally checked some weeks after starting or changing the dose, and liver tests may be done as well. If you miss a dose, take the next one at the usual time rather than doubling up. Do not stop the tablet because your cholesterol result has improved: the result is the medicine working, and levels drift back up when it stops. If side effects are the problem, tell your doctor rather than stopping quietly, because a lower dose, a different statin or a different schedule often solves it.
Is rosuvastatin available without a prescription in Ireland?
No. Rosuvastatin is a prescription-only medicine in Ireland and no pharmacy can supply it without a valid prescription. The dose depends on your cholesterol results, your overall cardiovascular risk, your kidney and liver function, your ethnic background and the other medicines you take, and those are things a prescriber has to weigh rather than guess. If you want to know your cholesterol, your GP can arrange the blood test. Rosuvastatin is not a controlled drug, so it is not among the substances excluded from cross-border prescriptions under Article 11(6) of Directive 2011/24/EU. A prescription issued by a prescriber elsewhere in the EU or EEA can be presented in an Irish pharmacy, and the Pharmaceutical Society of Ireland has published guidance for pharmacists on dispensing such prescriptions. The pharmacist still applies professional judgement and may decline where anything is unclear, so the document must carry the fields required by the Annex to Implementing Directive 2012/52/EU and name the active substance.
Renewing an existing rosuvastatin prescription
If a doctor has already assessed you, started you on rosuvastatin and your treatment needs to be continued, you can request a repeat prescription through our medical questionnaire. A doctor reviews what you write and, where continuation is appropriate, issues a cross-border prescription as a PDF document by e-mail; you bring it with photo identification to any pharmacy. There is no PIN code, and there is no video consultation, no telephone appointment and no live chat, because the review is asynchronous. Documents are issued by lek. Damian Wojno, a doctor registered in Poland, PWZ no. 3211301. Statin treatment needs blood tests, so have your recent cholesterol and liver results to hand when you fill in the questionnaire, and keep up reviews with your GP: a renewal is not a substitute for monitoring. This route is for continuing established treatment, not for deciding whether you should be on a statin at all, which is a risk assessment for your own doctor. The fee of 19,90 € covers the medical consultation, not the issuing of a document. If the doctor declines on medical grounds, the fee is returned. If you do not send documentation the doctor asks for, the consultation counts as carried out and the fee is not refunded.
Cost and reimbursement in Ireland
What rosuvastatin costs at the counter depends on the strength, the pack, the manufacturer and the pharmacy, and it is set by the pharmacy rather than by us. Generic rosuvastatin has been available for some years and is generally less expensive than the original brand. We do not sell medicines and we do not quote prices for them; ask the pharmacist before dispensing if cost matters. On the state side, the HSE runs the medical card scheme and the Drugs Payment Scheme, which caps what a household pays for approved prescribed medicines in a calendar month. Because a statin is usually taken for years, it is worth asking the pharmacy how your prescriptions sit within those schemes. How a prescription written by a prescriber in another EU country is treated under them is decided by the HSE and applied at the counter. Our charge is the consultation fee described above and is separate from the pharmacy's price.
Interactions and alcohol
Several interactions with rosuvastatin matter enough to change the dose or the choice of medicine. Ciclosporin is the one that is not a matter of caution at all: the two must not be taken together, because ciclosporin raises rosuvastatin levels several times over. Gemfibrozil, some antiviral medicines used for HIV and hepatitis C, and certain other lipid-lowering medicines can also raise rosuvastatin levels and with them the risk of muscle problems, and the combination of sofosbuvir with velpatasvir and voxilaprevir for hepatitis C must not be used either. Warfarin control can change when a statin is started, so your INR may need checking. Antacids containing aluminium or magnesium can reduce absorption if taken at the same time, so separate them by a couple of hours. Alcohol needs care for two reasons: heavy drinking is itself a cause of liver damage and of raised blood fats, and it adds to the load on a liver already handling a statin. Moderate intake is generally acceptable, but tell your doctor honestly how much you drink, because it changes both the risk assessment and the interpretation of liver tests. Give a full list of everything you take, including supplements.
Who should not take rosuvastatin
Rosuvastatin must not be taken in pregnancy or while breastfeeding, and women who can become pregnant may take it only while using reliable contraception. It must also not be taken by anyone with active liver disease or persistently raised liver enzymes, by anyone who has had an allergic reaction to it, by anyone with severe kidney impairment (creatinine clearance below 30 ml/min), by anyone who has a muscle disease (myopathy), or alongside ciclosporin or the hepatitis C combination of sofosbuvir with velpatasvir and voxilaprevir. The kidney limit, the muscle disease and those two drug combinations rule the medicine out at every strength, including the lowest, and not only at the higher ones. The 40 mg strength then carries restrictions of its own: it is not used where there is moderate kidney impairment (creatinine clearance below 60 ml/min), an untreated underactive thyroid, a personal or family history of inherited muscle disease, previous muscle toxicity on another statin or a fibrate, heavy alcohol use, Asian ancestry, or treatment with a fibrate. Blood levels of rosuvastatin run higher for the same dose in people of Asian ancestry, which is why a lower starting dose is used there, and previous muscle problems on another statin should be mentioned whatever strength you take. Tell the prescriber about thyroid problems, heavy alcohol intake, kidney disease and any family history of muscle disease. This is not a complete list. The contraindications and warnings for your product are set out in its leaflet and in the summary of product characteristics published by the HPRA, and only your own doctor can apply them to your history.
Generic and brand names
Rosuvastatin is the international non-proprietary name of the active substance. In Ireland it is dispensed both as generic rosuvastatin carrying the manufacturer's name and under the original brand name Crestor. The substance and the strength decide the effect, so a generic authorised by the HPRA works like the branded product. Rosuvastatin belongs to the same family as atorvastatin, simvastatin and pravastatin, but the statins are not interchangeable milligram for milligram: each has its own potency and its own interaction profile, so switching between them is a prescriber's decision and usually comes with a blood test afterwards. At the counter, check the active substance and the strength rather than the brand, because the supplier can change between prescriptions. A cross-border prescription names the active substance, which is what allows a pharmacist in another country to dispense the equivalent product authorised there.
Rosuvastatin in pregnancy and breastfeeding
Rosuvastatin is contraindicated in pregnancy and while breastfeeding under its European product information, because cholesterol is needed for the development of the baby and there is no benefit to the mother that justifies the risk over that period. Women who can become pregnant are expected to use reliable contraception while taking it. If you become pregnant while on a statin, stop taking it and contact your doctor, and tell your doctor before you start trying to conceive so treatment can be planned around it. For most people, pausing a statin during pregnancy and breastfeeding has little effect on long-term risk, but people with the inherited form of high cholesterol may need specialist advice, which is a conversation for a lipid clinic or your GP. Because this is an individual assessment, our questionnaire is not the route for it.
Where to find the patient information leaflet
Every medicine authorised in Ireland has a patient information leaflet, and the leaflet inside your own pack is the version that applies to you. The Health Products Regulatory Authority (HPRA) keeps a public database of medicines authorised here, where you can look up the leaflet and the summary of product characteristics for the exact strength and manufacturer you have been given. For centrally authorised medicines the European Medicines Agency publishes the same documents. Read the leaflet before the first dose and again if the pack you collect looks different from the last one, because generic versions can differ in their inactive ingredients even when the active substance and the strength are identical. If anything in the leaflet does not match what you were told, ask your pharmacist before taking the medicine. A leaflet is written for the whole patient population, so it lists effects that are uncommon; it is not a prediction of what will happen to you.
Is rosuvastatin prescription-only in Ireland?
Yes. No pharmacy in Ireland can supply rosuvastatin without a valid prescription, because the dose depends on your cholesterol results, your overall risk and your other medicines. It is not a controlled drug, so it is not excluded from cross-border prescriptions under Article 11(6) of Directive 2011/24/EU.
How long does rosuvastatin take to work?
Cholesterol starts to fall within the first weeks, and a blood test is normally arranged some weeks after starting or changing the dose to see the effect. You will not feel anything, because raised cholesterol causes no symptoms; the test is the measure.
What are the common side effects of rosuvastatin?
Headache, muscle aches, abdominal pain, nausea, constipation and dizziness are reported most often. Contact a doctor without delay for severe or widespread muscle pain or weakness, especially with fever or dark urine. Tell your doctor about muscle symptoms rather than stopping quietly, since a change of dose or product often helps.
Can I drink alcohol while taking rosuvastatin?
Moderate intake is generally acceptable, but heavy drinking damages the liver, raises blood fats and complicates the interpretation of liver tests taken during statin treatment. Tell your doctor honestly how much you drink, because it affects the risk assessment as well as the medicine.
How do I get a repeat prescription for rosuvastatin?
If a doctor has already started you on it, fill in our medical questionnaire with your recent cholesterol and liver results to hand. A doctor reviews it and, where continuation is appropriate, issues a cross-border prescription as a PDF by e-mail. Keep up your GP reviews; a renewal does not replace blood tests.