Can you take rosuvastatin and Lipidil (fenofibrate) together?

Rosuvastatin and Fenofibrate (Lipidil) Combination Therapy

Yes, rosuvastatin and fenofibrate (Lipidil) can be taken together, and this combination is preferred over statin-gemfibrozil combinations due to significantly lower risk of muscle-related toxicity. 1

Safety Profile of the Combination

The American Heart Association guidelines clearly indicate that fenofibrate has a substantially better safety profile than gemfibrozil when combined with statins:

• Fenofibrate has approximately 15 times fewer reports of rhabdomyolysis than gemfibrozil when prescribed with statins (0.58 vs 8.6 per million prescriptions) 1
• In large clinical trials such as the FIELD study (n=9795), none of the approximately 1000 patients on statin-fenofibrate combination therapy experienced rhabdomyolysis 1
• The ACCORD study showed no statistically significant differences in the incidence of myositis, rhabdomyolysis, or elevations of hepatic transaminases with simvastatin-fenofibrate combination therapy compared with simvastatin monotherapy 1

Pharmacokinetic Considerations

Rosuvastatin has favorable pharmacokinetic properties when combined with fenofibrate:

• Rosuvastatin is minimally metabolized via CYP450 enzymes (primarily CYP2C9) and is primarily eliminated unchanged in urine and feces 1, 2
• Rosuvastatin has high hydrophilicity and hepatoselectivity with low systemic bioavailability 2
• Unlike gemfibrozil, fenofibrate does not significantly inhibit the glucuronidation of statins or interfere with OATP1B1-mediated hepatic uptake 1

Monitoring Recommendations

When taking rosuvastatin and fenofibrate together:

1. Obtain baseline measurements of:

   • Creatine kinase
   • Liver function tests
   • Renal function tests
   • Lipid profile 3

2. Monitor for:

   • Muscle symptoms (pain, tenderness, weakness)
   • Liver enzyme elevations
   • Changes in renal function 3, 4

3. Instruct patients to report immediately:

   • Unexplained muscle pain or weakness
   • Dark urine
   • Fatigue 3

Potential Concerns

While generally safe, be aware of:

• Potential for mild elevation in homocysteine, blood urea nitrogen, and serum creatinine with combination therapy 4
• Rare cases of acute renal failure have been reported with the combination 5
• Patients with underlying renal dysfunction may require additional monitoring 4

Efficacy Benefits

The combination provides superior lipid management compared to statin monotherapy:

• Greater reductions in triglycerides compared to statin monotherapy 6
• Improved HDL-cholesterol levels 6
• Better management of mixed dyslipidemia (elevated LDL-C and triglycerides) 7, 6

Conclusion

The American Heart Association guidelines explicitly state that "combination therapy with fenofibrate/fenofibric acid and any statin is reasonable when clinically indicated" 1. This recommendation is based on extensive evidence showing the safety and efficacy of this combination, particularly for patients with mixed dyslipidemia.

For patients requiring both LDL-C and triglyceride management, the rosuvastatin-fenofibrate combination provides a safe and effective therapeutic option with minimal drug interaction concerns.