Are there any drug incompatibilities between rosuvastatin and Fosamax (alendronate)?

Drug Compatibility Between Rosuvastatin and Fosamax (Alendronate)

There are no clinically significant drug interactions between rosuvastatin and Fosamax (alendronate), making this combination safe to use without dose adjustments or special monitoring.

Pharmacokinetic Considerations

• Rosuvastatin is primarily metabolized via CYP2C9 and is a substrate for OATP1B1/1B3 transporters, with minimal involvement of CYP3A4 1
• Alendronate (Fosamax) is not metabolized through the cytochrome P450 system and is primarily excreted unchanged in urine 2, 3
• Unlike some other statins, rosuvastatin has minimal drug interactions due to its hydrophilic properties and limited metabolism through CYP450 pathways 4

Lack of Documented Interactions

• No specific drug interactions between rosuvastatin and alendronate are documented in clinical guidelines or drug interaction databases 1
• Unlike some other statins that have significant drug-drug interactions, rosuvastatin has a more favorable interaction profile due to its unique pharmacokinetic properties 4
• The American Heart Association guidelines on statin drug interactions do not list any concerns regarding rosuvastatin and bisphosphonates like alendronate 1

Contrasting with Other Statin Interactions

• While some statins (particularly those metabolized by CYP3A4 like simvastatin and lovastatin) have numerous drug interactions, rosuvastatin has fewer clinically significant interactions 1
• Rosuvastatin should be used with caution with certain medications like cyclosporine, gemfibrozil, and some antiretroviral agents, but alendronate is not among these concern medications 4
• Alendronate absorption can be affected by calcium, food, and antacids, but there are no documented interactions with statins 2, 3

Clinical Recommendations

• Both medications can be safely co-administered without dose adjustments 1, 4
• Maintain standard dosing protocols for both medications:
  • Rosuvastatin: typically 5-40 mg once daily 4
  • Alendronate: typically 70 mg once weekly or 10 mg daily 2, 3
• Both medications have specific administration requirements that should be followed independently:
  • Rosuvastatin can be taken with or without food at any time of day 4
  • Alendronate should be taken with at least 6 oz of water 30 minutes before the first food or beverage of the day to ensure proper absorption 3

Monitoring Considerations

• Standard monitoring for each medication should continue as usual 5, 2
• For rosuvastatin: periodic liver function tests and assessment for muscle symptoms 5
• For alendronate: monitoring for gastrointestinal side effects and bone mineral density evaluation 2
• There is no need for additional monitoring specifically due to the combination 4