Drug Interactions Between Irbesartan, Escitalopram, Rosuvastatin, Febuxostat, and Semaglutide
The most significant drug interaction in this medication regimen is between rosuvastatin and febuxostat, which requires limiting rosuvastatin to no more than 20 mg daily due to increased risk of myopathy and rhabdomyolysis. 1
Key Interactions by Medication
Rosuvastatin and Febuxostat
- Febuxostat increases rosuvastatin exposure by more than 1.9-fold, significantly increasing the risk of myopathy and rhabdomyolysis 1
- When using this combination, rosuvastatin dosage should not exceed 20 mg once daily 1
- This interaction occurs because febuxostat inhibits transporters (such as OATP1B1) that are involved in rosuvastatin metabolism 1, 2
Irbesartan Interactions
- Irbesartan is primarily metabolized via glucuronide conjugation and oxidation, with minimal involvement of CYP450 enzymes (primarily CYP2C9) 3
- No significant interactions have been documented between irbesartan and the other medications in this regimen 3, 4
- Irbesartan may actually have beneficial effects on uric acid levels, potentially complementing febuxostat therapy 5, 6
Semaglutide (Ozempic) Considerations
- Semaglutide delays gastric emptying, which may impact absorption of concomitantly administered oral medications 7
- This could potentially affect the absorption of rosuvastatin, escitalopram, irbesartan, and febuxostat, although specific interactions are not documented 7
- Monitor for changes in efficacy of oral medications when initiating or increasing semaglutide dose 7
Potential CYP450 Interactions
- Rosuvastatin is primarily metabolized via CYP2C9 and is a substrate for OATP1B1/1B3 transporters 1, 2
- Irbesartan is metabolized via CYP2C9 but with minimal involvement 3
- No documented significant interactions between escitalopram and the other medications in this regimen through CYP450 pathways
Monitoring Recommendations
Monitor for Myopathy Symptoms
- Watch for muscle pain, tenderness, or weakness, especially with fever or malaise, which could indicate statin-induced myopathy 8
- Check creatine kinase levels if symptoms develop 8
- Consider baseline and periodic liver function tests due to potential hepatotoxicity with statins 8
Monitor Blood Pressure and Renal Function
- Irbesartan may have hypotensive effects that could be additive with other medications 3, 9
- Monitor renal function, especially when initiating therapy or adjusting doses 3
- Semaglutide can cause volume depletion, which may affect renal function 7
Monitor Glycemic Control
- Semaglutide will lower blood glucose; monitor for hypoglycemia, especially if doses of other medications are changed 7
- Adjust semaglutide dosing according to glycemic response and tolerability 7
Risk Mitigation Strategies
For Statin-Related Risks
- Start with appropriate rosuvastatin dosing (not exceeding 20 mg daily) due to febuxostat interaction 1
- Consider monitoring liver enzymes and creatine kinase at baseline and periodically 8
- Educate patient about symptoms of myopathy that require immediate medical attention 8
For Gastrointestinal Effects
- Semaglutide commonly causes gastrointestinal adverse effects (nausea, vomiting, diarrhea) 7
- Follow recommended dose escalation schedule for semaglutide to minimize GI effects 7
- Take oral medications consistently with respect to meals to minimize potential absorption issues 7
Practical Administration Advice
- Administer semaglutide once weekly at any time of day, with or without meals 7
- Take rosuvastatin at the same time each day, preferably in the evening 1
- Irbesartan can be taken without regard to meals 3
- Space administration times of oral medications if possible to minimize potential absorption interactions with semaglutide 7