Are Rybelsus (semaglutide) 7mg and rosuvastatin (calcium channel blocker) 10mg causing my calf ache, joint pain in the fingers, and erectile dysfunction?

Rosuvastatin and Semaglutide Can Cause Muscle Pain and Erectile Dysfunction

Rosuvastatin is likely causing your calf and finger joint pain, while both medications may be contributing to your erectile dysfunction. 1

Statin-Related Muscle Pain

• Statins like rosuvastatin are well-established to cause muscle-related side effects, ranging from mild muscle aches to severe myopathy 1
• Muscle pain typically affects large muscle groups but can also occur in smaller areas like calves and even feet 2
• Non-specific muscle aches and joint pains occur in approximately 5% of statin users, though the actual incidence may be higher 1
• The temporal association between starting rosuvastatin and developing muscle symptoms strongly suggests a causal relationship 1

Mechanism of Statin-Induced Myopathy

• Statin metabolites can accumulate in muscle cells (myocytes), leading to inflammation and pain 2
• Rosuvastatin, despite being hydrophilic and having low systemic bioavailability, can still cause significant muscle-related adverse effects 3
• Muscle symptoms may occur without significant elevations in creatine kinase levels, making laboratory confirmation challenging 1

Erectile Dysfunction and Your Medications

• Both statins and GLP-1 receptor agonists like semaglutide can potentially contribute to erectile dysfunction 1, 4
• Statins have been associated with erectile dysfunction in multiple case reports and clinical trials 5
• Different statins may have varying effects on erectile function - rosuvastatin has shown mixed results in studies 4
• Diabetic autonomic neuropathy, which may be present in patients taking medications like semaglutide, can also cause erectile dysfunction independently 1

Management Recommendations

1. For muscle pain:

   • Consider requesting a dose reduction of rosuvastatin from 10mg to 5mg to see if symptoms improve 1, 3
   • Do not abruptly discontinue rosuvastatin without medical supervision, as this could increase cardiovascular risk 1
   • Ask your doctor about monitoring creatine kinase levels to assess for significant muscle damage 1

2. For erectile dysfunction:

   • Discuss with your physician about the possibility of switching to a different statin (like pravastatin or fluvastatin) that may have fewer sexual side effects 4, 5
   • Consider evaluation for other causes of erectile dysfunction, including diabetic autonomic neuropathy 1
   • Phosphodiesterase-5 inhibitors (like sildenafil) may be effective for erectile dysfunction but require caution with rosuvastatin due to potential interactions 1, 6

Important Precautions

• The combination of phosphodiesterase-5 inhibitors (erectile dysfunction medications) with rosuvastatin requires careful monitoring as there are reports of increased risk of myopathy with this combination 6, 3
• Never stop either medication without consulting your healthcare provider 1
• Report any worsening muscle symptoms, especially if accompanied by dark urine, as this could indicate rhabdomyolysis, a rare but serious complication 1

Follow-up Recommendations

• Schedule a follow-up appointment to discuss these side effects with your healthcare provider 1
• Consider requesting laboratory tests including creatine kinase, liver function tests, and possibly testosterone levels 1
• Ask about alternative statin options or dosing strategies that might reduce these side effects while maintaining cardiovascular protection 3, 4