What is the interaction between Crestor (rosuvastatin) and Pantoloc (pantoprazole)?

Interaction Between Crestor and Pantoloc

There is no clinically significant interaction between Crestor (rosuvastatin) and Pantoloc (pantoprazole), and these medications can be safely co-administered without dose adjustments. 1

Evidence for Safety of Combination

The most definitive evidence comes from a prospective pharmacokinetic study specifically designed to evaluate this interaction:

• A 2016 controlled study in healthy volunteers (n=16) demonstrated that pantoprazole 40 mg daily for 2 days had no effect on rosuvastatin pharmacokinetics. 1
  • Rosuvastatin Cmax ratio was 1.03 (90% CI: 0.91-1.16) 1
  • AUC ratio was 1.03 (90% CI: 0.89-1.19) 1
  • Renal clearance ratio was 0.96 (90% CI: 0.85-1.09) 1
  • All parameters fell within the pre-specified bioequivalence range of 0.8-1.25, confirming no interaction 1

Mechanistic Rationale

The lack of interaction is explained by distinct metabolic pathways:

• Pantoprazole undergoes extensive hepatic metabolism primarily through demethylation and sulfate conjugation, with minimal involvement of cytochrome P450 enzymes. 2
• Pantoprazole has demonstrated no cytochrome P450 interactions with concomitantly administered drugs in multiple studies. 2
• Rosuvastatin undergoes minimal CYP450 metabolism and is primarily transported by OATP1B1, P-gp, and BCRP. 3
• The 2016 study specifically refuted pantoprazole's role as a BCRP inhibitor in humans, eliminating theoretical concerns about transporter-mediated interactions. 1

Clinical Monitoring Recommendations

Despite the absence of interaction, standard statin monitoring remains appropriate:

• Monitor for muscle pain, tenderness, or weakness, especially with fever or malaise, and check creatine kinase levels if symptoms develop. 4
• Consider baseline and periodic liver function tests due to potential statin hepatotoxicity (not related to the combination). 4

Important Caveat

While pantoprazole is safe with rosuvastatin, be aware that:

• Other proton pump inhibitors may interact with certain hepatitis C antivirals (sofosbuvir/ledipasvir) when combined with rosuvastatin, as ledipasvir inhibits hepatic OATP and can significantly increase rosuvastatin concentrations. 5, 6
• This concern does not apply to pantoprazole with rosuvastatin in the absence of hepatitis C treatment. 1

Practical Algorithm

1. Prescribe both medications at standard doses without adjustment 1
2. Educate patients about general statin myopathy symptoms requiring medical attention 4
3. Apply routine statin monitoring protocols (not specific to this combination) 4
4. No need for staggered administration or dose modification 1