Is it safe to take Cipro (ciprofloxacin) with Crestor (rosuvastatin)?

Ciprofloxacin and Rosuvastatin Combination Safety

Yes, you can take ciprofloxacin with rosuvastatin, but this combination requires heightened vigilance for muscle toxicity, particularly if you are over 60 years old, have kidney disease, or are taking other medications that affect drug metabolism.

Key Safety Concerns

The combination of ciprofloxacin (Cipro) and rosuvastatin (Crestor) carries a documented risk of serious muscle-related adverse effects:

• Rhabdomyolysis risk: Case reports and systematic reviews have documented that quinolone antibiotics like ciprofloxacin can precipitate rhabdomyolysis when combined with statins, with 12 of 16 reported cases involving this life-threatening muscle breakdown 1
• Myopathy and muscle weakness: Additional cases have reported myopathy, muscle weakness, and extreme fatigue when ciprofloxacin is co-prescribed with statins 1, 2
• Mechanism: Animal studies demonstrate that ciprofloxacin co-administration with statins significantly increases statin blood levels (AUC), leading to skeletal muscle degeneration and potential acute kidney injury from myoglobin release 3

High-Risk Patient Populations

You face substantially elevated risk if you have any of these characteristics:

• Age over 60 years: Approximately 81% of reported adverse cases occurred in patients over 60 1
• Kidney disease: Nearly one-third of cases involved patients with diabetic nephropathy, post-transplantation status, or severe glomerulonephritis 1
• Concurrent medications: About two-thirds of cases involved patients taking CYP3A4 inhibitors, P-glycoprotein inhibitors, or OATP1B1 inhibitors alongside the statin-quinolone combination 1

Essential Monitoring Protocol

If you must take this combination, implement the following monitoring strategy:

• Baseline testing: Obtain creatine kinase (CK) and aspartate aminotransferase (AST) levels before starting ciprofloxacin 1
• Symptom surveillance: Monitor closely for muscle pain, weakness, dark urine, or extreme fatigue throughout ciprofloxacin therapy 1, 2
• Laboratory monitoring: Check CK and AST levels if any muscle symptoms develop 1
• Duration awareness: Most cases occurred within the typical 7-14 day course of ciprofloxacin therapy 1

Clinical Management Recommendations

The safest approach is to temporarily discontinue rosuvastatin during the short course of ciprofloxacin therapy. This strategy is supported by the following rationale:

• A 7-14 day interruption of statin therapy poses minimal cardiovascular risk, as statins have long-term benefits that are not compromised by brief interruptions 4
• The risk of severe muscle toxicity, including rhabdomyolysis and acute kidney injury, outweighs the minimal cardiovascular risk of temporary statin discontinuation 1, 3
• After completing ciprofloxacin, resume rosuvastatin at the previous dose 4

Alternative Antibiotic Considerations

If you require prolonged antibiotic therapy or have recurrent infections, discuss alternative antibiotics with your physician:

• Ciprofloxacin and levofloxacin carry the highest documented risk when combined with statins 1
• Ciprofloxacin remains highly effective against most Gram-negative bacteria and is appropriate for complicated urinary tract infections, gastrointestinal infections, and respiratory infections in selected patients 5
• The choice of antibiotic should balance infection severity, pathogen susceptibility, and drug interaction risk

Critical Pitfalls to Avoid

• Do not ignore muscle symptoms: Even mild muscle pain or weakness warrants immediate evaluation and potential discontinuation of both medications 1, 2
• Do not assume dose reduction alone is sufficient: Even lower statin doses may reach toxic levels when combined with ciprofloxacin due to altered pharmacokinetics 3
• Do not restart rosuvastatin before completing the full antibiotic course: Wait until ciprofloxacin is completely finished before resuming statin therapy 4