Can Rosuvastatin and Ezetimibe Be Given on the Same Day?
Yes, rosuvastatin and ezetimibe can and should be given on the same day—in fact, they are routinely prescribed as once-daily combination therapy taken simultaneously, not separately. For your diabetic male patient with a history of mild stroke, this combination is specifically recommended by current guidelines and represents optimal lipid management. 1, 2
Why Same-Day Administration Is Standard Practice
Rosuvastatin and ezetimibe work through complementary mechanisms: rosuvastatin decreases hepatic cholesterol production while ezetimibe inhibits intestinal cholesterol absorption via the NPC1L1 protein, making their combined effect additive without pharmacokinetic interaction. 3, 4
No pharmacokinetic drug interaction exists between these medications—a 2004 study specifically demonstrated that co-administration of ezetimibe 10 mg with rosuvastatin 10 mg showed no significant pharmacokinetic interaction and was well tolerated. 4
Both medications are typically dosed once daily in the morning, making simultaneous administration the most practical and adherence-friendly approach. 3, 5
Guideline-Recommended Approach for Your Patient
For a diabetic male patient with history of mild stroke, guidelines specifically recommend upfront combination therapy rather than sequential monotherapy:
The European Society of Cardiology recommends starting with rosuvastatin 20 mg plus ezetimibe 10 mg as upfront combination therapy for diabetic patients post-stroke, rather than statin monotherapy. 2
The American Heart Association/American Stroke Association 2021 guidelines support using ezetimibe as second-line therapy to achieve LDL-C target of <70 mg/dL (1.8 mmol/L) in stroke patients. 1
Target LDL-C goal for this patient is <55 mg/dL (<1.4 mmol/L) given the very high cardiovascular risk from diabetes plus stroke. 2
Clinical Evidence Supporting Combination Therapy
A 2023 randomized controlled trial in recent ischemic stroke patients demonstrated that rosuvastatin 10 mg/ezetimibe 10 mg achieved LDL-C reduction ≥50% in 72.5% of patients versus 57.6% with rosuvastatin 20 mg alone, with 80.2% reaching LDL-C <70 mg/dL on combination therapy. 6
The combination enables 60-75% LDL-C reduction with a good safety profile across broad patient populations including those at high cardiovascular risk. 5
In diabetic stroke patients specifically, ezetimibe-statin combination therapy reduced recurrent ischemic stroke risk compared to moderate-intensity statin monotherapy. 7
Safety Profile
The rosuvastatin/ezetimibe combination is as safe as rosuvastatin monotherapy, with no increased incidence of treatment-related or serious adverse events. 2, 3
Side effects are generally mild, nonspecific, and similar between combination therapy and monotherapy groups, with no significant increases in muscle or liver function abnormalities. 4
The combination allows avoidance of very high-intensity statin doses (rosuvastatin 40 mg) that may increase myopathy risk while achieving superior LDL-C reduction. 2
Practical Implementation
Prescribe rosuvastatin 20 mg/ezetimibe 10 mg as a fixed-dose combination to improve adherence—both medications should be taken together once daily. 2, 5
Measure LDL-C levels at 4-6 weeks to assess response. 2
If LDL-C remains ≥55 mg/dL despite combination therapy, consider adding bempedoic acid or escalating to PCSK9 inhibitor therapy. 2
Common Pitfall to Avoid
Do not unnecessarily separate the dosing times or give these medications on different days—there is no pharmacological reason to do so, and it only complicates the regimen and reduces adherence. 3, 4 The medications are designed to be taken together, and fixed-dose combinations exist specifically for this purpose. 5