Rosuvastatin Interactions

Rosuvastatin blocks HMG-CoA reductase, an enzyme required for both cholesterol and coenzyme Q10 synthesis. Although the CoQ10 depletion is generally smaller than with lipophilic statins, mitochondrial impairment is still one proposed mechanism for statin-associated muscle symptoms.

Rosuvastatin is taken into liver cells by the OATP1B1 transporter, and berberine has been shown to upregulate OATP1B1 in hepatocyte studies, increasing hepatic uptake of rosuvastatin. The clinical net effect (more LDL lowering vs. higher muscle/liver risk) is not well established in humans.