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rosuvastatin

Sold as Crestor, Ezallor. Class: HMG CoA reductase inhibitors. First FDA approval 08/12/2003: 23 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

A

Score breakdown (89/100)

Safety ×35%
A
Evidence ×25%
C
Regulatory ×15%
B
Money & lawsuits ×15%
A
Options ×10%
A

Safety: 100

Evidence: 69

Regulatory history: 81

Money & lawsuits: 100

Options: 100

What the FDA label says

Approved uses

Rosuvastatin tablets are indicated: To reduce the risk of stroke, myocardial infarction, and arterial revascularization procedures in adults without established coronary heart disease who are at increased risk of cardiovascular (CV) disease based on age, hsCRP ≥2 mg/L, and at least one additional CV risk factor. As an adjunct to diet to: Reduce LDL-C in adults with primary hyperlipidemia. Reduce low-density lipoprotein cholesterol (LDL-C) and slow the progression of atherosclerosis in adults. Reduce LDL-C in adults and pediatric patients aged 8 years and older with heterozygous familial hypercholesterolemia (HeFH). As an adjunct to other LDL-C-lowering therapies, or alone if such treatments are unavailable, to reduce LDL-C in adults and pediatric patients aged 7 years and older with homozygous familial hypercholesterolemia (HoFH). As an adjunct to diet for the treatment of adults with: Primary dysbetalipoproteinemia. Hypertriglyceridemia. Rosuvastatin tablets are an HMG Co-A reductase inhibitor (statin) indicated: ( 1 ) To reduce the risk of stroke, myocardial infarction, and arterial revascularization procedures in adults without established coronary heart disease who are at incre...

Contraindications

Rosuvastatin tablets are contraindicated in the following conditions: Acute liver failure or decompensated cirrhosis [see Warnings and Precautions (5.3) ] . Hypersensitivity to rosuvastatin or any excipients in rosuvastatin tablets. Hypersensitivity reactions including rash, pruritus, urticaria, and angioedema have been reported with rosuvastatin tablets [see Adverse Reactions (6.1) ] . Acute liver failure or decompensated cirrhosis. ( 4 ) Hypersensitivity to rosuvastatin or any excipients in rosuvastatin tablets. ( 4 )

Warnings and precautions

Myopathy and Rhabdomyolysis: Risk factors include age 65 years or greater, uncontrolled hypothyroidism, renal impairment, concomitant use with certain other drugs, and higher rosuvastatin tablets dosage. Asian patients may be at higher risk for myopathy. Discontinue rosuvastatin tablets if markedly elevated CK levels occur or myopathy is diagnosed or suspected. Temporarily discontinue rosuvastatin tablets in patients experiencing an acute or serious condition at high risk of developing renal failure secondary to rhabdomyolysis. Inform patients of the risk of myopathy and rhabdomyolysis when starting or increasing rosuvastatin tablets dosage. Instruct patients to promptly report unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever. ( 5.1 , 7.1 , 8.5 , 8.6 , 8.8 ) Immune-Mediated Necrotizing Myopathy (IMNM): Rare reports of IMNM, an autoimmune myopathy, have been reported with statin use. Discontinue rosuvastatin tablets if IMNM is suspected. ( 5.2 ) Hepatic Dysfunction: Increases in serum transaminases have occurred, some persistent. Rare reports of fatal and non-fatal hepatic failure have occurred. Consider testing liver enzymes before i...

Adverse reactions (label)

The following important adverse reactions are described below and elsewhere in the labeling: Myopathy and Rhabdomyolysis [see Warnings and Precautions (5.1) ] Immune-Mediated Necrotizing Myopathy [see Warnings and Precautions (5.2) ] Hepatic Dysfunction [see Warnings and Precautions (5.3) ] Proteinuria and Hematuria [see Warnings and Precautions (5.4) ] Increases in HbA1c and Fasting Serum Glucose Levels [see Warnings and Precautions (5.5) ] Most frequent adverse reactions (rate ≥ 2%) are headache, nausea, myalgia, asthenia, and constipation. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact ScieGen Pharmaceuticals, Inc., at 1-855-724-3436 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. Adverse reactions reported in ≥2% of patients in placebo-controlled clinical studies and at a rate greater than placebo are shown in Table 2. These studies had a treatment duration of up to 12...

Recent major label changes

Dosage and Administration Modifications Due to Drug Interactions ( 2.6 ) 07/2023 Contraindications, Pregnancy and Lactation ( 4 ) Removed 01/2023 Warnings and Precautions ( 5.2 ) 01/2023 Warnings and Precautions, Concomitant Coumarin Anticoagulants ( 5.4 ) Removed 01/2023

Source: FDA SPL label for Rosuvastatin (Aphena Pharma Solutions - Tennessee, LLC), effective 20240306. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

173,310reports that mention this drug
172,299of those blame this drug, not another one the person was taking
71%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
6.5%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Fatigue · 12,399Dyspnoea · 10,108Drug Ineffective · 9,993Nausea · 9,954Diarrhoea · 9,695Off Label Use · 9,666Pain · 8,814Headache · 8,179Arthralgia · 7,283Dizziness · 7,262Asthenia · 6,722Myalgia · 6,454Cough · 6,305Vomiting · 6,243Acute Kidney Injury · 6,198

Reports per year

20192020202120222023202420252026
14,22514,55915,24015,31515,82315,87320,19810,442

1,491 reports blaming this drug for every million Medicare prescriptions filled, which is 0.5× the typical drug on this site. (46,010 reports in 2024–2026, against 30,868,104 Medicare fills in one year. This is the one number here that accounts for how many people take the drug.)

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

6recall actions on file
2 / 29brand / generic applications
9label changes since 2021
NoREMS program
DateClassFirmReason
12/2025Class IIAvKAREOut of specification for dissolution.
03/2025Class IIGlenmark Pharmaceuticals Inc., USACGMP Deviations
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.

Class I = reasonable probability of serious harm. Class II = temporary or reversible harm. Class III = unlikely to harm. Most generic recalls are manufacturing or labeling defects for one lot, not a verdict on the molecule.

Evidence base

579randomized trials (PubMed)
52systematic reviews
904registered trials
22%of completed trials posted results
6%terminated or withdrawn
62%industry-funded

Independent Cochrane reviews

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $0 in payments to US physicians and hospitals tied to this drug across 0 transactions.

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

8,225,223Medicare Part D patients (2024)
30,868,104prescriptions filled
$15average cost per fill
$469Mtotal Medicare spend
ProductFills$/fill
Rosuvastatin Calcium30,813,501$14
Crestor54,565$585
Ezallor Sprinkle38$158

Same-class alternatives

cerivastatinfluvastatinpitavastatin

Same ATC pharmacological class, graded ones first, best grade at the top. Being in the same class does not make them interchangeable for your condition; it makes them worth asking about.

Questions to ask your prescriber

  1. The most-reported problems in FDA's adverse event data are fatigue, dyspnoea, nausea. How would we recognize and handle those?
  2. Off-label use is among the most-reported items for this drug. Is my use on-label, and if not, what evidence supports it?
  3. Why this one over atorvastatin, cerivastatin, fluvastatin? What would make you pick one of those instead?
  4. What result are we expecting, by when, and what is the plan if it does not happen?
  5. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)