What are the guidelines for rosuvastatin (generic name for Crestor) dosing in relation to patient age?

From the Guidelines

Rosuvastatin dosing should be adjusted based on age and individual risk factors, with elderly patients (over 65) generally starting at lower doses, such as 5 mg once daily, and adults under 65 starting at 10 mg once daily, as recommended by the American College of Cardiology/American Heart Association guidelines 1. When considering rosuvastatin dosing, several factors must be taken into account, including:

• Age: Elderly patients (over 65) should start at a lower dose due to decreased drug clearance and increased susceptibility to adverse effects.
• Renal impairment: Patients with severe renal impairment who are not on hemodialysis should not exceed 10 mg daily, regardless of age.
• Ethnicity: Asian patients should start at 5 mg due to higher systemic exposure.
• Individual risk factors: Patients with high-risk factors, such as diabetes or high LDL-C levels, may require higher doses or more intensive monitoring. The American College of Cardiology/American Heart Association guidelines recommend the following dosing for rosuvastatin:
• Low-risk patients: 5-10 mg once daily
• Moderate-risk patients: 10-20 mg once daily
• High-risk patients: 20-40 mg once daily It is essential to monitor lipid levels and liver function regularly, especially in elderly patients, to assess response and potential side effects, as noted in the 2018 cholesterol clinical practice guidelines 1. Dose adjustments should be made gradually, typically at 4-week intervals, to allow time to assess response and monitor for side effects such as myalgia or elevated liver enzymes. Regular monitoring of lipid levels and liver function is crucial for all patients on rosuvastatin, but particularly for elderly patients who may have altered pharmacokinetics and increased risk of drug interactions, as highlighted in the American Family Physician guidelines 1.

From the FDA Drug Label

Adults:Recommended dosage range is 5 mg to 40 mg once daily. Pediatric Patients with HeFH:Recommended dosage range is 5 mg to 10 mg once daily for patients aged 8 to less than 10 years of age, and 5 mg to 20 mg once daily for patients aged 10 years and older. Pediatric Patients with HoFH:Recommended dosage is 20 mg once daily for patients aged 7 years and older. Patients with Severe Renal Impairment (not on hemodialysis):Initiate at 5 mg once daily; do not exceed 10 mg once daily. Asian Patients:Initiate at 5 mg once daily. Consider risks and benefits of treatment if not adequately controlled at doses up to 20 mg once daily. 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.

The guidelines for rosuvastatin dosing and age are as follows:

• Adults: 5 mg to 40 mg once daily
• Pediatric patients:
  • HeFH:
    • 8 to less than 10 years: 5 mg to 10 mg once daily
    • 10 years and older: 5 mg to 20 mg once daily
  • HoFH: 20 mg once daily for patients aged 7 years and older
• Special populations:
  • Asian patients: initiate at 5 mg once daily, consider risks and benefits of treatment if not adequately controlled at doses up to 20 mg once daily
  • Patients with severe renal impairment: initiate at 5 mg once daily, do not exceed 10 mg once daily
  • Age 65 years or greater: increased risk of myopathy and rhabdomyolysis, use with caution 2

From the Research

Rosuvastatin Dosing Guidelines

• The recommended dosing for rosuvastatin varies based on the patient's condition and age, but there is no specific information on age-related dosing guidelines in the provided studies 3, 4, 5, 6, 7.
• However, the studies suggest that rosuvastatin can be effective in improving lipid profiles in patients with dyslipidemias at doses of 5-40 mg once daily 3.
• The combination of rosuvastatin and ezetimibe has been shown to be effective in reducing LDL-C levels and achieving LDL-C goals in patients with hypercholesterolemia 4, 6, 7.

Considerations for Specific Patient Populations

• High-risk patients: Rosuvastatin has been shown to be more effective than atorvastatin in achieving LDL-C goals in high-risk patients 5.
• Patients with hypercholesterolemia: The combination of rosuvastatin and ezetimibe has been shown to be effective in reducing LDL-C levels and achieving LDL-C goals in patients with hypercholesterolemia 4, 6, 7.
• Patients with low and moderate risk: The combination of low-intensity rosuvastatin and ezetimibe has been shown to be effective in lowering LDL cholesterol and achieving LDL cholesterol goals in patients with low and moderate risk 7.

Safety and Tolerability

• Rosuvastatin has been shown to be generally well-tolerated in patients with dyslipidemias, with common adverse events including myalgia, constipation, asthenia, abdominal pain, and nausea 3.
• The combination of rosuvastatin and ezetimibe has been shown to have a similar safety profile to rosuvastatin monotherapy and simvastatin/ezetimibe 6.