What to do if a dose of rosuvastatin (a statin medication) is missed?

From the Guidelines

If you miss a dose of rosuvastatin, take it as soon as you remember on the same day, but if it's already the next day, skip the missed dose and take your regular dose at the scheduled time. This approach is based on the understanding that rosuvastatin has a long half-life, staying in the system for about 19 hours, which means that occasional missed doses won't immediately reverse its benefits 1.

Key Considerations

• Never take two doses at once to make up for a missed dose, as this can increase the risk of side effects.
• If you frequently miss doses, your cholesterol levels may not be adequately controlled, which could increase your risk of cardiovascular problems over time.
• Set reminders or link taking your medication to a daily routine to help remember your dose.
• If you're concerned about repeatedly missing doses, speak with your healthcare provider about your medication schedule or possibly adjusting to a different statin that better fits your routine.

Clinical Guidance

The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol provides guidance on the use of statins, including rosuvastatin, but does not specifically address missed doses 1. However, the principle of maintaining consistent therapy to achieve optimal cholesterol control is emphasized.

Patient Safety

It's crucial to prioritize patient safety by avoiding unnecessary dose doubling and ensuring that the patient understands the importance of consistent medication adherence. If a patient is experiencing difficulties with adherence, a discussion with the healthcare provider about adjusting the medication regimen or providing additional support may be necessary.

Conclusion Not Applicable

Instead, the focus remains on the practical application of the guideline recommendations in real-world clinical practice, emphasizing the importance of patient education and support in maintaining optimal cholesterol control and minimizing cardiovascular risk.

From the FDA Drug Label

If a dose is missed, advise patients not to take an extra dose Resume treatment with the next dose.

• Missed dose instructions: If a dose of rosuvastatin is missed, patients should not take an extra dose.
• Recommended action: Resume treatment with the next scheduled dose. 2

From the Research

Missing a Dose of Rosuvastatin

If a patient misses a dose of rosuvastatin, the following steps can be taken:

• Take the missed dose as soon as it is remembered, according to general principles of missed-dose management 3
• Do not double the dose, as this can increase the risk of side effects
• If the patient is unsure about what to do, they should consult their doctor or pharmacist for advice

General Guidance on Missed Doses

Research has shown that patient information leaflets (PILs) and summaries of product characteristics (SmPCs) often lack clear instructions on what to do if a dose is missed 4

• A study found that 52% of PILs and SmPCs had no instructions on missed doses, while 32% provided non-specific advice
• Only 9% of PILs and SmPCs provided specific instructions on what to do if a dose is missed
• The study suggests that pharmaceutical companies and regulatory authorities should produce clear and concise instructions on what patients should do if they miss doses, with supporting evidence where necessary

Theoretical Approach to Missed Doses

A theoretical approach to missed doses suggests that taking a double dose after a missed dose may be beneficial for drugs with a long half-life, such as rosuvastatin 5

• However, this approach is not universally accepted and may depend on the specific drug and patient characteristics
• Further research is needed to determine the best approach to handling missed doses of rosuvastatin and other medications

Rosuvastatin Specifics

Rosuvastatin is a potent statin with a favorable balance of effects on atherogenic and protective lipoproteins 6, 7

• It has been shown to slow the progression of atherosclerosis and reduce cardiovascular events in high-risk patients
• However, the optimal approach to handling missed doses of rosuvastatin is not well established and may require individualized advice from a healthcare professional