What labs and diagnostics are needed before starting Crestor (rosuvastatin) and during ongoing monitoring?

From the Guidelines

Before starting Crestor (rosuvastatin), baseline laboratory tests should include a lipid panel, liver function tests (ALT, AST), creatine kinase (CK), and kidney function tests (creatinine, eGFR) to establish baseline values and identify any contraindications to therapy. During ongoing monitoring, lipid panels should be checked 4-12 weeks after starting therapy to assess efficacy, then annually once stable, as recommended by the 2020 standards of medical care in diabetes 1.

Initial Labs and Diagnostics

The initial labs and diagnostics needed before starting Crestor include:

• Lipid panel to assess baseline cholesterol levels
• Liver function tests (ALT, AST) to evaluate liver health
• Creatine kinase (CK) to assess muscle health
• Kidney function tests (creatinine, eGFR) to evaluate kidney function

Ongoing Monitoring

During ongoing monitoring, the following tests should be performed:

• Lipid panels every 4-12 weeks after starting therapy, then annually once stable, to assess efficacy and medication adherence 1
• Liver function tests before treatment, 12 weeks after initiation, after any dose increase, and periodically thereafter, as recommended by the 2016 ESC/EAS guidelines for the management of dyslipidaemias 1
• Kidney function should be monitored annually, with more frequent monitoring in patients with renal impairment or risk factors
• CK levels should be checked if muscle symptoms develop, as recommended by the 2019 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1

Additional Monitoring Considerations

Additional monitoring considerations include:

• Checking thyroid function (TSH) in patients with unexplained dyslipidemia
• HbA1c or fasting glucose in patients at risk for diabetes
• Vitamin D levels in patients with muscle symptoms
• Monitoring for potential side effects like myopathy, hepatotoxicity, or worsening kidney function while ensuring the medication is effectively managing cholesterol levels.

From the FDA Drug Label

Your healthcare provider may do blood tests to check your cholesterol levels before and during your treatment with rosuvastatin tablets Your healthcare provider may do blood tests to check your liver before you start taking rosuvastatin tablets and if you have symptoms of liver problems while you take rosuvastatin tablets Consider liver enzyme testing before rosuvastatin initiation and when clinically indicated thereafter

The labs and diagnostics needed before starting Crestor (rosuvastatin) and during ongoing monitoring include:

• Blood tests to check cholesterol levels: before and during treatment
• Liver enzyme tests: before initiation and when clinically indicated
• CK levels: to monitor for myopathy, especially if symptoms occur
• Urinalysis: to monitor for proteinuria and hematuria, especially in patients taking higher doses of rosuvastatin
• Fasting serum glucose levels: to monitor for increases in blood sugar levels
• HbA1c: to monitor for increases in HbA1c levels 2, 2, 2

From the Research

Labs and Diagnostics Needed Before Starting Crestor

• Liver function tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), to assess hepatic function 3, 4
• Serum creatinine and estimated glomerular filtration rate (GFR) to evaluate renal function 3, 5
• Lipid profiles, including total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides, to assess the need for lipid-lowering therapy 3, 6
• Creatine kinase (CK) levels, although not routinely monitored, may be measured in patients with muscle symptoms or those at high risk of myopathy 3, 6

Ongoing Lab Monitoring

• Regular monitoring of liver function tests, such as ALT and AST, to detect potential hepatotoxicity, although the frequency of monitoring may be reduced due to the low risk of significant elevations 4, 6
• Periodic assessment of renal function, including serum creatinine and GFR, to monitor for potential changes in renal function 3, 5
• Lipid profiles should be monitored regularly to assess the efficacy of Crestor therapy and adjust treatment as needed 3, 6
• CK levels may be monitored in patients with muscle symptoms or those at high risk of myopathy, although routine monitoring is not necessary 3, 6

Special Considerations

• Patients taking concomitant medications, such as amiodarone, may require more frequent monitoring of liver function tests due to the potential for drug interactions 7
• Patients with pre-existing renal or hepatic disease may require more frequent monitoring and dose adjustments to minimize the risk of adverse effects 3, 5