What is the starting dose of rosuvastatin for a patient with elevated Low-Density Lipoprotein Cholesterol (LDL-C) level of 150?

From the Guidelines

The recommended starting dose of rosuvastatin for a patient with an elevated LDL-C level of 150 mg/dL is typically 10 mg once daily. This dose is based on the most recent and highest quality study available, which suggests that starting with a low dose and titrating as needed is the best approach to minimize side effects and maximize efficacy 1. The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol recommends starting with a low to moderate intensity statin, such as rosuvastatin 10 mg daily, for patients with elevated LDL-C levels 1.

When initiating rosuvastatin therapy, it is essential to consider the patient's individual characteristics, such as renal function, potential drug interactions, and risk factors for myopathy. The dose may be adjusted after 2-4 weeks based on the patient's response and tolerability. Some patients may require dose titration up to 20 mg or 40 mg daily for optimal LDL-C reduction, while others with certain risk factors might benefit from starting at a lower 5 mg dose. Regular monitoring of lipid levels and liver function tests is recommended during treatment, and patients should be advised about potential side effects such as muscle pain and the importance of reporting these symptoms promptly 1.

Key considerations when prescribing rosuvastatin include:

• Starting with a low dose and titrating as needed
• Monitoring lipid levels and liver function tests regularly
• Advising patients about potential side effects and the importance of reporting symptoms promptly
• Considering individual patient characteristics, such as renal function and potential drug interactions, when determining the starting dose and titration schedule.

From the FDA Drug Label

Adults:Recommended dosage range is 5 mg to 40 mg once daily. ( 2.1) The starting dose of rosuvastatin for a patient with elevated Low-Density Lipoprotein Cholesterol (LDL-C) level of 150 is 5 mg once daily 2.

From the Research

Starting Dose of Rosuvastatin for Elevated LDL-C

The starting dose of rosuvastatin for a patient with an elevated Low-Density Lipoprotein Cholesterol (LDL-C) level of 150 can be determined based on the patient's risk category and the desired reduction in LDL-C.

• According to the study 3, rosuvastatin 5 mg/d was administered to patients categorized as moderately high risk, and rosuvastatin 10 mg/d was administered to patients categorized as high or very high risk.
• The study 4 reviews the efficacy of rosuvastatin 5 mg and shows that it is highly effective in lowering LDL-C to recommended levels for most patients, with mean reductions ranging from 42 to 52%.
• The study 5 demonstrates that rosuvastatin is associated with highly significant dose-dependent reductions in LDL cholesterol, with decreases ranging from 34% (1 mg) to 65% (80 mg).
• The study 6 compares rosuvastatin with pravastatin and simvastatin and shows that rosuvastatin 5 and 10 mg reduced LDL-C by 42 and 49%, respectively.

Dosage Recommendations

Based on these studies, the starting dose of rosuvastatin for a patient with an elevated LDL-C level of 150 could be:

• 5 mg/d for patients at moderate risk 3, 4
• 10 mg/d for patients at high or very high risk 3, 6

Considerations

It is essential to consider the patient's individual risk factors, medical history, and other medications when determining the starting dose of rosuvastatin. The dosage may need to be adjusted based on the patient's response to treatment and the achievement of LDL-C goals.