What is the dosage and management of Crestor (rosuvastatin) for cholesterol management?

From the Guidelines

Rosuvastatin (Crestor) should be started at a dose of 5-10 mg once daily for most patients with hypercholesterolemia, with a maximum dose of 40 mg daily, as recommended by recent guidelines 1. The recommended starting dose is lower (5 mg) for patients with predisposing factors for myopathy, those of Asian descent, and patients with severe renal impairment. Dosage adjustments should be made at 2-4 week intervals based on lipid levels and tolerability, with a target LDL cholesterol level of less than 130 mg/dL 1. Rosuvastatin should be taken at the same time each day, with or without food, and patients should follow a cholesterol-lowering diet during treatment. Regular monitoring of lipid levels and liver function tests is recommended, particularly when initiating therapy or increasing the dose, with a threshold for worrisome levels of ALT or AST being 3 times the upper limit of reported normal 1. Common side effects include muscle pain, weakness, and elevated liver enzymes, and patients should report unexplained muscle pain, tenderness, or weakness, especially if accompanied by fever or malaise, as these could indicate rare but serious muscle problems. The medication works by inhibiting HMG-CoA reductase, the enzyme responsible for cholesterol production in the liver, thereby reducing LDL cholesterol levels and decreasing cardiovascular risk, with an estimated LDL reduction of 39-45% at a dose of 5-10 mg/day 1. Key considerations for management include:

• Starting with the lowest dose once daily, usually at bedtime, or at any time of day due to its long half-life 1
• Measuring baseline CK, ALT, and AST, and monitoring for potential adverse effects, especially muscle cramps, weakness, asthenia, and more diffuse symptoms suggestive of myopathy 1
• Advising female patients about concerns with pregnancy and the need for appropriate contraception, and potential future medication interactions, especially cyclosporine, niacin, fibric acid derivatives, erythromycin, azole antifungal agents, nefazodone, and HIV protease inhibitors 1

From the FDA Drug Label

The dosage range for rosuvastatin tablets is 5 to 40 mg orally once daily. The recommended dose of rosuvastatin tablets depends on a patient’s indication for usage, LDL-C, and individual risk for cardiovascular events. Assess LDL-C when clinically appropriate, as early as 4 weeks after initiating rosuvastatin tablets, and adjust the dosage if necessary.

The dosage and management of Crestor (rosuvastatin) for cholesterol management is as follows:

• Adults: The recommended dosage range is 5 to 40 mg once daily.
• Pediatric Patients with HeFH: The recommended dosage range is 5 to 10 mg once daily for patients aged 8 to less than 10 years, and 5 to 20 mg once daily for patients aged 10 years and older.
• Pediatric Patients with HoFH: The recommended dosage is 20 mg once daily for patients aged 7 years and older.
• Asian Patients: Initiate at 5 mg once daily and consider the 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 and do not exceed 10 mg once daily 2.

From the Research

Dosage and Management of Crestor (Rosuvastatin)

The dosage and management of Crestor (rosuvastatin) for cholesterol management can be understood through various studies.

• The recommended dosage of rosuvastatin is 5-40 mg once daily, with 10 mg being the most commonly prescribed dose 3, 4.
• Rosuvastatin has been shown to be effective in reducing LDL-C levels and improving lipid profiles in patients with hypercholesterolemia, with significant reductions in LDL-C levels observed at doses of 10-40 mg 3, 4.
• The drug has also been shown to be well-tolerated, with a safety profile similar to that of other available statins 3, 4, 5.

Efficacy of Rosuvastatin

The efficacy of rosuvastatin in reducing cardiovascular risk has been demonstrated in several studies.

• The JUPITER trial showed that rosuvastatin 20 mg once daily significantly reduced the occurrence of first major cardiovascular events in apparently healthy women and men with normal LDL-C levels and elevated hsCRP levels 5.
• Rosuvastatin has also been shown to be effective in reducing LDL-C levels and improving lipid profiles in patients with hypertriglyceridemia or mixed dyslipidemia, including diabetic patients 4.

Safety and Tolerability

The safety and tolerability of rosuvastatin have been evaluated in several studies.

• The most commonly reported treatment-related adverse events were myalgia, constipation, asthenia, abdominal pain, and nausea, which were mostly transient and mild 3, 4, 5.
• The incidence of proteinuria or microscopic hematuria with rosuvastatin was <1% versus <1.5% with rosuvastatin 40 mg/day, and these events were mostly transient and not associated with acute or progressive deterioration in renal function at recommended dosages 3.