Recommended Dosage of Rosuvastatin for Hypercholesterolemia
For treating hypercholesterolemia, rosuvastatin should be initiated at 5-20 mg once daily, with dosing based on cardiovascular risk factors and LDL-C reduction goals, and can be titrated up to 40 mg daily for those requiring greater LDL-C reduction. 1
Dosing Guidelines Based on Risk Category
Primary Prevention (without established ASCVD)
Low to moderate risk patients (age 40-75 years):
Higher risk patients (age 40-75 years with additional ASCVD risk factors):
- Start with 10-20 mg once daily 2
- Target LDL-C reduction of ≥50% and goal LDL-C <70 mg/dL
Severe hypercholesterolemia (LDL-C ≥190 mg/dL):
- Start with 20 mg once daily 2
- May increase to 40 mg if needed to achieve ≥50% LDL-C reduction
Secondary Prevention (with established ASCVD)
- All patients with diabetes and ASCVD:
- Start with 20-40 mg once daily 2
- Target LDL-C reduction of ≥50% and goal LDL-C <55 mg/dL
Special Populations and Dosage Adjustments
Asian patients:
- Start with 5 mg once daily 1
- Maximum recommended dose is 20 mg daily
Elderly (>75 years):
- Start with 5-10 mg once daily 2
- Carefully monitor for adverse effects
Severe renal impairment (not on hemodialysis):
- Start with 5 mg once daily 1
- Do not exceed 10 mg once daily
Rosuvastatin Intensity and Expected LDL-C Reduction
According to current guidelines 2:
High-intensity (reduces LDL-C by ≥50%):
- Rosuvastatin 20-40 mg daily
Moderate-intensity (reduces LDL-C by 30-49%):
- Rosuvastatin 5-10 mg daily
Administration and Monitoring
- Can be taken with or without food, at any time of day 1
- Assess LDL-C when clinically appropriate, as early as 4 weeks after initiating therapy 1
- Monitor liver function tests before starting therapy and as clinically indicated thereafter
- Consider checking creatine kinase (CK) levels in patients at high risk for myopathy
Safety Considerations
Most common adverse effects: headache, nausea, myalgia, asthenia, and constipation 1, 3
Risk of myopathy and rhabdomyolysis increases with:
- Age >65 years
- Renal impairment
- Concomitant use of certain medications
- Higher rosuvastatin doses
- Asian ancestry
Contraindicated in:
- Acute liver failure or decompensated cirrhosis
- Pregnancy
- Hypersensitivity to rosuvastatin
Clinical Pearls
- Rosuvastatin 10 mg has been shown to be more effective than atorvastatin 20 mg in reducing LDL-C (44.6% vs 42.7%) 4
- Rosuvastatin has a favorable pharmacologic profile with selective hepatic uptake and minimal CYP3A4 metabolism, reducing potential drug interactions 3
- For patients with cost concerns, every-other-day dosing of rosuvastatin 10 mg may be considered as an alternative regimen, though it results in slightly less LDL-C reduction (39% vs 48%) compared to daily dosing 5
- When treating patients with severe hypercholesterolemia, rosuvastatin 40 mg has demonstrated long-term efficacy and safety with LDL-C reductions of 52-54% over 96 weeks 6
Remember that statin therapy should be part of a comprehensive approach to cardiovascular risk reduction that includes lifestyle modifications such as diet, exercise, and smoking cessation.