What is the recommended dosage of Rosuvastatin (rosuvastatin) for adults with impaired renal function?

Rosuvastatin Dosing in Patients with Impaired Renal Function

For adults with impaired renal function, rosuvastatin should be initiated at 5 mg daily when creatinine clearance is less than 30 mL/min/1.73 m² and should not exceed 10 mg daily in these patients. 1

Dosing Algorithm Based on Renal Function

1. Normal to Moderate Renal Impairment (CrCl ≥30 mL/min/1.73 m²):

   • No dose modification necessary 2
   • Standard dosing range: 5-40 mg once daily 1

2. Severe Renal Impairment (CrCl <30 mL/min/1.73 m²):

   • Starting dose: 5 mg once daily 1
   • Maximum dose: 10 mg once daily 1
   • Not recommended for patients on hemodialysis 3

Special Considerations

Ethnic Factors

Asian patients require lower doses due to increased rosuvastatin plasma concentrations:

• Initial dose should be 5 mg once daily for Asian patients 1
• FDA specifically recommends a lower starting dose (5 mg) in Asian patients compared to 10 mg in non-Asian patients 2
• Clinicians should take Asian race into account when prescribing rosuvastatin 2

Efficacy at Lower Doses

• Rosuvastatin 5 mg produces significant LDL-C reductions (42-52%) and is highly effective for most patients 4
• Even at lower doses, rosuvastatin maintains efficacy compared to other statins 5

Drug Interactions in Renal Impairment

• Avoid concomitant use with cyclosporine or darolutamide, or limit rosuvastatin to 5 mg daily if combination is necessary 1
• With gemfibrozil, initiate at 5 mg and do not exceed 10 mg daily 1
• For patients taking teriflunomide, enasidenib, or capmatinib, do not exceed 10 mg daily 1

Monitoring Recommendations

1. Before Initiation:

   • Assess baseline renal function
   • Check for potential drug interactions

2. During Treatment:

   • Monitor for myopathy symptoms (muscle pain, tenderness, or weakness)
   • Periodically reassess renal function
   • Monitor liver function tests

Clinical Rationale

Rosuvastatin has a unique pharmacologic profile with selective uptake by hepatic cells and hydrophilic nature 6. Unlike some other statins, rosuvastatin is not extensively metabolized by the CYP3A4 pathway, which reduces potential drug interactions 7. However, it requires dose adjustment in severe renal impairment because:

1. Higher plasma concentrations occur in patients with severe renal impairment
2. The risk of myopathy increases with higher plasma concentrations
3. The KDIGO guidelines support statin therapy in CKD patients but emphasize appropriate dosing 3

The evidence clearly demonstrates that proper dose adjustment allows patients with renal impairment to benefit from rosuvastatin therapy while minimizing adverse effects.