What is the recommended dosage of Crestor (rosuvastatin) for adults?

Rosuvastatin (Crestor) Dosage for Adults

The recommended dosage range for rosuvastatin (Crestor) in adults is 5 mg to 40 mg orally once daily, with the specific dose depending on the patient's cardiovascular risk factors, LDL-C levels, and treatment goals. 1

Standard Dosing Guidelines

Rosuvastatin can be administered at any time of day, with or without food. The dosage should be individualized based on:

• Starting dose:

  • Standard starting dose: 10-20 mg daily
  • For patients requiring less aggressive LDL-C reductions: 5 mg daily
  • For high-risk patients requiring >50% LDL-C reduction: 20 mg daily

• Intensity-based dosing:

  • High-intensity therapy (reduces LDL-C by >50%): 20-40 mg daily 2, 3
  • Moderate-intensity therapy (reduces LDL-C by 30-49%): 5-10 mg daily 2, 3

Special Population Considerations

Renal Impairment

• Severe renal impairment (CrCl <30 mL/min/1.73 m²):
  • Starting dose: 5 mg daily
  • Maximum dose: 10 mg daily 1, 3
• No dosage adjustment needed for mild to moderate renal impairment

Asian Patients

• Starting dose: 5 mg daily (due to increased plasma concentrations)
• Maximum recommended dose: 20 mg daily 1

Elderly Patients (>75 years)

• Moderate-intensity statin therapy is generally recommended
• Careful monitoring for adverse effects is advised 2

Drug Interactions

Dosage modifications are necessary with certain concomitant medications:

• Maximum 5 mg daily when used with:

  • Cyclosporine 1, 3
  • Darolutamide 1

• Maximum 10 mg daily when used with:

  • Gemfibrozil (start at 5 mg daily) 1
  • Various antiviral medications (start at 5 mg daily) 1
  • Teriflunomide, enasidenib, capmatinib 1

• Maximum 20 mg daily when used with:

  • Fostamatinib, febuxostat 1
  • Tafamidis (start at 5 mg daily) 1

Monitoring and Dose Adjustments

• Assess LDL-C levels as early as 4 weeks after initiation
• Adjust dosage based on response and tolerability
• Monitor for muscle symptoms, which may indicate myopathy
• For patients not achieving target LDL-C levels on maximum tolerated statin dose, consider adding ezetimibe or a PCSK9 inhibitor 2

Common Pitfalls to Avoid

1. Overdosing: Doses exceeding 40 mg daily are considered an overdose and increase risk of myopathy and rhabdomyolysis 3

2. Inadequate dose adjustments with drug interactions: Failure to adjust rosuvastatin dosage when used with medications that affect its metabolism can lead to increased risk of adverse effects

3. Ignoring special populations: Asian patients, elderly patients, and those with renal impairment require careful dose selection and monitoring

4. Missing target goals: Rosuvastatin has demonstrated superior efficacy in LDL-C reduction compared to equivalent doses of other statins 4, 5, but proper dose selection is critical to achieve treatment goals

Remember that rosuvastatin is generally well-tolerated, with most adverse events being mild to moderate in severity. The most common side effects include myalgia, constipation, asthenia, abdominal pain, and nausea 4.