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

Recommended Dosage of Rosuvastatin for Adults with Hyperlipidemia

The recommended dosage of rosuvastatin (Crestor) for adults with hyperlipidemia ranges from 5-40 mg once daily, with 10-20 mg being the standard starting dose for most patients, and dosage adjustments based on cardiovascular risk factors and LDL-C reduction goals. 1

Dosage Based on Intensity and Treatment Goals

High-Intensity Therapy (≥50% LDL-C reduction)

• Dosage: 20-40 mg once daily 2
• Recommended for:
  • Adults aged 40-75 years with diabetes and additional ASCVD risk factors 2
  • Patients requiring ≥50% LDL-C reduction to reach goal of <70 mg/dL (<1.8 mmol/L) 2
  • Those with established ASCVD or at very high risk 2

Moderate-Intensity Therapy (30-49% LDL-C reduction)

• Dosage: 5-10 mg once daily 2
• Recommended for:
  • Adults aged 40-75 years with diabetes without additional risk factors 2
  • Primary prevention in patients requiring 30-49% LDL-C reduction 2

Special Population Considerations

Asian Patients

• Starting dose: 5 mg once daily 1
• Higher plasma concentrations observed in Japanese, Chinese, Malay, and Asian Indians compared to white patients 2
• FDA recommends lower starting dose due to increased rosuvastatin exposure 1

Renal Impairment

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

Elderly Patients (>75 years)

• In adults with diabetes aged >75 years already on statin therapy, it is reasonable to continue statin treatment 2
• Consider starting with moderate-intensity therapy if initiating treatment 2

Drug Interactions Requiring Dosage Modifications

• Cyclosporine: Do not exceed 5 mg once daily 1
• Gemfibrozil: Avoid concomitant use; if necessary, start at 5 mg and do not exceed 10 mg daily 1
• Antiviral medications (including atazanavir/ritonavir, lopinavir/ritonavir): Start at 5 mg and do not exceed 10 mg daily 1
• Aluminum and magnesium hydroxide antacids: Administer rosuvastatin at least 2 hours before the antacid 1

Administration Guidelines

• Administer orally as a single dose at any time of day, with or without food 1
• Swallow tablets whole 1
• Assess LDL-C as early as 4 weeks after initiating therapy and adjust dosage if necessary 1

Efficacy Considerations

• Rosuvastatin 10 mg reduces LDL-C significantly more than equivalent doses of atorvastatin, simvastatin, and pravastatin 3
• At 10-40 mg doses, rosuvastatin produces 52-63% reductions in LDL-C 3
• Also produces favorable effects on HDL-C (increases of 8.2-13%) and triglycerides (reductions of approximately 16%) 4

Safety Considerations

• Most common adverse effects include myalgia, constipation, asthenia, abdominal pain, and nausea 5
• Monitor for muscle symptoms and liver function abnormalities 5
• Very low incidence (<0.4%) of significant CPK elevations (>10x ULN) at recommended doses 5

By following these evidence-based dosing recommendations and considering patient-specific factors, clinicians can optimize the use of rosuvastatin to effectively manage hyperlipidemia while minimizing potential adverse effects.