What is the recommended dosage and usage of Rosuvastatin (rosuvastatin) for managing elevated cholesterol levels?

Rosuvastatin Dosage and Usage for Managing Elevated Cholesterol

Rosuvastatin should be initiated at 5-20 mg once daily for most patients with hypercholesterolemia, with dosage adjustments based on LDL-C reduction goals, cardiovascular risk factors, and patient characteristics. 1, 2

Initial Dosing Recommendations

• Primary Prevention (without established ASCVD):

  • Adults 40-75 years without additional risk factors: 5-10 mg once daily 2
  • Adults 40-75 years with diabetes and additional ASCVD risk factors: 20-40 mg once daily 2
  • Patients requiring 30-49% LDL-C reduction: 5-10 mg once daily 2
  • Patients requiring ≥50% LDL-C reduction: 20-40 mg once daily 2

• Secondary Prevention (with established ASCVD):

  • High-intensity therapy (20-40 mg once daily) is recommended 3, 2

Administration Guidelines

• Take orally as a single dose at any time of day, with or without food 1
• Swallow tablets whole 1
• If a dose is missed, do not take an extra dose; resume with the next scheduled dose 1
• When taking with aluminum and magnesium hydroxide antacids, administer rosuvastatin at least 2 hours before the antacid 1

Special Population Considerations

Asian Patients

• Start with 5 mg once daily due to increased plasma concentrations 1
• Consider risks/benefits when treating Asian patients not adequately controlled at doses up to 20 mg 1

Renal Impairment

• Severe renal impairment (CL_cr <30 mL/min/1.73 m²) not on hemodialysis:
  • Start with 5 mg once daily
  • Do not exceed 10 mg once daily 1
• No dosage adjustments needed for mild to moderate renal impairment 1

Elderly Patients

• For adults >75 years already on statin therapy, it's reasonable to continue treatment
• When initiating in this population, consider starting with moderate-intensity therapy 2

Drug Interactions and Dosage Modifications

• Cyclosporine: Do not exceed 5 mg once daily 1
• Gemfibrozil: Avoid concomitant use; if necessary, start at 5 mg and don't exceed 10 mg daily 1
• Antiviral medications (including sofosbuvir/velpatasvir/voxilaprevir, ledipasvir/sofosbuvir): Concomitant use not recommended 1
• Other antiviral medications (including atazanavir/ritonavir, lopinavir/ritonavir): Start at 5 mg and don't exceed 10 mg daily 1

Monitoring and Dose Adjustment

• Assess LDL-C as early as 4 weeks after initiating therapy 1
• Adjust dosage if necessary based on LDL-C response and treatment goals 1
• At daily doses of 5-40 mg, rosuvastatin produces mean reductions in LDL-C of 45-63% 4

Combination Therapy Considerations

• If LDL-C goals are not reached with rosuvastatin alone, consider adding ezetimibe 3
• The combination of rosuvastatin 5-10 mg with ezetimibe 10 mg produces greater improvements in lipid profile than up-titration of rosuvastatin alone 3
• Combination therapy may be particularly beneficial for high-risk patients, including those with diabetes 3

Clinical Efficacy

• Rosuvastatin demonstrates superior efficacy in lowering LDL-C compared to equivalent doses of atorvastatin, simvastatin, and pravastatin 4
• A starting dose of 10 mg typically reduces LDL-C by approximately 50% 5
• Rosuvastatin 5 mg produces mean LDL-C reductions ranging from 42-52% 6
• Long-term treatment with rosuvastatin 40 mg has been shown to be safe and effective in patients with severe hypercholesterolemia 7

Rosuvastatin is a potent statin that effectively reduces LDL-C levels and cardiovascular risk when dosed appropriately according to patient characteristics and risk factors.