What is the recommended dose of Rosuvastatin ( Crestor ) for treating hyperlipidemia?

Recommended Dosage of Rosuvastatin for Hyperlipidemia

The recommended dosage of rosuvastatin for treating hyperlipidemia ranges from 5-40 mg once daily, with the specific dose determined by the patient's cardiovascular risk profile, LDL-C levels, and treatment goals. 1

Initial Dosing Recommendations

• For primary prevention in patients aged 40-75 years without established ASCVD, moderate-intensity statin therapy with rosuvastatin 5-10 mg daily is recommended, targeting an LDL-C reduction of ≥30% 2, 3
• For patients with additional ASCVD risk factors or higher baseline LDL-C levels, high-intensity statin therapy with rosuvastatin 20-40 mg daily is recommended to reduce LDL-C by ≥50% 2, 3
• For secondary prevention in patients with established ASCVD, high-intensity statin therapy with rosuvastatin 20-40 mg daily is recommended to achieve maximum LDL-C reduction 2, 3
• For patients with severe hypercholesterolemia (LDL-C ≥190 mg/dL), maximally tolerated statin therapy is recommended, typically starting with rosuvastatin 20 mg daily 2

Special Population Considerations

• In Asian patients, start with 5 mg daily due to increased rosuvastatin plasma concentrations 3, 1
• In patients with severe renal impairment (CL_cr <30 mL/min/1.73 m²), start with 5 mg daily and do not exceed 10 mg daily 3, 1
• For pediatric patients 8 years and older with heterozygous familial hypercholesterolemia, the recommended dosage is 5-10 mg daily for ages 8-9 and 5-20 mg daily for ages 10 and older 1
• For pediatric patients 7 years and older with homozygous familial hypercholesterolemia, the recommended dosage is 20 mg daily 1

Dosage Modifications for Drug Interactions

• When used concomitantly with cyclosporine, do not exceed 5 mg daily 2, 1
• When used with gemfibrozil, avoid concomitant use if possible; if necessary, initiate at 5 mg daily and do not exceed 10 mg daily 1
• When used with certain antiviral medications (including atazanavir/ritonavir, lopinavir/ritonavir), initiate at 5 mg daily and do not exceed 10 mg daily 1
• For patients taking teriflunomide, enasidenib, or capmatinib, do not exceed 10 mg daily 1
• For patients taking fostamatinib or febuxostat, do not exceed 20 mg daily 1

Administration Guidelines

• Administer rosuvastatin orally as a single dose at any time of day, with or without food 1
• Swallow tablets whole 1
• When taking rosuvastatin with an aluminum and magnesium hydroxide combination antacid, administer rosuvastatin at least 2 hours before the antacid 1
• Assess LDL-C when clinically appropriate, as early as 4 weeks after initiating therapy, and adjust the dosage if necessary 1, 4

Efficacy Considerations

• Rosuvastatin 5-40 mg daily effectively reduces LDL-C by 42-63%, with higher doses providing greater reductions 4, 5
• Rosuvastatin 10 mg reduces LDL-C significantly more than equivalent doses of atorvastatin, simvastatin, and pravastatin 5, 6
• Rosuvastatin also favorably modifies triglycerides (16% reduction) and increases HDL-C (8-13% increase) across the dose range 6, 7

Safety Considerations

• Monitor for muscle symptoms and elevated liver enzymes, particularly with high-intensity therapy 3
• The most commonly reported adverse events include myalgia, constipation, asthenia, abdominal pain, and nausea; these are mostly transient and mild 4
• Very few patients experience elevations in serum creatine phosphokinase levels >10-fold the upper limit of normal (0.2-0.4% of patients) or treatment-related myopathy (≤0.1%) at dosages of 5-40 mg daily 4
• Rosuvastatin has a terminal elimination half-life of approximately 20 hours, allowing for once-daily dosing 8