Rosuvastatin Dosage for Primary Prevention and Hyperlipidemia
For primary prevention and hyperlipidemia, initiate rosuvastatin at 5-10 mg once daily for moderate-intensity therapy (30-50% LDL-C reduction) or 20-40 mg once daily for high-intensity therapy (≥50% LDL-C reduction), with the specific dose determined by your patient's cardiovascular risk profile and LDL-C goals. 1, 2, 3
Dosing Algorithm Based on Clinical Scenario
High-Intensity Therapy (Rosuvastatin 20-40 mg daily)
Use high-intensity rosuvastatin when patients require ≥50% LDL-C reduction: 1, 2
- LDL-C ≥190 mg/dL: Start rosuvastatin 20-40 mg daily 2
- Established ASCVD: Use rosuvastatin 20-40 mg daily 2
- Primary prevention with high CV risk: For patients without established coronary disease but at increased risk based on age, hsCRP ≥2 mg/L, and additional CV risk factors, consider rosuvastatin 20 mg daily 3
- Diabetes with additional ASCVD risk factors: Use rosuvastatin 20-40 mg daily 2
Moderate-Intensity Therapy (Rosuvastatin 5-10 mg daily)
Use moderate-intensity rosuvastatin when patients require 30-49% LDL-C reduction: 1, 2
- Primary prevention in diabetes (age 40-75) without additional risk factors: Start rosuvastatin 5-10 mg daily 2
- Patients >75 years who are statin candidates: Use rosuvastatin 5-10 mg daily 2
- Patients intolerant to high-intensity therapy: Down-titrate to rosuvastatin 5-10 mg daily 2
- Primary hyperlipidemia requiring moderate LDL-C lowering: Start rosuvastatin 5-10 mg daily 3
Practical Starting Doses
Standard starting dose: Rosuvastatin 10 mg once daily is appropriate for most patients with primary hyperlipidemia, producing mean LDL-C reductions of approximately 45-52% 4, 5
Lower starting dose (5 mg): Consider in: 3
- Asian patients (due to increased plasma concentrations) 3
- Patients with severe renal impairment (CrCl <30 mL/min/1.73 m²) 3
- Patients on interacting medications (cyclosporine, gemfibrozil, darolutamide) 3
Higher starting dose (20 mg): Appropriate for patients requiring aggressive LDL-C lowering, including those with homozygous familial hypercholesterolemia (age ≥7 years) 3
Administration Details
- Timing: Administer once daily at any time of day, with or without food 3
- Tablet form: Swallow whole 3
- Antacid interaction: If using aluminum/magnesium hydroxide antacids, give rosuvastatin at least 2 hours before the antacid 3
- Monitoring: Assess LDL-C as early as 4 weeks after initiation and adjust dosage accordingly 3
Comparative Efficacy Context
Rosuvastatin demonstrates superior LDL-C lowering compared to other statins at equivalent doses. At 12 weeks, rosuvastatin 10 mg produces significantly greater LDL-C reduction than atorvastatin 10 mg, simvastatin 20 mg, or pravastatin 40 mg (all p<0.001), with more patients achieving NCEP ATP III LDL-C goals 6, 4, 7
Important Dosing Restrictions
Maximum doses with drug interactions: 3
- With cyclosporine or darolutamide: Do not exceed 5 mg daily
- With teriflunomide, enasidenib, capmatinib, or regorafenib: Do not exceed 10 mg daily
- With fostamatinib or febuxostat: Do not exceed 20 mg daily
- With gemfibrozil: Avoid concomitant use; if necessary, start at 5 mg and do not exceed 10 mg daily
Severe renal impairment: Starting dose 5 mg daily, maximum 10 mg daily 3
Safety Considerations
Both moderate and high-intensity rosuvastatin demonstrate acceptable safety profiles, with myalgia, constipation, and asthenia being the most common adverse events (mostly mild and transient). 4 The incidence of myopathy remains very low (<0.1%) at recommended doses of 5-40 mg daily. 4 Monitor for new-onset diabetes, particularly in patients on high-intensity therapy with metabolic syndrome features, though the ASCVD risk reduction benefit outweighs this risk. 6