Starting Dose of Rosuvastatin
The standard starting dose of rosuvastatin is 10 mg once daily for most adult patients, though 5 mg once daily is recommended for Asian patients, those with severe renal impairment, and patients on certain interacting medications. 1
Standard Dosing for General Population
The FDA-approved dosage range for rosuvastatin is 5-40 mg orally once daily, with the specific dose depending on the patient's indication, baseline LDL-C level, and cardiovascular risk 1
For most adult patients without special considerations, initiate rosuvastatin at 10 mg once daily 1
The medication can be taken at any time of day, with or without food 1
Special Population Dosing Adjustments
Asian Patients
Start at 5 mg once daily in Asian patients due to significantly increased rosuvastatin plasma concentrations (approximately 2-fold higher than in Caucasian patients) 2, 1
Exercise caution when considering doses above 20 mg daily in this population 1
Renal Impairment
For severe renal impairment (CrCl <30 mL/min/1.73 m²) not on hemodialysis: start at 5 mg once daily and do not exceed 10 mg daily 3, 1
No dose adjustment needed for mild to moderate renal impairment 3, 1
Pediatric Patients
Ages 8-10 years with heterozygous familial hypercholesterolemia (HeFH): 5-10 mg once daily 1
Ages ≥10 years with HeFH: 5-20 mg once daily 1
Ages ≥7 years with homozygous familial hypercholesterolemia (HoFH): 20 mg once daily 1
Drug Interaction-Based Dose Modifications
Severe Restrictions (Maximum 5 mg daily)
Cyclosporine: Do not exceed 5 mg once daily due to 7-fold increase in rosuvastatin exposure 2, 1
Darolutamide: Do not exceed 5 mg once daily 1
Moderate Restrictions (Maximum 10 mg daily)
Teriflunomide, enasidenib, capmatinib: Do not exceed 10 mg once daily 1
Gemfibrozil: Avoid concomitant use if possible; if necessary, start at 5 mg and do not exceed 10 mg daily 1
Protease inhibitors (atazanavir/ritonavir, lopinavir/ritonavir): Start at 5 mg and do not exceed 10 mg daily 1
Less Restrictive Modifications (Maximum 20 mg daily)
- Fostamatinib, febuxostat, tafamidis: Do not exceed 20 mg once daily 1
Intensity-Based Dosing Strategy
Moderate-Intensity Therapy (30-49% LDL-C reduction)
Rosuvastatin 5-10 mg daily achieves moderate-intensity statin therapy 4, 3
Appropriate for primary prevention in patients aged 40-75 years without established ASCVD 3
High-Intensity Therapy (≥50% LDL-C reduction)
Rosuvastatin 20-40 mg daily achieves high-intensity statin therapy 4, 3
Recommended for secondary prevention in patients with established ASCVD 3
Common Pitfalls to Avoid
Failing to reduce the starting dose in Asian patients can lead to increased risk of myopathy due to higher drug exposure 2, 1
Not adjusting for severe renal impairment increases the risk of adverse effects 1
Overlooking drug interactions with immunosuppressants (particularly cyclosporine) can result in dangerous elevations in statin levels and muscle toxicity 2, 1
Starting at unnecessarily high doses when 5-10 mg may be sufficient for many patients to reach LDL-C goals 5, 6