What is the recommended dose for Crestor (rosuvastatin)?

Crestor (Rosuvastatin) Dosing

The recommended dose range for rosuvastatin is 5-40 mg orally once daily, with most patients starting at 10 mg and titrating based on LDL-C goals and cardiovascular risk. 1

Standard Dosing by Indication

Primary Prevention (No Established CVD)

• Moderate-intensity therapy: 5-10 mg daily for patients aged 40-75 years targeting ≥30-49% LDL-C reduction and LDL-C <70 mg/dL 2
• High-intensity therapy: 20-40 mg daily for patients with additional ASCVD risk factors targeting ≥50% LDL-C reduction and LDL-C <70 mg/dL 2

Secondary Prevention (Established ASCVD)

• High-intensity therapy: 20-40 mg daily targeting ≥50% LDL-C reduction and LDL-C <55 mg/dL 2

Familial Hypercholesterolemia

• Heterozygous (HeFH):
  • Ages 8 to <10 years: 5-10 mg daily 1
  • Ages ≥10 years: 5-20 mg daily 1
• Homozygous (HoFH): 20 mg daily for patients ≥7 years 1

Special Population Dosing

Asian Patients

• Start at 5 mg daily due to increased plasma concentrations (approximately 2-fold higher) 1
• Consider risks and benefits when doses >20 mg daily are needed 1

Severe Renal Impairment (CrCl <30 mL/min/1.73 m²)

• Start at 5 mg daily and do not exceed 10 mg daily 1
• No adjustment needed for mild-moderate renal impairment 2

Critical Drug Interaction Dose Limits

Maximum 5 mg Daily

• Cyclosporine: Rosuvastatin AUC increases 7-fold 3
• Darolutamide 1

Maximum 10 mg Daily

• Teriflunomide 1
• Enasidenib 1
• Capmatinib 1
• Gemfibrozil: Avoid concomitant use if possible; if used, start at 5 mg and max 10 mg daily 1
• Regorafenib 1
• Protease inhibitors (atazanavir/ritonavir, lopinavir/ritonavir) 1

Maximum 20 mg Daily

• Fostamatinib 1
• Febuxostat 1
• Tafamidis: Avoid if possible; if used, start at 5 mg and max 20 mg daily 1

Avoid Concomitant Use

• Sofosbuvir/velpatasvir/voxilaprevir 1
• Ledipasvir/sofosbuvir 1

Administration Guidelines

• Take once daily at any time of day, with or without food 1
• Swallow tablets whole 1
• If taking aluminum/magnesium antacids, administer rosuvastatin at least 2 hours before the antacid 1
• Check lipid levels 4-12 weeks after initiation or dose change 1, 2

Statin Intensity Classification

• Moderate-intensity (30-49% LDL-C reduction): 5-10 mg daily 4
• High-intensity (≥50% LDL-C reduction): 20-40 mg daily 4

Common Pitfalls to Avoid

• Failing to reduce dose with cyclosporine or other immunosuppressants can lead to severe myopathy or rhabdomyolysis 3
• Not starting at 5 mg in Asian patients increases risk of adverse effects due to higher drug exposure 1
• Exceeding 10 mg daily in severe renal impairment increases toxicity risk 1
• Inadequate dose titration to achieve LDL-C goals, particularly in high-risk patients 2
• Not monitoring for muscle symptoms when using high-intensity therapy 2