What should be done for a patient on Crestor (rosuvastatin) 20mg experiencing a swollen throat after a dose increase from 10mg?

Immediate Management of Suspected Hypersensitivity Reaction to Rosuvastatin

Discontinue rosuvastatin 20mg immediately and do not rechallenge at any dose, as throat swelling represents a potentially serious hypersensitivity reaction that can progress to life-threatening angioedema. 1

Acute Symptom Management

Administer antihistamines and corticosteroids immediately for symptomatic control:

• Give diphenhydramine 25-50 mg IV or orally as first-line treatment for the hypersensitivity reaction 2
• Administer corticosteroids such as methylprednisolone 100 mg IV or oral prednisone equivalent for aggressive control, as combination therapy with antihistamines and corticosteroids provides optimal symptom control 2, 3
• Monitor continuously for progression to anaphylaxis by assessing for dyspnea, bronchospasm, hypotension, or worsening laryngeal edema, which would require immediate epinephrine administration 2

Assessment of Reaction Severity

Evaluate for systemic involvement beyond throat swelling:

• Check vital signs for hypotension or tachycardia, assess respiratory status for dyspnea or wheezing, and examine for widespread urticaria or angioedema 2
• Document that rosuvastatin is contraindicated in this patient due to hypersensitivity, as the FDA label specifically lists hypersensitivity reactions including rash, pruritus, urticaria, and angioedema as contraindications 1

Ongoing Treatment Protocol

• Continue antihistamine therapy with diphenhydramine 25-50 mg every 6 hours for 24-48 hours or until symptoms completely resolve 2
• Administer a corticosteroid taper if the reaction is moderate to severe, typically starting with methylprednisolone or prednisone and tapering over several days 2, 3
• Observe the patient for at least 30-60 minutes after initiating treatment to ensure the reaction is resolving and not progressing to more severe manifestations 2

Critical Management Pitfalls to Avoid

Do not attempt dose reduction or rechallenge with rosuvastatin:

• Throat swelling represents a severe systemic hypersensitivity reaction requiring permanent discontinuation of rosuvastatin, not dose adjustment 2, 1
• Avoid delaying treatment, as hypersensitivity reactions can rapidly progress to anaphylaxis with cardiovascular collapse 2
• Never use corticosteroids alone without antihistamines, as combination therapy is essential for optimal symptom control 2

Alternative Lipid Management Strategy

Select an alternative statin from a different structural class:

• Consider switching to pravastatin 10-40 mg daily or fluvastatin 20-80 mg daily, as these are structurally distinct from rosuvastatin and less likely to cross-react 4
• Atorvastatin or simvastatin may also be considered, though all statins carry some risk of hypersensitivity reactions 1
• If the patient had good lipid control on rosuvastatin 10mg previously, initiate the alternative statin at an equipotent dose based on LDL-lowering efficacy 5, 6

Documentation and Follow-up

• Document the hypersensitivity reaction thoroughly in the medical record, clearly noting rosuvastatin as a drug allergy to prevent future re-exposure 2
• Monitor for delayed reactions over the next 24-48 hours, as some hypersensitivity reactions can have delayed components 2
• Recheck lipid panel 4-6 weeks after initiating alternative statin therapy to ensure adequate LDL-cholesterol control 4