What is the dosage and treatment plan for Rosugolf (rosuvastatin) tablets for patients with high cholesterol?

Rosuvastatin (Rosugolf) Dosing and Treatment Strategy

For adults with hypercholesterolemia, initiate rosuvastatin at 5-10 mg once daily, with the option to titrate up to 40 mg based on LDL-C response and cardiovascular risk, and strongly consider adding ezetimibe 10 mg rather than doubling the statin dose if LDL-C goals are not achieved. 1

Standard Dosing Guidelines

Initial Dosing for Adults

• Standard starting dose: 5-10 mg once daily for most patients with hypercholesterolemia 1
• Dosage range: 5-40 mg once daily, taken with or without food at any time of day 1
• Reassess LDL-C as early as 4 weeks after initiation and adjust dosage accordingly 1

Intensity-Based Approach by Risk Category

For patients aged 40-75 years with diabetes:

• Use moderate-intensity statin therapy (rosuvastatin 5-10 mg) as baseline treatment 2
• Escalate to high-intensity therapy (rosuvastatin 20-40 mg) if patient has ≥1 additional ASCVD risk factor, targeting LDL-C <70 mg/dL 2

For severe hypercholesterolemia (LDL-C ≥190 mg/dL):

• Initiate maximally tolerated statin therapy immediately 2
• Target ≥50% LDL-C reduction from baseline 2
• Rosuvastatin 40 mg produces 52-54% LDL-C reduction and is well-tolerated long-term 3

For primary prevention in intermediate-risk patients:

• Rosuvastatin 10 mg daily demonstrated significant ASCVD risk reduction in diverse populations after 5.6 years 2
• Rosuvastatin 20 mg daily achieved median 50% LDL-C reduction and highly significant ASCVD risk reduction at 1.9 years in the JUPITER trial 2

Critical Treatment Algorithm: When Goals Are Not Met

Add Ezetimibe Rather Than Uptitrating Statin Alone

If LDL-C remains ≥70 mg/dL on rosuvastatin 5-10 mg, add ezetimibe 10 mg instead of doubling the rosuvastatin dose because:

• Rosuvastatin 10 mg + ezetimibe 10 mg produces greater LDL-C lowering than rosuvastatin 20 mg alone with fewer drug-related adverse events 4
• 94% of patients achieve LDL-C <100 mg/dL with combination therapy versus 79% with rosuvastatin monotherapy 4
• 79.6% of very high-risk patients achieve LDL-C <70 mg/dL with combination versus only 35% with rosuvastatin alone 4
• Combination therapy achieves >50% LDL-C reduction across all dose combinations 4

For Severe Hypercholesterolemia Not at Goal

• If LDL-C remains ≥100 mg/dL on maximally tolerated statin, add ezetimibe 10 mg (Class IIa recommendation) 2, 4
• If LDL-C remains ≥100 mg/dL on maximally tolerated statin plus ezetimibe, consider PCSK9 inhibitor 2, 4

Special Population Dosing Adjustments

Asian Patients

• Initiate at 5 mg once daily due to increased systemic exposure 1
• Consider risks and benefits if not adequately controlled at doses up to 20 mg daily 1

Severe Renal Impairment (not on hemodialysis)

• Initiate at 5 mg once daily 1
• Do not exceed 10 mg once daily 1

Pediatric Patients

• Ages 8 to <10 years with heterozygous familial hypercholesterolemia: 5-10 mg once daily 1
• Ages ≥10 years with heterozygous familial hypercholesterolemia: 5-20 mg once daily 1
• Ages ≥7 years with homozygous familial hypercholesterolemia: 20 mg once daily 1

Elderly Patients (>75 years)

• Continue statin therapy if already established 2
• Consider initiating moderate-intensity statin after weighing benefits and risks 2

Safety and Tolerability Profile

Rosuvastatin is well-tolerated with a favorable safety profile:

• Most common adverse events: myalgia, constipation, asthenia, abdominal pain, nausea (mostly transient and mild) 5
• Myopathy incidence ≤0.1% at doses 5-40 mg/day 5
• CPK elevations >10x ULN occur in 0.2-0.4% of patients 5
• Proteinuria/microscopic hematuria <1% at 10-20 mg, <1.5% at 40 mg (mostly transient, not associated with renal function deterioration) 5
• Long-term treatment up to 96 weeks with rosuvastatin 40 mg is safe in patients with severe hypercholesterolemia 3

Key Clinical Pitfalls to Avoid

Do not use ezetimibe monotherapy when combination with rosuvastatin is possible - combination provides superior LDL-C reduction and proven cardiovascular event reduction 4

Do not automatically uptitrate rosuvastatin dose - adding ezetimibe to rosuvastatin 10 mg is more effective and better tolerated than increasing to rosuvastatin 20 mg 4

Do not delay combination therapy - it should be the default strategy rather than stepwise titration, as it provides synergistic effects and improves adherence 4

Avoid high-dose statin monotherapy when combination achieves better results - combination therapy allows avoidance of high-intensity statin doses that may cause myopathy while achieving superior LDL-C reduction 4