Crestor (Rosuvastatin) Dosage Range
The FDA-approved dosage range for Crestor (rosuvastatin) is 5 mg to 40 mg orally once daily, administered at any time of day with or without food. 1
Standard Dosing Parameters
- General adult dosing: Rosuvastatin tablets are available in 5 mg, 10 mg, 20 mg, and 40 mg strengths, with the full therapeutic range spanning 5-40 mg once daily 1
- Typical starting dose: Most patients begin with 10 mg daily, which produces approximately 50% LDL-C reduction 2
- Dose titration: LDL-C should be assessed as early as 4 weeks after initiation, with dose adjustments made based on response and cardiovascular risk 1
Intensity Classification by Dose
- Moderate-intensity therapy: Rosuvastatin 5-10 mg daily achieves 30-49% LDL-C reduction 3, 4
- High-intensity therapy: Rosuvastatin 20-40 mg daily achieves ≥50% LDL-C reduction (approximately 50-63%) and is recommended for adults ≤75 years with established ASCVD 3
Special Population Dosing Restrictions
Asian Patients
- Initiate at 5 mg once daily due to increased rosuvastatin plasma concentrations in Asian populations 1
- Consider risks and benefits when treating Asian patients not adequately controlled at doses up to 20 mg daily 1
Severe Renal Impairment
- Starting dose: 5 mg once daily in patients with CrCl <30 mL/min/1.73 m² not on hemodialysis 1
- Maximum dose: 10 mg once daily in this population 1
- No dosage adjustments needed for mild to moderate renal impairment 1
Critical Drug Interaction Dose Limits
Common pitfall: Failing to recognize that certain medications require strict rosuvastatin dose caps to prevent severe myopathy and rhabdomyolysis.
- 5 mg maximum daily: Cyclosporine, darolutamide 1
- 10 mg maximum daily: Teriflunomide, enasidenib, capmatinib, gemfibrozil (if concomitant use unavoidable), regorafenib, and certain antivirals (atazanavir/ritonavir, lopinavir/ritonavir) 1
- 20 mg maximum daily: Fostamatinib, febuxostat, tafamidis (if concomitant use unavoidable), and resmetirom for MASH/NASH 3, 1
Ruxolitinib Interaction
- Maximum 5 mg daily when combined with ruxolitinib due to 7-fold increase in rosuvastatin exposure through OATP1B1 and P-glycoprotein inhibition 5
- Switching to higher rosuvastatin doses with ruxolitinib substantially increases myopathy risk; consider pravastatin as a safer alternative 5
Pediatric Dosing
- Ages 8 to <10 years with HeFH: 5-10 mg once daily 1
- Ages ≥10 years with HeFH: 5-20 mg once daily 1
- Ages ≥7 years with HoFH: 20 mg once daily 1