Rosuvastatin (Rosuva) Dosing and Usage
Rosuvastatin should be initiated at 5-10 mg once daily for most patients requiring moderate-intensity statin therapy, with doses of 20-40 mg reserved for those requiring high-intensity therapy to achieve ≥50% LDL-C reduction. 1
Standard Dosing Regimen
General Administration:
- Administer as a single dose at any time of day, with or without food 1
- Swallow tablets whole 1
- Assess LDL-C as early as 4 weeks after initiation and adjust dosage accordingly 1
- If taking with aluminum/magnesium hydroxide antacids, administer rosuvastatin at least 2 hours before the antacid 1
Dosing by Intensity Classification
Moderate-Intensity Therapy (30-49% LDL-C reduction):
High-Intensity Therapy (≥50% LDL-C reduction):
- Rosuvastatin 20-40 mg daily 2, 3
- Appropriate for patients with severe hypercholesterolemia (LDL-C ≥190 mg/dL), established ASCVD requiring aggressive secondary prevention, or heterozygous familial hypercholesterolemia 3
Special Population Dosing
Asian Patients:
- Initiate at 5 mg once daily due to increased plasma concentrations 1
- Consider risks and benefits when treating Asian patients not adequately controlled at doses up to 20 mg daily 1
Severe Renal Impairment (CrCl <30 mL/min/1.73 m²):
- Start at 5 mg once daily 1
- Do not exceed 10 mg once daily 1
- No dosage adjustment needed for mild-to-moderate renal impairment 1
Pediatric Patients:
- 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
Drug Interaction Dosing Modifications
Do Not Exceed 5 mg Daily:
Do Not Exceed 10 mg Daily:
- Teriflunomide, enasidenib, capmatinib 1
- Gemfibrozil (avoid concomitant use if possible; if used, initiate at 5 mg) 1
- Regorafenib 1
- Antiviral medications: simeprevir, dasabuvir/ombitasvir/paritaprevir/ritonavir, elbasvir/grazoprevir, sofosbuvir/velpatasvir, glecaprevir/pibrentasvir, atazanavir/ritonavir, lopinavir/ritonavir 1
Do Not Exceed 20 mg Daily:
- Fostamatinib, febuxostat 1
- Tafamidis (avoid concomitant use if possible; if used, initiate at 5 mg) 1
Avoid Concomitant Use:
Combination Therapy Strategies
When LDL-C Goals Not Met with Statin Alone:
- Add ezetimibe 10 mg to stable rosuvastatin therapy rather than up-titrating rosuvastatin dose 4
- The ACTE trial demonstrated that ezetimibe 10 mg added to rosuvastatin 5 or 10 mg produced greater LDL-C improvements than rosuvastatin dose escalation 4
- All fixed-dose combinations of ezetimibe/rosuvastatin (5 mg, 10 mg, or 20 mg) achieved >50% LDL-C reduction from baseline 4
- Combination therapy has fewer adverse events and better tolerability than high-dose statin monotherapy 4
For Statin-Intolerant Patients:
- Consider every-other-day dosing: 72.5% of previously statin-intolerant patients tolerated rosuvastatin every-other-day (mean dose 5.6 mg), achieving 34.5% LDL-C reduction 5
- Once-weekly rosuvastatin may be feasible for patients intolerant to daily dosing 6
- Re-challenge with rosuvastatin after documented intolerance to other statins, as true statin intolerance affects only a minority of patients 4
Clinical Efficacy
LDL-C Reduction:
Additional Lipid Effects:
- Marked HDL-C elevations maintained across dose range 7
- Up to 14% increase in HDL-C and 28% reduction in triglycerides 2
- Superior to atorvastatin, simvastatin, and pravastatin at milligram-equivalent doses 8
Common Pitfalls to Avoid
- Failing to adjust for renal impairment: Always check CrCl before prescribing doses >10 mg in patients with severe renal dysfunction 1
- Ignoring drug interactions: Review concomitant medications, particularly antivirals and immunosuppressants, before prescribing 1
- Unnecessary dose escalation: Consider adding ezetimibe before increasing rosuvastatin dose, as combination therapy has better tolerability 4
- Premature discontinuation for myalgias: Trial every-other-day or once-weekly dosing before abandoning rosuvastatin entirely 6, 5
- Not monitoring early enough: Assess LDL-C at 4 weeks to ensure adequate response 1