What is a moderate dose of rosuvastatin (generic name) for an adult patient with known heart disease and impaired renal function?

Moderate-Dose Rosuvastatin Definition

Moderate-intensity rosuvastatin is defined as 5-10 mg once daily, which achieves a 30-50% reduction in LDL-C. 1

Dosing Framework by Intensity

The ACC/AHA guidelines establish three intensity categories for statin therapy based on expected LDL-C reduction 1:

• Low-intensity: Not applicable for rosuvastatin in standard practice
• Moderate-intensity: Rosuvastatin 5-10 mg daily (30-50% LDL-C reduction) 1
• High-intensity: Rosuvastatin 20-40 mg daily (≥50% LDL-C reduction) 1, 2

Special Considerations for Renal Impairment

Mild to Moderate Renal Impairment (CrCl ≥30 mL/min)

• No dose adjustment required for moderate-intensity therapy (5-10 mg daily) 3
• Standard moderate-intensity dosing (5-10 mg) remains appropriate for patients with known heart disease 2
• Pharmacokinetic studies show only 9.7-17% reduction in clearance with mild-to-moderate renal impairment, which is not clinically significant 4

Severe Renal Impairment (CrCl <30 mL/min)

• Initiate at 5 mg once daily and do not exceed 10 mg daily 2, 3
• This maximum dose of 10 mg daily represents the upper limit of moderate-intensity therapy 2, 5
• Plasma concentrations increase approximately 2-fold in severe renal impairment, necessitating dose limitation to prevent myopathy 2, 3

Clinical Context for Heart Disease Patients

For patients with established heart disease, the treatment approach differs based on renal function 2:

• Mild-moderate renal impairment (CrCl ≥30 mL/min): High-intensity therapy (20-40 mg) is recommended unless contraindicated 2
• Severe renal impairment (CrCl <30 mL/min): Maximum dose is 10 mg daily (moderate-intensity), even though high-intensity would otherwise be preferred 2, 3

Important Caveat for Dialysis Patients

Do not initiate rosuvastatin in patients already on hemodialysis, though continuation is reasonable if already established on therapy 2, 5. The AURORA trial demonstrated no cardiovascular benefit with rosuvastatin 10 mg in hemodialysis patients 2, 5.

Practical Implementation

When prescribing moderate-intensity rosuvastatin 1, 3:

• Assess LDL-C as early as 4 weeks after initiation and adjust dosage accordingly 2, 3
• Administer at any time of day, with or without food 3
• If taking aluminum/magnesium antacids, administer rosuvastatin at least 2 hours before the antacid 3
• Monitor for myopathy risk, especially in patients >65 years, with hypothyroidism, or on interacting medications 2

Asian Patient Considerations

Asian patients require a lower starting dose of 5 mg daily regardless of renal function due to 2-fold higher plasma concentrations 2, 3, 4. Consider risks and benefits when treating Asian patients not adequately controlled at doses up to 20 mg daily 3.