Adults

Initial dose is 5 mg once daily. For primary hypercholesterolemia, usual dose is 5-20 mg once daily. Max dose is 40 mg once daily, used only for patients with severe hypercholesterolemia and high cardiovascular risk who have not achieved their treatment goal on 20 mg and who will be routinely monitored.

Elderly

A starting dose of 5 mg once daily is recommended for patients >70 years old. No other dosage adjustment is typically needed unless severe renal impairment.

Renal_impairment

Severe renal impairment (CrCl <30 mL/min): Start with 5 mg once daily, max 10 mg once daily. No dose adjustment needed for mild to moderate renal impairment.

Onset

Significant lipid-lowering effect seen within 1 week, maximal effect achieved within 2-4 weeks.

Excretion

Primarily via feces (90%), with about 5% excreted in urine.

Half life

Approximately 19 hours.

Absorption

Peak plasma concentration (Cmax) occurs 3-5 hours post-dose. Absolute bioavailability is approximately 20%.

Metabolism

Minimal metabolism, primarily by CYP2C9 (approximately 10% of metabolism). The main metabolite is N-desmethyl rosuvastatin.

Ezetimibe

Concomitant use may increase the risk of myopathy.

Ciclosporin

Concomitant use significantly increases rosuvastatin exposure (AUC) and is contraindicated.

Gemfibrozil

Increases rosuvastatin exposure; co-administration should be avoided.

Warfarin and other Vitamin K antagonists

May enhance anticoagulant effect; INR should be monitored when starting or stopping rosuvastatin.

Antacids (aluminum and magnesium hydroxide)

Administer rosuvastatin at least 2 hours after antacid administration as antacids decrease rosuvastatin plasma concentration.

Protease inhibitors (e.g., ritonavir-boosted lopinavir)

May significantly increase rosuvastatin exposure; dose adjustment or discontinuation may be necessary.