Adults

The usual starting dose is 5 mg or 10 mg once daily. For patients with marked hypercholesterolemia (e.g., LDL-C > 190 mg/dL) and aggressive lipid targets, a 20 mg starting dose may be considered. The dose can be adjusted after 2-4 weeks. Maximum dose is 40 mg once daily.

Elderly

No dosage adjustment is generally required for patients >70 years old, but a 5 mg starting dose is recommended.

Renal_impairment

For patients with severe renal impairment (CrCl < 30 mL/min/1.73m²), excluding those on hemodialysis, the starting dose should be 5 mg once daily and should not exceed 10 mg once daily. No dose adjustment is needed for mild to moderate renal impairment.

Onset

Lipid-lowering effects typically begin within 1 week, with 90% of the maximum response usually achieved within 2 weeks.

Excretion

Approximately 90% of a rosuvastatin dose is excreted unchanged in the feces, with the remainder excreted in the urine.

Half life

The elimination half-life of rosuvastatin is approximately 19 hours.

Absorption

Approximately 20% of rosuvastatin is absorbed after oral administration, with peak plasma concentrations achieved in 3-5 hours.

Metabolism

Rosuvastatin undergoes limited metabolism, primarily by CYP2C9 (approximately 10% of total metabolism). N-desmethyl rosuvastatin is the major metabolite.

Gemfibrozil

Increases rosuvastatin exposure (about 2-fold). Avoid co-administration. If necessary, limit rosuvastatin to 10 mg once daily.

Cyclosporine

Concomitant use significantly increases rosuvastatin exposure (up to 7-fold). Avoid co-administration. If necessary, limit rosuvastatin to 5 mg once daily.

Warfarin and other Coumarin Anticoagulants

Increases INR. INR should be monitored when rosuvastatin is started or discontinued, or dosage is changed.

Protease Inhibitors (e.g., Atazanavir/Ritonavir, Lopinavir/Ritonavir)

Significant increase in rosuvastatin exposure. Dose adjustment of rosuvastatin may be necessary; consult prescribing information.