Rosuvastatin is a selective and competitive inhibitor of HMG-CoA reductase, the enzyme responsible for converting 3-hydroxy-3-methyl glutaryl coenzyme A to mevalonate, a precursor of cholesterol. Rosuvastatin exerts its lipid-modifying properties in two ways. First, it increases the number of hepatic LDL receptors on the cell surface, which improves LDL absorption and catabolism. Second, rosuvastatin suppresses hepatic VLDL production, lowering the overall amount of VLDL and LDL particles.
Dosage & Administration
Dose range: 5-40 mg once daily. Initially 5-10 mg once daily increased if
necessary at intervals of at
least 4 weeks to 20 mg once daily. Daily dose can be increased after further 4 weeks to 40 mg only in
severe hypercholesterolaemia with high cardiovascular risk and under specialist supervision. Dose for
elder patients initially 5 mg once daily.
@ HoFH: Starting dose 20 mg.
@ In pediatric patients 10 to 17 years of age with HeFH, the usual dose range is 5-20 mg/day; doses greater than 20 mg have not been studied in this patient population.
@ Use 40 mg dose only for patients not reaching LDL-C goal with 20 mg. Rosuvastatin can be taken with or without food, at any time of day.
Remarkable drug interactions of Rosuvastatin are-
Cyclosporine: Combination increases Rosuvastatin exposure. Rosuvastatin dose should be limited to 5 mg once daily.
Gemfibrosil: Combination should be avoided. If used together, Rosuvastatin dose should be limited to 10 mg once daily.
Lopinavir/Ritonavir or atazanavir/ritonavir: Combination increases Rosuvastatin exposure.
Rosuvastatin dose should be to 10 mg once daily.
Coumarin anticoagulants: Combination prolongs international normalized ratio (INR).
Stable INR should be achieved prior to starting Rosuvastatin. INR should be monitored frequently until stable upon initiation or alteration of Rosuvastatin therapy.
Concomitant lipid-lowering therapies: Use with fibrates and niacin products may increase the risk ofskeletal muscle effects.
Rosuvastatin is contraindicated if-
Known hypersensitivity to product components
Active liver disease, which may include unexplained persistent elevations in hepatic transaminase levels
women and women who may become pregnant
Rosuvastatin is generally well tolerated. The adverse events seen with Rosuvastatin are generally mild and transient. Most commonly occurring side-effects are headache, myalgia, asthenia, constipation, dizziness, nausea, abdominal pain. Uncommonly pruritus, rash and urticaria may occur. Myopathy (including myositis), hypersensitivity reactions (including angioedema), rhabdomyolysis, pancreatitis etc are the rarely occurring side-effects of Rosuvastatin.
Pregnancy & Lactation
Rosuvastatin should be administered to women of childbearing age only when such patients are highly unlikely to conceive and have been informed of the potential hazards. If the patient becomes pregnant while taking this drug, therapy should be discontinued and the patient apprised of the potential hazard to the fetus. Because of the potential for adverse reactions in nursing infants, women taking Rosuvastatin should not breast-feed.
Precautions & Warnings
Skeletal muscle effects (e.g., myopathy and rhabdomyolysis): Risks increase with use of 40 mg dose, advanced age (>65 year), hypothyroidism, renal impairment, and combination use with cyclosporine, lopinavir/ritonavir, atazanavir/ritonavir, or certain other lipid-lowering drugs. Patients should be advised to promptly report unexplained muscle pain, tenderness or weakness. Rosuvastatin can be discontinued if signs or symptoms appear.Liver enzyme abnormalities and monitoring: Persistent elevations in hepatic transaminases can occur. Liver enzymes should be monitored before and during treatment.
Statins and other anti-anginal and anti-ischaemic medications
Keep below 30oC temperature, protected from light & moisture. Keep out of the reach of children.