Rosuvastatin (Crestor)
One of the most potent statins available, rosuvastatin lowers LDL (“bad”) cholesterol more aggressively than most alternatives. Can be taken any time of day, unlike some other statins.
What it's used for
High cholesterol (hyperlipidemia), prevention of cardiovascular events (heart attack, stroke) in at-risk patients, and slowing the progression of atherosclerosis. Also approved for primary prevention in patients with elevated C-reactive protein (CRP) even with normal cholesterol.
Typical dosing (adults)
- Starting: 10–20 mg once daily (5 mg for Asian patients or those on certain interacting drugs).
- Range: 5–40 mg daily. The 40 mg dose is reserved for patients not at goal on 20 mg.
- Can be taken at any time of day, with or without food.
- Cholesterol levels are typically rechecked 4–12 weeks after starting or changing dose.
Key interactions
- Cyclosporine: major — dramatically raises rosuvastatin levels; dose must be capped at 5 mg.
- Gemfibrozil: major — significantly increases risk of muscle damage (rhabdomyolysis); avoid combination.
- Warfarin: moderate — rosuvastatin may enhance warfarin's blood-thinning effect; monitor INR when starting.
- Antacids (aluminum/magnesium): minor — reduce rosuvastatin absorption; take antacid at least 2 hours after statin.
- Certain HIV protease inhibitors (lopinavir/ritonavir): major — raise rosuvastatin levels; dose limits apply.
Common side effects
Muscle aches and pains (myalgia, reported in 5–10% of patients), headache, nausea, abdominal pain, and weakness. Elevated liver enzymes (usually mild and reversible). Rare but serious: rhabdomyolysis (severe muscle breakdown — seek immediate care for unexplained severe muscle pain, dark urine, or weakness), new-onset diabetes (slight increased risk at higher doses).
Who should be cautious
- Liver disease (active liver disease or unexplained persistent elevated liver enzymes — do not use).
- Kidney disease (dose adjustment needed; max 10 mg in severe cases).
- Asian descent (higher blood levels at same dose; start at 5 mg).
- Pregnancy and breastfeeding (statins are contraindicated).
- History of muscle problems with other statins.
What to ask your pharmacist
- Should I be concerned about the muscle aches I'm experiencing?
- Do I need regular liver function tests while on rosuvastatin?
- Can I eat grapefruit? (Rosuvastatin is less affected than atorvastatin, but worth asking.)
- I'm taking an antacid daily — when is the best time to separate them?
- How does rosuvastatin compare to atorvastatin for my situation?