Rosuvastatin

Oral
Mixed dyslipidaemia
Adult: Dosage is individualised based on treatment goals, patient response and clinical practice guidelines. Initially, 5 or 10 mg once daily; may increase after 4 weeks if necessary. Usual Max: 20 mg once daily; a Max of 40 mg once daily may be used only in patients with severe hypercholesterolaemia at high CV risk who do not achieve the target cholesterol concentration at lower doses and who do not have risk factors for adverse effects. Patients with homozygous familial hypercholesterolaemia may be started on 20 mg once daily. Dosage may be increased at intervals of 2-4 weeks.
Child: Heterozygous familial hypercholesterolaemia: Initially, 5 mg once daily. Usual dose range: 6-9 years 5-10 mg once daily; 10-17 years 5-20 mg once daily. Familial homozygous hypercholesterolaemia: 6-17 years Initially, 5 or 10 mg once daily, depending on age, weight and prior statin use, may titrate dose up to Max of 20 mg once daily according to individual response and tolerability, and depending on treatment recommendations.
Elderly: >70 years Initially, 5 mg once daily.
Renal impairment:

CrCl (ml/min)	Dosage Recommendation
<30	Contraindicated.
30-60	Initially, 5 mg once daily (Max: 20 mg once daily).

Hepatic impairment: Active liver disease: Contraindicated.

Oral
Hypercholesterolaemia
Adult: Dosage is individualised based on treatment goals, patient response and clinical practice guidelines. Initially, 5 or 10 mg once daily; may increase after 4 weeks if necessary. Usual Max: 20 mg once daily; a Max of 40 mg once daily may be used only in patients with severe hypercholesterolaemia at high CV risk who do not achieve the target cholesterol concentration at lower doses and who do not have risk factors for adverse effects. Patients with homozygous familial hypercholesterolaemia may be started on 20 mg once daily. Dosage may be increased at intervals of 2-4 weeks.
Child: Heterozygous familial hypercholesterolaemia: Initially, 5 mg once daily. Usual dose range: 6-9 years 5-10 mg once daily; 10-17 years 5-20 mg once daily. Familial homozygous hypercholesterolaemia: 6-17 years Initially, 5 or 10 mg once daily, depending on age, weight and prior statin use, may titrate dose up to Max of 20 mg once daily according to individual response and tolerability, and depending on treatment recommendations.
Elderly: >70 years Initially, 5 mg once daily.
Renal impairment:

CrCl (ml/min)	Dosage Recommendation
<30	Contraindicated.
30-60	Initially, 5 mg once daily (Max: 20 mg once daily).

Hepatic impairment: Active liver disease: Contraindicated.

Oral
Prophylaxis of cardiovascular events in high-risk patients
Adult: 20 mg once daily.
Elderly: >70 years Initially, 5 mg once daily.
Renal impairment:

CrCl (ml/min)	Dosage Recommendation
<30	Contraindicated.
30-60	Initially, 5 mg once daily (Max: 20 mg once daily).

Hepatic impairment: Active liver disease: Contraindicated.

Special Populations: Patients of Asian ancestry; those with predisposing factors to myopathy (e.g. hypothyroidism, personal or familial history of hereditary muscular disorders; alcohol abuse): Initially, 5 mg once daily. 40 mg dose is contraindicated. Patients receiving concomitant therapy: Ciclosporin: Avoid use. If use cannot be avoided, Max rosuvastatin dose is 5 mg once daily. Gemfibrozil: Avoid use. If use cannot be avoided, initiate rosuvastatin at 5 mg once daily. Max: 10 mg once daily. Atazanavir/ritonavir, lopinavir/ritonavir, or simeprevir: Initiate rosuvastatin at 5 mg once daily. Max: 10 mg once daily. Pharmacogenomics: The SLCO1B1 gene, which encodes the transporter protein OATP1B1, and the efflux transporter ABCG2, both play a role in the disposition of rosuvastatin and mediate the hepatic uptake of statins. Genetic polymorphism in SLCO1B1 or ABCG2 may affect the plasma concentrations of rosuvastatin. rs4149056 (SLCO1B1) Patient with CC or CT genotype may have higher plasma concentrations of rosuvastatin but no change in LDL-cholesterol (LDL-C) levels has been noted. Other genetic and clinical factors may also influence the metabolism and response of the patient to rosuvastatin. Patient with TT genotype may have lower plasma concentrations of rosuvastatin but no change in LDL-C levels has been noted. Other genetic and clinical factors may also influence the metabolism and response of the patient to rosuvastatin. rs2231142 (ABCG2) Patient with GG genotype may have 1) lower plasma concentrations of rosuvastatin 2) reduced response to treatment as determined by a lower reduction in LDL-C. Other genetic and clinical factors may also influence a patient's response to rosuvastatin treatment and pharmacokinetics. Patient with GT genotype may have 1) lower plasma concentrations of rosuvastatin 2) reduced response to treatment as determined by a lower reduction in LDL-C, or may have 1) higher plasma concentrations of rosuvastatin 2) better response to treatment as determined by a higher reduction in LDL-C. Other genetic and clinical factors may also influence a patient's response to rosuvastatin treatment and pharmacokinetics. Patient with TT genotype may have 1) higher plasma concentrations of rosuvastatin 2) better response to treatment as determined by a higher reduction in LDL-C. Other genetic and clinical factors may also influence a patient's response to rosuvastatin treatment and pharmacokinetics.

May be taken with or without food.

Active liver disease, including unexplained, persistent elevations of serum transaminases; myopathy. Severe renal impairment (CrCl <30 mL/min). Pregnancy and lactation.

Patient with hypothyroidism; history of hereditary muscular disorders or muscular toxicity with another HMG-CoA reductase inhibitor or fibrates; excessive alcohol consumption, history of liver disease, severe respiratory failure. Patients of Asian ancestry, those with predisposing factors to myopathy or those taking concomitant ciclosporin, gemfibrozil, atazanavir/ritonavir, lopinavir/ritonavir, or simeprevir. Patient with SLCO1B1 and ABCG2 polymorphism. Moderate renal impairment (CrCl 30-60 mL/min). Children and elderly. Monitoring Parameters Obtain lipid panel (HDL, LDL, total cholesterol, triglycerides) prior to therapy, then every 4-12 weeks after initial therapy and every 3-12 months thereafter; LFT prior to therapy and as needed thereafter; creatine phosphokinase when myopathy is considered or in high-risk patients.

Significant: Myopathy, myalgia, diabetes mellitus, haematuria, proteinuria, interstitial lung disease, liver enzyme abnormalities, increased creatine phosphokinase levels. Blood and lymphatic system disorders: Rarely, thrombocytopenia. Gastrointestinal disorders: Abdominal pain, constipation, nausea. General disorders and administration site conditions: Asthenia. Hepatobiliary disorders: Rarely, pancreatitis, hepatitis, jaundice. Immune system disorders: Hypersensitivity (e.g. angioedema). Musculoskeletal and connective tissue disorders: Rarely, arthralgia, muscle rupture, Lupus-like syndrome. Nervous system disorders: Dizziness, headache, peripheral neuropathy. Psychiatric disorders: Depression, sleep disorders (e.g. insomnia, nightmares). Reproductive system and breast disorders: Rarely, gynaecomastia. Skin and subcutaneous tissue disorders: Pruritus, rash, urticaria.
Potentially Fatal: Rarely, rhabdomyolysis with acute renal failure secondary to myoglobinuria, hepatic failure.

Increased exposure with certain protease inhibitors (e.g. ritonavir-boosted regimens, simeprevir), gemfibrozil, ezetimibe, ciclosporin, colchicine. Decreased plasma concentration with Al- and Mg-containing antacids, erythromycin. May increase INR when given with vit K antagonists (e.g. warfarin). May increase the plasma concentration of oral contraceptives. May increase risk of myopathy with concurrent use of strong CYP3A4 inhibitors (e.g. clarithromycin, itraconazole), fenofibrate, nicotinic acid.

Rosuvastatin selectively and competitively inhibits 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, the rate-limiting enzyme in cholesterol synthesis. It increases the number of hepatic LDL receptors on the cell surface, thereby enhancing the uptake and catabolism of LDL. It also decreases apolipoprotein B, triglyceride and increases HDL concentrations.
Onset: Within 1 week.
Absorption: Incompletely absorbed from the gastrointestinal tract. Time to peak plasma concentration: 3-5 hours. Bioavailability: Approx 20%.
Distribution: Enters breast milk. Volume of distribution: 134 L. Plasma protein binding: Approx 90%, mainly to albumin.
Metabolism: Limited metabolism in the liver via CYP2C9 isoenzyme into N-desmethyl (approx 50% less active) and lactone metabolites (inactive).
Excretion: Via faeces (approx 90%, mainly as unchanged drug); urine (approx 5%, as unchanged drug). Elimination half-life: Approx 19 hours.

Oral: Store between 20-25°C. Protect from moisture.

Dyslipidaemic Agents

C10AA07 - rosuvastatin ; Belongs to the class of HMG CoA reductase inhibitors. Used in the treatment of hyperlipidemia.