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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
It may seem reductive to compare statin drugs such as Crestor to the story of Goldilocks and the Three Bears, but the core idea is the same. Just as Goldilocks wanted a bowl of oatmeal that wasn’t too big or too small, your healthcare provider will look for a dose that’s just right. As with any prescription medication, statins come with potential side effects. The best dosage for you minimizes the risk of experiencing these adverse effects and maximizes the drug’s cholesterol-lowering effects. But that dose, and the process of finding it, may differ from person to person. Here’s what you need to know about how your healthcare provider will find the right Crestor dosage for you.
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What is Crestor, and is generic Crestor different?
Crestor is simply the brand name for the generic medication rosuvastatin (or rosuvastatin calcium); AstraZeneca sells Crestor. Both Crestor and rosuvastatin are statin drugs, also known as HMG-CoA reductase inhibitors. This is a class of prescription drugs that aim to reduce elevated cholesterol levels in people with a high risk of developing cardiovascular disease (also called heart disease). Heart disease is a group of conditions that may cause heart attacks, chest pain, and strokes. Other common statins include atorvastatin (brand name Lipitor), lovastatin (brand name Altoprev), pravastatin (brand name Pravachol), and simvastatin (brand name Zocor).
Rosuvastatin is most well-known for its cholesterol-lowering abilities in people with hyperlipidemia or high cholesterol levels. Rosuvastatin blocks a liver enzyme (HMG-CoA reductase) responsible for making cholesterol, thereby lowering your cholesterol levels (Luvai, 2012). It also encourages your liver to break down cholesterol that’s already in the blood so your body can remove it (Luvai, 2012). By lowering cholesterol, rosuvastatin decreases your risk of developing heart disease because high cholesterol is one of the key risk factors for developing CVD; other risk factors include high blood pressure and smoking (CDC, 2019).
Crestor and generic Crestor (rosuvastatin) are both approved by the U.S. Food and Drug Administration (FDA) for more than their cholesterol-lowering effects (FDA-a, 2016). Both of these medications may be prescribed to (FDA-b, 2016):
- Treatment of high triglycerides (hypertriglyceridemia), along with diet modifications
- Treatment of patients with primary dysbetalipoproteinemia (Type III Hyperlipoproteinemia), a disorder where you have trouble breaking down cholesterol and triglycerides, along with diet modifications
- Treatment of homozygous familial hypercholesterolemia, a genetic condition where you not only have high LDL cholesterol but your liver has a hard time removing cholesterol from the body
Cholesterol levels: LDL, HDL, triglycerides, total cholesterol
Although they aren’t approved uses of rosuvastatin, this prescription drug may also help slow the progression of atherosclerosis (the buildup of plaque on walls of the blood vessels) and raise “good” HDL cholesterol while lowering LDL and total cholesterol (Thondapu, 2019; Adams, 2014).
But what you’re probably wondering is how this generic drug works differently from the brand name, and that question has a simple answer: it doesn’t. Drug companies that develop prescription medications get patents for these chemicals, but those patents can expire. Once they’re expired, a generic form of the mediation can be approved by the FDA for sale (FDA, 2018). That’s what happened to rosuvastatin in April 2016 (FDA, 2016-a). Watson Pharmaceuticals Inc. was the first company to receive approval to produce and market generic Crestor in multiple strengths, but other companies quickly followed.
Whoever makes the generic version of a drug has to prove to the FDA that it’s the same as the brand-name drug before approval—and that’s across multiple facets of the medication. These generic drugs have to have the same efficacy and safety of the original brand-name prescription medication and be offered in the same strength, dosage form, and route of administration (FDA, 2018).
Crestor and generic rosuvastatin are available in four dosages: 5 mg, 10 mg, 20 mg, and 40 mg. In most cases, the dose ranges from 10-20 mg per day. Adults with homozygous familial hypercholesterolemia are generally started at 20 mg daily since clinical trials suggest that this condition may require more aggressive treatment (Lambert, 2014). Regardless of your starting dose, your healthcare provider may recommend blood tests after 2–4 weeks of treatment to see if your dosage needs to be adjusted. It’s important to mention any side effects you’re experiencing at that time because this information may help your healthcare provider tailor the dosage to your individual state of health.
Rosuvastatin should always be stored at room temperature out of the reach of children. In the case of a missed dose, you should take rosuvastatin as soon as you remember unless it’s close to your next dose.
Dosages in people of Asian descent
Researchers aren’t sure why, but clinical trials have shown that rosuvastatin blood levels are sometimes higher in Asian patients, increasing the risk of side effects, so they are often started at a 5 mg dose (Wu, 2017). If cholesterol levels are still high, healthcare providers may increase the rosuvastatin dose.
How to lower cholesterol: medication and lifestyle
Dosages in pediatric patients
The FDA approved Crestor and rosuvastatin for use in pediatric patients as well as adults. Treatment of children is limited to kids with familial hypercholesterolemia, and the dose range varies depending on age (FDA, 2016-b).
Dosages while on other medications
Dosages of this prescription drug may need to be adjusted if it needs to be taken along with certain other medications because of potential drug interactions, including (FDA, 2016-b):
- If you are taking cyclosporine, an immunosuppressant drug, you should not take more than 5 mg daily of rosuvastatin.
- Ideally, you should not take gemfibrozil, a fibrate, with rosuvastatin. But if it’s unavoidable, limit your rosuvastatin dosage to 5mg daily.
- If you’re taking HIV antivirals such as atazanavir and lopinavir/ritonavir or medications for hepatitis C such as simeprevir, limit rosuvastatin to 10 mg daily.
Dosages for patients with kidney disease
Those with severe kidney problems and who are not on hemodialysis should have not more than 10 mg daily.
Rosuvastatin drug interactions
Rosuvastatin may cause adverse effects if combined with other medications at all or in specific dosages. You may need to avoid fibrates such as fenofibrate, niacin, protease inhibitors such as ritonavir/lopinavir and atazanavir, blood thinners such as coumadin, and simeprevir if you are taking rosuvastatin. Combining these medications may be unavoidable; in these cases, your dosage of rosuvastatin may be adjusted to minimize the risk of side effects from drug interactions. Talk to your healthcare provider if you’re on cyclosporine, as this limits the rosuvastatin dosage that may be prescribed safely (FDA-b, 2016).
Rosuvastatin side effects
The most common side effects of rosuvastatin are (FDA-b, 2016):
- Myalgia (muscle pain)
- Asthenia (weakness or lack of energy)
Side effects vary based on your individual dose of Crestor or rosuvastatin. There have also been reports of memory loss and confusion while taking this drug. Talk to your healthcare provider about any side effects you may be experiencing.
What are the bad side effects of Crestor?
Serious side effects of rosuvastatin can rarely happen, including muscle problems (myopathy) and liver disease. It may cause rhabdomyolysis, a breakdown of muscle tissue that, in severe cases, may cause renal failure.
Speak with your healthcare provider right away if you experience unexplained muscle aches or muscle pain (especially in combination with a fever), unusual tiredness or weakness, loss of appetite, abdominal pain, dark urine, or yellowing of the whites of your eyes or skin. These symptoms may be signs of muscle damage, like rhabdomyolysis, or liver disease. Get medical advice right away if you have any symptoms of an allergic reaction such as swelling of the face, lips, or tongue (FDA-b, 2016). Those who are pregnant or may become pregnant should not take rosuvastatin; if you become pregnant while taking this prescription drug, stop it right away and tell your healthcare provider (FDA-b, 2016). Those who are breastfeeding should not take rosuvastatin as the medication may get into breast milk (FDA-b, 2016).
- Adams, S. P., Sekhon, S. S., & Wright, J. M. (2014). Rosuvastatin for lowering lipids. Cochrane Database of Systematic Reviews, (11), cd010254. https://doi.org/10.1002/14651858.cd010254.pub2. Retrieved from https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010254.pub2/full
- AstraZeneca. (2020, July). CRESTOR FAQs. Retrieved Aug. 11, 2020 from https://www.crestor.com/cholesterol-medicine/faqs.html
- Centers for Disease Control and Prevention (CDC). (2019). Know Your Risk for Heart Disease (2019). Retrieved Aug. 11, 2020 from https://www.cdc.gov/heartdisease/risk_factors.htm
- Food and Drug Administration (FDA-a). (2016, April 29). FDA approves first generic Crestor. Retrieved Aug. 10, 2020 from https://www.fda.gov/news-events/press-announcements/fda-approves-first-generic-crestor
- Food and Drug Administration (FDA-b). (2016, March). Highlights of prescribing information for rosuvastatin calcium tablets. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/079167Orig1s000lbl.pdf
- Food and Drug Administration (FDA). (2018, June 01). Generic Drug Facts. Retrieved Aug. 9, 2020 from https://www.fda.gov/drugs/generic-drugs/generic-drug-facts
- Lambert, C. T., Sandesara, P., Isiadinso, I., Gongora, M. C., Eapen, D., Bhatia, N., et al. (2014). Current Treatment of Familial Hypercholesterolaemia. European Cardiology Review, 9(2), 76-81. https://doi.org/10.15420/ecr.2014.9.2.76. Retrieved from https://www.ecrjournal.com/articles/current-treatment-familial-hypercholesterolaemia
- Luvai, A., Mbagaya, W., Hall, A. S., & Barth, J. H. (2012). Rosuvastatin: A Review of the Pharmacology and Clinical Effectiveness in Cardiovascular Disease. Clinical Medicine Insights: Cardiology, 6, 17-33. https://doi.org/10.4137/cmc.s4324. Retrieved from https://journals.sagepub.com/doi/10.4137/CMC.S4324
- Thondapu, V., Kurihara, O., Yonetsu, T., Russo, M., Kim, H. O., Lee, H., et al. (2019). Comparison of Rosuvastatin Versus Atorvastatin for Coronary Plaque Stabilization. The American Journal of Cardiology, 123(10), 1565-1571. https://doi.org/10.1016/j.amjcard.2019.02.019. Retrieved from https://www.ajconline.org/article/S0002-9149(19)30224-3/fulltext
- Wu, H., Hristeva, N., Chang, J., Liang, X., Li, R., Frassetto, L., & Benet, L. Z. (2017). Rosuvastatin Pharmacokinetics in Asian and White Subjects Wild Type for Both OATP1B1 and BCRP Under Control and Inhibited Conditions. Journal of Pharmaceutical Sciences, 106(9), 2751-2757. https://doi.org/10.1016/j.xphs.2017.03.027. Retrieved from https://jpharmsci.org/article/S0022-3549(17)30213-7/fulltext
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.