ROSUDEX FILM-COATED TABLET 20MG

TABLET, FILM COATED

**Recommended Dosage:** The dosage of rosuvastatin should be individualized according to the goal of therapy and patient response. The recommended starting dose is 5 or 10 mg once daily in both statin naive patients or patients switched from another HMG-CoA reductase inhibitor. The choice of starting dose should take into account the individual patient’s cholesterol level and future cardiovascular risk as well as the potential risk for adverse reactions. A dose adjustment to the next dose level can be made after 4–6 weeks, if necessary (see **Pharmacodynamics** – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). Increasing the dose to 40 mg should be reserved for patients with severe hypercholesterolemia at high cardiovascular risk (in particular those with familial hypercholesterolemia), who do not achieve their treatment goal on 20 mg and should only be initiated under close specialist supervision (see **Warnings and Precautions** – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). The physician who elects to use rosuvastatin at doses higher than 20 mg should periodically reevaluate the long-term risk/benefit of rosuvastatin for the individual patient. Rosuvastatin should be prescribed with caution in patients with predisposing factors for myopathy/rhabdomyolysis (see **Warnings and Precautions- _Skeletal muscle_** – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). Rosuvastatin may be given at any time of day, with or without food. _**Use in Asian population**_ Increased plasma concentration of rosuvastatin has been observed in Asian subjects including subjects of Japanese, Chinese, Malay, and Indian ancestry (see **Warnings and Precautions** and **Pharmacokinetics** – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). Increased systemic exposure, which is considered a predisposing factor for myopathy, should be taken into consideration when making dose decisions for Asian patients. Initiation of rosuvastatin therapy with 5 mg once daily should be considered for Asian patients. This should take into account the individual patient’s cholesterol level and future cardiovascular risk as well as the potential risk for adverse reactions. Doses exceeding 20 mg are not generally recommended and should only be considered for patients with high cardiovascular risk whose hypercholesterolemia is not controlled with doses up to 20 mg. In rare cases where rosuvastatin at doses higher than 20 mg is indicated, initiation of therapy should be under close specialist supervision. The physician who elects to use rosuvastatin at doses higher than 20 mg should periodically reevaluate the long-term risk/benefit of rosuvastatin for the individual patient. _**Use in children**_ In pediatric patients with heterozygous familial hypercholesterolemia the recommended starting dose of rosuvastatin is 5 mg taken orally once daily. The rosuvastatin dose should be individualized according to baseline LDL-C levels and the recommended goal of therapy. The maximum daily dose in this patient population is 10 mg. Adjustments should be made at intervals of 4 weeks or more. The safety and efficacy of rosuvastatin doses greater than 20 mg have not been studied in this population. Treatment experience in pediatric patients with heterozygous familial hypercholesterolemia is limited to 52 weeks. _**Use in the elderly**_ No dose adjustment is necessary. _**Dosage in patients with renal insufficiency**_ No dose adjustment is necessary in patients with mild to moderate renal impairment. For patients with severe renal impairment the use of rosuvastatin is contraindicated (see **Pharmacokinetics** – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). _**Dosage in patients with hepatic insufficiency**_ The usual dose range applies in patients with mild hepatic impairment \[Child-Pugh scores of ≤7\]. Increased systemic exposure to rosuvastatin has been observed in patients with moderate hepatic impairment \[Child-Pugh scores of 8 or 9\]. There is no experience in patients with severe hepatic impairment. Rosuvastatin is contraindicated in patients with active liver disease (see **Pharmacokinetics** – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). _**Genetic polymorphisms**_ Genotypes of SLCO1B1 (OATP1B1) c.521CC and ABCG2 (BCRP) c.421AA have been shown to be associated with an increase in rosuvastatin exposure (AUC) compared to SLCO1B1 c.521TT and ABCG2 c.421CC. For patients known to have the c.521CC or c.421AA genotype, a maximum once daily dose of 20 mg of rosuvastatin is recommended (see **Warnings and Precautions, Interactions with Other Medicines and Other Forms of Interaction,** and **Pharmacokinetics** – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). _**Concomitant therapy**_ Rosuvastatin is a substrate of various transporter proteins (e.g., OATP1B1 and BCRP). The risk of myopathy (including rhabdomyolysis) is increased when rosuvastatin is administered concomitantly with certain medicinal products that may increase the plasma concentration of rosuvastatin due to interactions with these transporter proteins (e.g., ciclosporin and certain protease inhibitors including combinations of ritonavir with atazanavir, lopinavir, and/or tipranavir (see **Warnings and Precautions** and **Interactions with Other Medicines and Other Forms of Interaction** – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). It is recommended that prescribers consult the relevant product information when considering administration of such products together with rosuvastatin. Whenever possible, alternative medications should be considered, and if necessary, consider temporarily discontinuing rosuvastatin therapy. In situations where coadministration of these medicinal products with rosuvastatin is unavoidable, the benefit and the risk of concurrent treatment and rosuvastatin dosing adjustments should be carefully considered (see **Interactions with Other Medicines and Other Forms of Interaction** – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_).