Why are kidney function requirements required when taking rosuvastatin? What else should we pay attention to?

A friend left a message asking Huazi, what precautions should be taken when taking rosuvastatin? Huazi said that rosuvastatin is one of the only two powerful statins, the other powerful statin is atorvastatin. When taking rosuvastatin, you need to be careful not to exceed the safe dose and the requirements for kidney function.

Taking rosuvastatin requires kidney function. It does not damage the kidneys , but some rosuvastatin needs to be excreted through the kidneys. If the kidney function is not good, it is easy to cause rosuvastatin accumulation and increase toxic reactions. In fact, rosuvastatin also has a protective effect on the kidneys.

1. The largest dose of "double standards" at home and abroad

A friend who has lived abroad told Huazi that the maximum daily dose of rosuvastatin abroad is 40 mg, but the maximum daily dose of rosuvastatin in China is 20 mg. Why is there a "double standard" for the maximum dose of the same drug at home and abroad? Is it because of the drug?

Huazi said that this situation has nothing to do with the drugs, but that the Chinese people have different physical constitutions from foreigners and have a low tolerance to statins . This is especially true for rosuvastatin. When taking the same dose, the area under the drug concentration curve for Chinese people is twice that of Europeans and Americans.

Therefore, in order to reduce adverse reactions, the maximum dose of rosuvastatin abroad is 40 mg per day, while in China the maximum dose is reduced by half to 20 mg per day .

2. Rosuvastatin, which has a kidney-protecting effect

Because the drug instructions state that it is contraindicated for people with severe renal insufficiency, many people believe that rosuvastatin has an impact on the kidneys. However, this is a misunderstanding. A small part of rosuvastatin needs to be excreted through the kidneys. For people with severe renal insufficiency (creatinine clearance <30mL/min), drug excretion will be impaired, which will cause drug accumulation and cause toxic reactions .

However, for people with mild to moderate renal insufficiency, taking rosuvastatin does not affect drug excretion, but actually has a protective effect on the kidneys by lowering blood lipids, alleviating renal artery atherosclerosis, and improving kidney blood supply.

In trials with high doses (40 mg daily), transient, intermittent proteinuria was observed in most cases but was not considered a precursor to renal disease.

3. Rosuvastatin and Atorvastatin

In foreign clinical trials, rosuvastatin can reduce low-density lipoprotein cholesterol (LDL-C) levels by up to 63%, making it the most potent lipid-lowering statin . Atorvastatin can reduce LDL-C levels by up to 55%.

However, compared with atorvastatin, rosuvastatin has a slightly higher incidence of adverse reactions, so atorvastatin is usually chosen during initial statin treatment, and rosuvastatin is only used when it is intolerant or contraindicated .

Atorvastatin needs to be metabolized by liver enzymes and interacts with many drugs, while only a small part of rosuvastatin is metabolized by liver enzymes and has few interactions with other drugs. For patients with multiple coexisting diseases who need to use multiple drugs in combination, rosuvastatin is more suitable .

4. Pay attention to adverse reactions when using

During medication, pay attention to the effect on liver function. Although rosuvastatin is rarely metabolized by the liver, its "workplace" is in the liver cells, which may affect liver function. Therefore, pay attention to the level of transaminase (AST, ALT) during medication. If it exceeds 3 times the normal upper limit, it is recommended to stop the medication .

Statins have the adverse reaction of muscle damage. During medication, you may experience muscle soreness and fatigue, and may also cause rare but fatal rhabdomyolysis. Therefore , you should pay attention to creatine kinase (CK) during medication. If it exceeds 5 times the normal upper limit, you should stop taking the drug .

Rosuvastatin may cause abnormal blood sugar levels and increase the risk of new-onset diabetes. However, elevated blood sugar levels are not an indication for discontinuation of the drug . It is recommended to use hypoglycemic drugs in combination to control blood sugar levels and maintain statin treatment as much as possible.

In summary, rosuvastatin will not harm the kidneys, but in patients with severe renal insufficiency, it will affect the excretion of the drug and may cause cumulative poisoning. Rosuvastatin has fewer interactions with other drugs and is more suitable for multi-drug combination. Pay attention to adverse reactions during medication. It is recommended to recheck blood lipids, liver function, kidney function, and creatine kinase in the first, third, and sixth months of medication to evaluate the efficacy and prevent adverse reactions.

The medicine should be taken under the guidance of a doctor. If you have any questions about the use of the medicine, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.