Rosuvastatin

INTRODUCTION

Indications

Adjunctive management of primary hypercholesterolemia and mixed dyslipidemias.

Action

Inhibits 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, an enzyme which is responsible for catalyzing an early step in the synthesis of cholesterol. Therapeutic Effects: Lowering of total and LDL cholesterol and triglycerides. Slightly increases HDL cholesterol. Slows the progression of coronary atherosclerosis.

Adverse Reactions/Side Effects

CNS: weakness. GI: abdominal pain, constipation, nausea. Derm: rash. Metab: RHABDOMYOLYSIS, myalgia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess any joint pain or muscle pain, tenderness, or weakness, especially if accompanied by fever, malaise, and dark-colored urine. Advise patient that these symptoms may represent drug-induced myopathy, and that myopathy can progress to severe muscle damage (rhabdomyolysis). Report any unexplained musculoskeletal symptoms to the physician immediately, and suspend exercise and gait training until these symptoms can be evaluated.

Interventions

• In patients with drug-induced myopathy, implement gradual strengthening and other therapeutic exercises to facilitate recovery from muscle pain and weakness. Use caution during early stages to avoid fatigue of affected muscles, and implement assistive devices (walker, cane, crutches) as needed to prevent falls and assist mobility. Increase exercise intensity as tolerated; recovery from myopathy typically takes 4–6 wk, but can be longer in older patients or people with comorbidities.

• Design and implement aerobic exercise and endurance training programs to improve cardiovascular function and help reduce the risk of coronary heart disease.

Patient/Client-Related Instruction

• Remind patients to take medication as directed to control hyperlipidemia even though they are asymptomatic.

• Counsel patients about additional interventions to help control lipid disorders and improve cardiovascular health, including dietary modification, regular exercise, moderation of alcohol consumption, and smoking cessation.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged skin rash or GI problems such as nausea, constipation, and abdominal pain.

Pharmacokinetics

Absorption: 20% absorbed following oral administration.

Distribution: Unknown.

Metabolism and Excretion: 10% metabolized, 90% excreted unchanged in feces.

Half-life: 19 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Active liver disease or unexplained persistent elevations in AST & ALT; OB: Pregnancy or lactation.

Use Cautiously in: History of liver disease; Alcoholism; Renal impairment; Patients of Asian ancestry (may have ↑ blood levels and ↑ risk of rhabdomyolysis); Concurrent use of gemfibrozil, azole antifungals, protease inhibitors, niacin, ...