Atorvastatin, Simvastatin, and More: Your Guide to Comparing Statins
Key takeaways:
Statins are a class of medications used to lower high cholesterol and reduce the risk of heart attack and stroke. Common examples include atorvastatin (Lipitor), simvastatin (Zocor, FloLipid), and rosuvastatin (Crestor).
Statins are often categorized by how much they lower LDL (“bad”) cholesterol. This is referred to as statin “intensity,” which is divided into three categories: low, moderate, and high.
The best statin and dosage for you depends on several factors. Your cholesterol goals, health conditions, and interactions are a few examples.
Table of contents
If you have high cholesterol, you may be prescribed a statin if lifestyle changes alone haven’t been enough. These popular medications are also used to prevent or slow the progression of heart disease. And they can treat high cholesterol caused by inherited (passed down) conditions, too.
You may have heard statins compared in terms of their “intensity.” In short, this means that certain statins doses lower your LDL (“bad”) cholesterol more than others. Each one falls into one of three categories: low-, moderate-, and high-intensity, with reductions ranging from less than 30% to 50% or more.
But does this mean that one statin is better than another? Not necessarily. And there are several other differences between statins to consider, including interactions and when you take them. Below, we’ll discuss seven different statins and how they compare.
1. Lovastatin
Lovastatin became the first FDA-approved statin medication in 1987. Today, it’s available as an immediate-release (IR) tablet approved for use in adults and adolescents ages 10 to 17. It also comes as an extended-release (ER) tablet called Altoprev, which is approved for adults only.
When to take it: If you take lovastatin IR tablets once daily, it’s best to take your dose with your evening meal. If you’re taking two doses per day, take one with your morning meal and the other with your evening meal. The ER tablets are dosed once daily and should be taken on an empty stomach at bedtime.
Interactions: Lovastatin has several interactions that can increase the risk of side effects like muscle pain. Examples include diltiazem (Cardizem) and verapamil (Calan SR).
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Dosage and intensity: Typical lovastatin starting doses (10 mg to 20 mg) are considered to be low intensity. These doses will typically lower LDL by less than 30%. Higher doses (40 mg to 80 mg) are considered moderate intensity. They can lower LDL between 30% and 49%.
Ways to save: Lovastatin tablets are available as a lower-cost generic. With a free GoodRx discount, you could pay as little as $8.25 at certain pharmacies. Lovastatin ER tablets (Altoprev) are only available as a brand-name product.
2. Atorvastatin
Atorvastatin (Lipitor) is one of the most prescribed medications in the U.S. It’s available as an IR tablet approved for use in adults and adolescents ages 10 to 17.
When to take it: Atorvastatin is taken once daily. You can take your dose at any time of day, with or without food.
Interactions: Atorvastatin has many of the same interactions as lovastatin. It can also raise digoxin levels in your body, increasing the risk of digoxin toxicity.
Dosage and intensity: The typical atorvastatin dosage starts at 10 mg to 20 mg daily. These doses are considered to be moderate intensity. However, the 40 mg and 80 mg doses are considered high intensity. This means they can lower LDL by 50% or more. Atorvastatin is one of two high-intensity statins.
Ways to save: Atorvastatin is available as a lower-cost generic. You could pay as little as $6.60 at certain pharmacies with a free GoodRx discount.
3. Simvastatin
Simvastatin is another popular statin medication. It’s available as a tablet (Zocor) and oral suspension (FloLipid). Both products can be taken by adults and adolescents ages 10 to 17.
When to take it: Simvastatin tablets are taken once daily, with or without food. The oral suspension should be taken on an empty stomach. Similar to lovastatin, it’s best to take your dose in the evening.
Interactions: Simvastatin has many of the same interactions as lovastatin and atorvastatin. One interaction that the FDA has highlighted is with amlodipine (Norvasc).
Dosage and intensity: The typical simvastatin dosage starts at 10 mg to 20 mg daily. The maximum dosage is 40 mg daily. The 10 mg dose is considered low intensity, while the 20 mg and 40 mg doses are considered moderate intensity.
Ways to save: Simvastatin tablets are available as a lower-cost generic. The price at certain pharmacies with a free GoodRx discount is as low as $12.60. FloLipid is only available as a brand-name product. It’s available for as low as $ with a free GoodRx discount.
4. Rosuvastatin
Compared to other statins, rosuvastatin tends to have the greatest effect on cholesterol levels. It’s available as a tablet (Crestor) and sprinkle capsule (Ezallor Sprinkle). But unlike other statins covered so far, rosuvastatin is only approved for use in adults.
When to take it: You can take rosuvastatin at any time of day, with or without food. The sprinkle capsule can be swallowed whole, or opened with its contents sprinkled on top of soft food.
Interactions: Rosuvastatin tends to have fewer interactions than the statins listed above. But there are still ones to know about, including Paxlovid (nirmatrelvir/ritonavir).
Dosage and intensity: Typical rosuvastatin dosages range from 5 mg to 40 mg daily. The 5 mg and 10 mg doses are considered moderate intensity. Doses from 20 mg to 40 mg are considered high intensity. Along with atorvastatin, rosuvastatin is one of two high intensity statins.
Ways to save: Rosuvastatin tablets are available as a lower-cost generic. You can pay as little as $7.80 at certain pharmacies with a free GoodRx discount. Ezallor Sprinkle capsules are brand-name only. Their price is as low as $302.33 with a GoodRx discount.
5. Pravastatin
Pravastatin is another statin that’s available as an oral tablet. It’s approved for use in adults and children ages 8 and older.
When to take it: Pravastatin is taken once daily, with or without food. You can take it at any time of day, but it’s recommended to take your dose in the evening.
Interactions: Pravastatin also tends to have fewer interactions than other statins. But unlike rosuvastatin, it doesn’t have a significant interaction with Paxlovid. However, it can interact with certain transplant medications and antibiotics.
Dosage and intensity: The typical pravastatin dosage range is 10 mg to 80 mg daily. The 10 and 20 mg doses are considered low intensity. And the 40 mg to 80 mg doses are considered moderate intensity.
Ways to save: Pravastatin is available as a lower-cost generic. Prices are as low as $14.40 at certain pharmacies with a free GoodRx discount.
6. Pitavastatin
Pitavastatin is a statin that’s available in two forms: pitavastatin calcium (Livalo) and pitavastatin magnesium (Zypitamag). Zypitamag should provide the same benefits as Livalo. But Livalo is approved for use in adults and children ages 8 and older. Zypitamag is only approved for adults.
When to take it: Pitavastatin is taken once daily, at any time of day. You can take it with or without food.
Interactions: Like pravastatin, pitavastatin has fewer interactions, and you can take it with Paxlovid. It can also interact with certain transplant medications and antibiotics.
Dosage and intensity: The typical pitavastatin dosage range is 2 mg to 4 mg daily. Some people may need to start with 1 mg daily. All of these doses are considered moderate intensity.
Ways to save: Pitavastatin is only available as brand-name products: Livalo and Zypitamag. If you have commercial insurance, you could pay as little as $25 for Livalo with a manufacturer savings card. For Zypitamag, you could pay as little as $10 with a manufacturer savings card.
7. Fluvastatin
Fluvastatin is available as an IR capsule and ER tablet (Lescol XL). Both forms are approved for use in adults and adolescents ages 10 to 16.
When to take it: Fluvastatin IR capsules are taken once or twice daily, with or without food. If you take it once daily, it’s best to take your dose in the evening. Fluvastatin ER tablets, on the other hand, can be taken at any time of day.
Interactions: Fluvastatin has similar interactions to rosuvastatin. It can also interact with fluconazole (Diflucan) and glyburide (Diabeta, Glynase).
Dosage and intensity: The typical fluvastatin dosage range is 20 mg to 80 mg daily. The 20 mg and 40 mg doses are considered low intensity. If you’re taking two 40 mg IR capsules or one 80 mg ER tablet, these are considered moderate intensity.
Ways to save: Fluvastatin capsules and tablets are available as lower-cost generics. At certain pharmacies, the capsule price is as low as $42.28 and the tablet price is as low as $108.30 with a free GoodRx discount.
Are all statins equally effective?
The short answer: No.
Certain statins have a greater effect on lowering LDL levels than others. These include the two high-intensity statins: rosuvastatin and atorvastatin. And certain doses of statins can have higher (or lower) intensity, too.
That said, many people don’t need a high-intensity statin. And in some cases, your dosage may be lower due to other health conditions, drug interactions, or side effects. But when it comes to preventing heart disease, significant differences haven’t been found between statins.
Your healthcare provider can help you determine which statin is best for you. If any side effects become bothersome, they may adjust your dose or switch you to a different statin.
The bottom line
Statins are a class of medications used to lower high cholesterol and reduce the risk of heart attack and stroke. Atorvastatin, simvastatin, and rosuvastatin are common examples.
Statin doses are often categorized as low, moderate, and high intensity. Atorvastatin and rosuvastatin are the only two statins with high-intensity doses. Your cholesterol goals, medical conditions, and other factors may determine which statin is right for you.
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References
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