Rosuvastatin (Crestor) vs. Atorvastatin (Lipitor): 5 Ways They Compare for High Cholesterol

Statins are among the most commonly prescribed medications for lowering cholesterol levels. Two of the most widely used statins are rosuvastatin (Crestor) and atorvastatin (Lipitor, Atorvaliq). Both medications work the same way. But they have differences in potency, potential interactions, and available dosage forms.

If you’re not sure which statin might be right for you, we review five ways that rosuvastatin and atorvastatin compare below.

1. Rosuvastatin and atorvastatin work the same way to lower cholesterol

Both rosuvastatin and atorvastatin belong to a class of medications called HMG-CoA reductase inhibitors, commonly known as statins. They work by blocking an enzyme (protein) called HMG-CoA reductase in the liver, which plays a key role in cholesterol production. By reducing cholesterol production, statin medications:

• Lower LDL (“bad”) cholesterol, which is the main contributor to plaque buildup in the arteries

• Slightly raise HDL (“good”) cholesterol, which helps remove LDL from the bloodstream

• Reduce triglycerides, a type of fat in the blood that can contribute to heart disease

Rosuvastatin and atorvastatin are approved to treat high cholesterol levels from different causes. Atorvastatin is also approved to lower the risk of serious cardiovascular problems, such as heart attack, in adults with or at higher risk of heart disease. Rosuvastatin is approved for this use in adults with heart disease risk factors.

2. Rosuvastatin is generally more potent than atorvastatin

Even though rosuvastatin and atorvastatin work the same way, their potency isn’t the same. Rosuvastatin is about twice as potent as atorvastatin. This means you need a lower dose to achieve the same cholesterol-lowering effects.

How much a statin lowers LDL cholesterol is referred to as its “intensity.” Statins are categorized as low, moderate, and high intensity based on their ability to lower LDL cholesterol levels by a certain percentage. This ranges from less than 30% for low-intensity statins to 50% or more for high-intensity statins.

EXPERT PICKS: WHAT TO READ NEXT

• Statin side effects: You may have heard that statin medications can cause muscle pain. Here’s what you should know about statin side effects and how to manage them.

• Statins and alcohol: Is it safe to drink alcohol while taking a statin? Learn how alcohol can affect statin side effects, liver health, and cholesterol levels.

• Real stories: Three people describe their experiences with taking rosuvastatin (Crestor) for high cholesterol — from benefits to side effects.

The right statin and dose for you depends on your treatment goals. Here’s how rosuvastatin and atorvastatin doses compare for intensity:

3. Both rosuvastatin and atorvastatin can be taken at any time of day

Shorter-acting statins are best taken at night because the liver produces the most cholesterol while you sleep. But rosuvastatin and atorvastatin can be taken at any time of day. This is because their effects last long enough to lower cholesterol at night, even if you take them in the morning.

Though you can take them at any time of the day, you should take rosuvastatin or atorvastatin at the same time each day. This helps keep the amount of medication in your system consistent and allows you to establish a routine to stay on track with your doses.

4. Atorvastatin comes in an oral liquid if you have difficulty taking pills

If you have trouble swallowing pills, atorvastatin is available as an oral liquid (Atorvaliq). In contrast, rosuvastatin only comes in tablet form. Rosuvastatin used to come as Ezallor Sprinkle, a capsule that could be opened and sprinkled onto soft foods. But that form has been discontinued. In this case, atorvastatin may be a better option if taking pills is an issue.

Another difference between their dosage forms is that atorvastatin comes in combination products. If you also take amlodipine (Norvasc) or ezetimibe (Zetia), you can get them in a single pill with atorvastatin to simplify your medication regimen:

• Amlodipine / atorvastatin (Caduet)

• Atorvastatin / ezetimibe (Lypqozet)

Rosuvastatin used to be available with ezetimibe in a combination pill called Roszet. But similar to Ezallor Sprinkle, Roszet is no longer available.

5. Rosuvastatin may have fewer interactions compared to atorvastatin

Another key difference between rosuvastatin and atorvastatin is how they are broken down in the liver. This can affect how they interact with certain medications, foods, and drinks. Some interactions apply to all or most statins. But in general, rosuvastatin tends to have fewer interactions than atorvastatin.

Atorvastatin is broken down by an enzyme (protein) called CYP3A4, which is thought to break down about half of all medications on the market. Some medications and substances can speed up or slow down the activity of this enzyme, which can affect atorvastatin levels in the body. Examples of atorvastatin interactions include:

• Azole antifungals, such as ketoconazole

• Macrolide antibiotics, such as erythromycin (Ery-Tab)

• Rifampin (Rifadin)

• Grapefruit (fruit and juice)

Rosuvastatin, on the other hand, is primarily broken down by the enzyme CYP2C9. CYP2CP breaks down about 15% of medications on the market. Examples of rosuvastatin interactions include:

• Antacids that contain magnesium or aluminum

• Febuxostat (Uloric)

• Teriflunomide (Aubagio)

• Darolutamide (Nubeqa)

Make sure your healthcare team has your full medication list, including over-the-counter products and supplements, for review. They can help determine if rosuvastatin or atorvastatin is a better fit for your treatment plan.

How to choose

Rosuvastatin and atorvastatin are both effective medications for treating high cholesterol levels and lowering cardiovascular risks. The best option for you can depend on factors such as:

• Your treatment goals

• If you take medications that interact with rosuvastatin or atorvastatin

• If you have difficulty taking pills and would prefer a liquid option

• If you would prefer to have a combination product option to reduce the number of pills you take each day

How to save on rosuvastatin and atorvastatin

Rosuvastatin and atorvastatin are both available as brand-name medications and lower-cost generics. GoodRx can help you save money on your prescription. The price of generic rosuvastatin is as low as $7.80 and the price of generic atorvastatin is as low as $6.60 at certain pharmacies with GoodRx discounts.

For brand-name Crestor, you could pay as little as $3 for a 30- to 90-days supply with a manufacturer copay card.

Why trust our experts?

Written by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Our editorial standards

Meet our experts