Crestor vs. Simvastatin: How Do They Compare for High Cholesterol?

Statins are first-choice medications for high cholesterol. But with numerous statins on the market, it can make picking the best one for you tricky.

For example, Crestor (rosuvastatin) and simvastatin (Zocor, FloLipid) are statins that work in similar ways. So what sets them apart? Below, we discuss some key differences that healthcare providers may consider when discussing which statin is best for you.

How do Crestor and simvastatin work?

Crestor and simvastatin are both statins, a type of medication that can lower cholesterol. They work by lowering how much low-density lipoprotein (LDL, or “bad cholesterol”) your liver makes.

Our bodies need cholesterol to function. Your liver naturally makes various types of cholesterol. The two types that get the most attention are LDL and high-density lipoprotein (HDL or “good cholesterol”).

You need both LDL and HDL in your body. Problems, such as atherosclerosis (hardening of the arteries), can arise when LDL levels are too high. Over time, atherosclerosis can lead to serious complications, such as a heart attack or stroke.

As mentioned above, Crestor and simvastatin work by reducing how much LDL your liver makes. And this can help lower your risk of developing atherosclerosis and its heart-related complications.

Which is better at lowering cholesterol?

The short answer: High doses of Crestor can lower cholesterol more than high doses of simvastatin.

Certain doses of statins are considered more “intense” than others. A statin’s intensity refers to how much it can lower LDL. There are three statin intensity levels:

• Low intensity: Lower LDL by less than 30%

• Moderate intensity: Lower LDL by 30% to 49%

• High intensity: Lower LDL by 50% or more

Many statins may fit into more than one intensity category, depending on the dose. This is true for Crestor and simvastatin, as well. Lower Crestor dosages (5 mg to 10 mg) are moderate intensity. Higher dosages (20 mg to 40 mg) are high intensity.

No dose of simvastatin qualifies as a high-intensity statin. Low dosages of simvastatin (up to 10 mg) are low intensity. Higher dosages (20 mg to 40 mg) are moderate intensity. So lower Crestor dosages should provide similar LDL-lowering effects as higher simvastatin dosages.

If you need a high-intensity statin, Crestor would be a better option than simvastatin. But not everyone needs a high-intensity statin. They’re typically prescribed if you have a high risk of developing heart-related complications, such as people with LDL levels of 190 mg/dL or more. They may also be prescribed if lower or moderate-intensity statins haven’t worked well enough for you.

How do you take Crestor and simvastatin?

Crestor and simvastatin are typically taken once a day, with or without food. But there are some differences when it comes to the best time of day to take them and managing missed doses.

What time you should take them

You can take Crestor at any time of day. But it’s important to take it at about the same time each day. This helps provide your body with consistent amounts of medication.

On the other hand, you should take simvastatin in the evening. Your liver makes most of its cholesterol overnight. But simvastatin doesn’t stay in your body as long as Crestor. So taking it in the evening means the medication is in your system when more cholesterol is being made. This helps simvastatin have the greatest possible cholesterol-lowering effect.

If you miss a dose

If you miss a dose of Crestor, skip your missed dose. Take your next dose at its regular time. Crestor lasts in your body for a long time. Trying to correct a missed dose can raise your risk of side effects.

If you miss a dose of simvastatin, take it as soon as you remember. But if it’s almost time for your next dose, skip the missed dose. Take your next dose at its usual time.

Regardless of which medication you take, never take a double dose to make up for missed doses. Taking extra statins can lead to unwanted side effects.

What are some common side effects of Crestor and simvastatin?

Statin side effects have made news headlines. This can make people hesitant to take them. But many people who take statins don’t experience these problems.

Side effects from Crestor and simvastatin are similar and commonly include:

• Muscle pain or weakness (more detail below)

• Headache

• Nausea

• Constipation

These aren’t the only possible side effects. Be sure to discuss them with your healthcare provider or pharmacist when taking Crestor or simvastatin. Below, we’ll detail two side effects that tend to get attention: muscle pain and Type 2 diabetes.

Muscle pain

Muscle pain is a side effect that people associate with statins. But it’s not as common as many people think. And the likelihood of experiencing muscle pain is similar for Crestor and most doses of simvastatin.

However, it’s important to note that the 80 mg simvastatin dose has a higher risk for muscle pain and damage compared to other statins and other simvastatin doses. As a result, the FDA recommends that most people avoid taking this dose of simvastatin.

Let your provider know if you develop muscle pain while taking a statin. It often resolves on its own with time. Lowering your statin dose or switching to a different statin are other options that can help.

Type 2 diabetes

Statins are typically recommended for people with Type 2 diabetes. People with diabetes have a higher risk of heart problems, and statins can help lower this risk. But in some cases, statins can raise blood glucose (sugar) and lead to the development of Type 2 diabetes. The risk of this side effect is similar for Crestor and simvastatin.

Experts aren’t sure why this happens. It could be because statins change how the body makes and reacts to its own insulin. If you already have risk factors for developing Type 2 diabetes, your risk of this side effect may be greater.

For most people, the benefits of taking a statin outweigh these potential risks. If you take a statin and have a high risk of developing diabetes, your provider may regularly monitor your blood glucose. Talk with your provider to learn more about your personal risks.

Do Crestor and simvastatin interact with other medications?

Crestor and simvastatin have several interactions to keep in mind. In many instances, interactions raise the risk of statin side effects.

Some medications that interact with both statins include:

• Cyclosporine (Sandimmune)

• Fibrates, especially gemfibrozil (Lopid)

• Colchicine

• Niacin

• Medications containing ritonavir, such as Paxlovid (nirmatrelvir / ritonavir)

Simvastatin has several more interactions to consider, though. For example, it also interacts with grapefruit and macrolide antibiotics, such as erythromycin (EryTab). Crestor doesn’t interfere with these substances.

This isn’t a full list of interactions for either Crestor or simvastatin. And tips for managing interactions depend on which statin you’re taking. Be sure to provide your healthcare provider and pharmacist with a complete medication list. This will help them comprehensively check for Crestor or simvastatin interactions.

Are there other risks with Crestor and simvastatin you should be aware of?

There are other risks with Crestor and simvastatin to discuss with your healthcare provider. Two notable examples are discussed below:

• Pregnancy: Typically, you shouldn’t take Crestor or simvastatin if you’re pregnant. But some studies suggest there are times when statins could be beneficial during pregnancy. Contact your healthcare provider right away if you become pregnant while taking a statin. They’ll help determine if you should continue taking it.

• Alcohol: Liver damage is a rare but serious side effect of Crestor and simvastatin. Consuming alcohol can also damage the liver over time. Combining the two further raises your risk for this side effect. What’s more, alcohol can raise your cholesterol and make it harder for statins to do their job. It’s best to avoid or limit alcohol if you’re taking Crestor or simvastatin.

How to save on Crestor and simvastatin

There are ways to save on Crestor and simvastatin. Both are available as brand-name medications. But you can also find them as lower-cost generics. GoodRx can help you navigate ways to save on your prescription.

• Save with GoodRx. GoodRx can help you save over 90% off the average retail price of the generic versions. Generic rosuvastatin’s price at certain pharmacies is as low as $7.80 with a free GoodRx discount. Generic simvastatin’s price may be as low as $12.60 with a free GoodRx discount.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for patient assistance programs through the PAN Foundation. If eligible, your prescription for either statin (brand-name or generic) may be free of charge.

• Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, brand-name Crestor’s price is as little as $3 for up to a 3-month supply using a savings card from the manufacturer.

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Written by:

Alex Brewer, PharmD, MBA

Alex Brewer, PharmD, MBA, is a licensed pharmacist specializing in chronic disease and health and wellness. Upon completing his residency, he worked in the managed care field, conducting medication therapy management and adherence counseling sessions with Medicaid, Medicare, and private insurance patients, before transitioning to a career in medical writing.

Edited 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.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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