Comparison · Medication vs Medication
Atorvastatin vs rosuvastatin
The two high-intensity statins share a mechanism and most of their effects. They differ in potency per milligram, in how they are cleared, and therefore in which other medicines and conditions limit their dose. This comparison describes those differences; the choice of statin and dose is made by a prescriber.
| Aspect | Atorvastatin | Rosuvastatin |
|---|---|---|
| Drug class and target | Statin; HMG-CoA reductase | Statin; HMG-CoA reductase |
| LDL reduction | About 40-55% across 10-80 mg | About 45-63% across 5-40 mg (roughly twice as potent per milligram) |
| Metabolism | CYP3A4: levels raised by clarithromycin, itraconazole, ciclosporin, some HIV medicines and grapefruit juice | Minimal CYP metabolism; levels raised by ciclosporin (contraindicated), gemfibrozil, some HIV medicines; grapefruit irrelevant |
| Kidney impairment | No dose adjustment | Start 5 mg and maximum 20 mg when eGFR 30-60; contraindicated below 30 |
| Ethnicity | No specific adjustment | Asian ancestry: start 5 mg, maximum 20 mg (about twice the exposure) |
| Shared cautions | Active liver disease, pregnancy and breastfeeding, myopathy, fusidic acid | Active liver disease, pregnancy and breastfeeding, myopathy, fusidic acid |
| Monitoring | Lipids and liver tests at baseline, 3 and 12 months; CK if muscle symptoms | As atorvastatin, plus kidney function to set the dose and urine dipstick at high doses |
| Licensed status | Prescription only (UK, US, EU) | Prescription only (UK, US, EU) |
Where Atorvastatin fits
The usual first choice in UK guidance (20 mg for primary prevention, 80 mg for secondary prevention); no dose limit in kidney impairment
Where Rosuvastatin fits
An alternative when atorvastatin is not tolerated or targets are not met, or when CYP3A4 interactions are a problem; dose capped by kidney function and ethnicity
Educational content. A comparison explains what each test, marker or medicine is for and how they differ. It is educational and does not say which one a person should have; that decision belongs to the clinician who knows the person and the question.