Atorvastatin and rosuvastatin are generic cholesterol medications that are widely used to lower LDL. Both of these medications frequently show up in the top 10 most frequently used medications. I wanted to provide a comparison of atorvastatin versus rosuvastatin to give you the subtle differences in pharmacokinetics and other important medication factors.
CYP3A4 plays a role in atorvastatin metabolism. Because of this fact, atorvastatin (drug interactions post) has a few more drug interactions compared to rosuvastatin. Rosuvastatin is excreted primarily in the feces as unchanged drug with a very minor percentage being altered by CYP2C9.
Efficacy and Potency
Both drugs are very effective at lowering LDL but rosuvastatin has been proven to have a slightly more potent effect. The URANUS study did show this effect. “Rosuvastatin reduced LDL-C levels significantly more than atorvastatin during the fixed-dose and titration periods (p < 0.0001). Significantly more patients reached the 1998 LDL-C goal with rosuvastatin 10 mg compared with atorvastatin 10 mg at 4 weeks (81% vs 65%, p < 0.001).”
Potency is an expression of the activity of a drug in terms of the concentration or amount of the drug required to produce a defined effect. Essentially, which medication can produce a greater effect at a lower dose. In this case, rosuvastatin is more potent because it can cause more LDL lowering at lower dosages.
Cognitive impairment/Memory Loss
First and foremost, the risk for cognitive issues associated with statins is very low. The only evidence that I’m aware of is case reports. In this report “Statin-associated memory loss: analysis of 60 case reports and review of the literature” it was found that lipophilic statins seemed to have a greater incidence of causing cognitive loss. It should be noted this evidence is very old from 2003 and rosuvastatin wasn’t approved until this year.
The above reasons are why I generally prefer rosuvastatin over atorvastatin when first selecting a statin for use in a patient who needs one. Please feel free to leave a comment below if I missed something that you would consider in this comparison.
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