Atorvastatin Versus Rosuvastatin Comparison

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.

Drug Interactions

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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  1. Thabat

    Did Rosuvastatin show to be associated with “Statin-associated memory loss” from 2003 evidence from literature review? If not, which statin specifically has this medical concern?

    Thank you

    • Eric Christianson

      Unfortunately from that older literature review, rosuvastatin wasn’t FDA approved until 2003 so I don’t think there was any real data from the medication.

    • Ilene

      The URANUS study states “significantly more patients reached the 1998 LDL-C goal with rosuvastatin 10 mg compared with atorvastatin 10 mg at 4 weeks”, but rosuvastatin 10 mg and atorvastatin 10 mg are not equivalent. They are both moderate intensity doses but, rosuvastatin 5 mg is equivalent to atorvastatin 10 mg. So, it makes sense that rosuvastatin 10 mg has better results than atorvastatin 10 mg. I don’t think that proves that rosuvastatin is better, at least with regards to potency.

  2. TL, NP

    I’ve definitely seen better adherence due to less muscle ache with rosuvastatin in practice. Rosuvastatin is also my first choice when starting patients on a statin. Thanks for all your work in keeping us educated on best practice

    • Thiago

      Hello, Eric! Thanks for your site, it is very supportive! Concerning the statins, do you know if there is any difference in terms of clinical outcomes between rosuvastatin and atorvastatin? Thank you!


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Written By Eric Christianson

July 26, 2023

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