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Drug Info

Switching from atorvastatin to rosuvastatin

Atorvastatin and rosuvastatin are both effective in reducing bad cholesterol. Here’s how to safely switch.
Keith Gardner, RPh, medical writer and reviewer for SingleCare
By | Jan. 14, 2025
Three Rx bottles: Switching from atorvastatin to rosuvastatin

Key takeaways

  • Atorvastatin and rosuvastatin are different medicines but belong to the same class of drugs (HMGCoA reductase inhibitors, more commonly referred to as statins), and both are effective in lowering cholesterol levels.

  • People taking atorvastatin may want to switch to rosuvastatin because of the side effects they are experiencing or because their therapeutic goals are not being met with atorvastatin.

  • Although no waiting period is necessary when discontinuing atorvastatin and initiating rosuvastatin therapy, your prescribing healthcare professional can provide guidance on dosage conversion.

  • Both drugs may cause similar side effects like nausea, muscle aches and pain, and joint pain, but there are some differences that your healthcare professional can explain to you.

In this article:

Many drug types help treat high blood cholesterol (hyperlipidemia). One class of drugs often considered first-line therapy are HMGCoA reductase inhibitors, more commonly referred to as statins. They work by blocking an enzyme called HMG-CoA reductase that your body needs to make cholesterol.

Atorvastatin, also known by the brand name Lipitor, and rosuvastatin, also known by the brand name Crestor, are two commonly prescribed statins used to lower cholesterol levels. Both drugs are approved by the U.S. Food and Drug Administration (FDA), along with a diet low in saturated fat and cholesterol, to lower cholesterol. Although atorvastatin and rosuvastatin are both statins, they are not the same. You may wonder whether it is possible to switch from atorvastatin to rosuvastatin. The answer is yes, as long as your healthcare provider approves. However, there are some essential things to consider before switching, including differences in dosing and cost. 

What are the benefits of switching from atorvastatin to rosuvastatin?

Although both atorvastatin and rosuvastatin have been found to be effective when taken for certain types of high cholesterol conditions or in patients with cardiovascular risks, there may be reasons for changing from atorvastatin to rosuvastatin. Both have similar costs (available as lower-cost generics) and dosing regimens (once daily dosing). Still, certain people may have differences in effectiveness and side effect profiles. The most effective medication for you can be determined by your healthcare provider, who can consider your medical condition, history, and other medications you take. 

Atorvastatin vs. rosuvastatin comparison chart
Atorvastatin Rosuvastatin
Drug class HMGCoA reductase inhibitor (statin) HMGCoA reductase inhibitor (statin
Brand name Lipitor Crestor
Dosage forms available 10, 20, 40, and 80 mg tablets 5, 10, 20, and 40 mg tablets
Dose/frequency Starting dose 10 or 20 mg once daily Starting dose 20 mg once daily
Who can use the medication Adults; children 10 years and older (for some indications) Adults; children 7 years and older (for some indications)
Approximate retail cost (generic) $123 for 30, 20 mg tablets  $82 for 30, 20 mg tablets
SingleCare cost (generic) $11+ for 30, 20 mg tablets $15+ for 30, 20 mg tablets

Conditions treated by atorvastatin and rosuvastatin

Atorvastatin and rosuvastatin are used to reduce blood cholesterol. They should be used as an adjunct to a diet low in saturated fat and cholesterol to lower total cholesterol, low-density lipoprotein cholesterol (LDL), apolipoprotein B (ApoB), and triglycerides. They also increase high-density lipoprotein (HDL) cholesterol, the good kind of cholesterol. Complete conditions treated are listed in the chart below. 

Atorvastatin Rosuvastatin
Condition Applicable? Applicable?
Lower the level of low-density lipoprotein (LDL) cholesterol in adults with primary hyperlipidemia Yes Yes
Lower cholesterol due to heterozygous familial hypercholesterolemia in adults and children  Yes; adults and children ≥10 years  Yes; adults and children ≥7 years 
Lower cholesterol in adults and children with homozygous familial hypercholesterolemia in adults and children Yes; adults and children ≥10 years  Yes; adults and children ≥8 years 
Treat adults with primary dysbetalipoproteinemia (type III hyperlipoproteinemia) Yes Yes
Lower the blood levels of fat (triglycerides) in adults with hypertriglyceridemia Yes Yes
Reduce the risk of heart attack, stroke, certain types of heart surgery, and chest pain in adults who do not have heart disease but have other multiple risk factors for heart disease Yes Yes
Reduce the risk of heart attack and stroke in adults with Type 2 diabetes mellitus who do not have heart disease but have other multiple risk factors Yes Off-label
Reduce the risk of heart attack that does not cause death, stroke, certain types of heart surgery, hospitalization for congestive heart failure, and chest pain in adults with heart disease Yes Yes
Slow the buildup of fatty deposits (plaque) in the walls of blood vessels Off-label Yes

Effectiveness

In clinical trials, both atorvastatin and rosuvastatin were found to be effective and well-tolerated. Two clinical studies compared the two medications.

In the STELLAR Trial (Statin Therapies for Elevated Lipid Levels Compared Across Doses to Rosuvastatin), researchers compared the reduction of low-density lipoprotein (LDL) cholesterol of rosuvastatin with atorvastatin and two other statins: pravastatin (brand name Pravachol) and simvastatin (brand name Zocor). Study participants were given a range of doses for six weeks. The study concluded that atorvastatin lowered LDL cholesterol by 8.2% more than rosuvastatin and lowered total cholesterol significantly more than rosuvastatin. Atorvastatin also increased HDL cholesterol (the good cholesterol) more than rosuvastatin. In patients who took atorvastatin, 82-89% (depending on dose) achieved LDL cholesterol goals, compared to 69-85% of patients who took rosuvastatin. Drug tolerability, i.e., side effects, was similar for all four study drugs.

A second study called the SATURN Trial (Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin versus Atorvastatin) compared high doses of atorvastatin (40 mg daily) and rosuvastatin (80 mg daily) and their effect on the progression of coronary atherosclerosis (the narrowing of blood vessels and buildup of calcium and fatty deposits in the arteries). Coronary atherosclerosis increases the risk of coronary heart disease. After the study participants took the higher doses for two years, the atorvastatin group had lower LDL and slightly higher HDL levels than the rosuvastatin group. Both medications had acceptable side-effect profiles.

Side effects

Because atorvastatin and rosuvastatin are in the same statin drug family, they share many of the same side effects. However, there are some differences. Some of the side effects reported in clinical trials of these medications are listed below.

A rare but serious side effect of both atorvastatin and rosuvastatin is myopathy (muscle pain, tenderness, and weakness) and rhabdomyolysis (the breakdown of muscle tissue). Tell your healthcare provider right away if you experience unexplained muscle pain, tenderness, or weakness, especially if you have a fever or feel more tired than usual. 

Atorvastatin Rosuvastatin
Side effect Applicable? Frequency Applicable? Frequency
Headache No – Yes 5.5%
Nausea Yes 4% Yes 3.4%
Muscle aches/pain Yes 3.8% Yes 2.8%
Joint pain Yes 6.9% Yes Varies
Pain in extremities Yes 6% No –
Urinary tract infection Yes 5.7% No –
Weakness Yes 6.9% Yes 2.7%
Indigestion Yes 4.7% No –
Constipation No – Yes 2.4%
Diarrhea Yes 6.8% No –
Abdominal pain Yes Varies Yes ≥2%
Common cold Yes 8.3% No –

This is not a complete list. Consult your healthcare provider for other possible side effects.

Source: DailyMed (atorvastatin), DailyMed (rosuvastatin)

How to switch from atorvastatin to rosuvastatin

If you are experiencing side effects or if your cholesterol is not being well-controlled on atorvastatin, you may need to switch to another statin drug such as rosuvastatin. In consultation with your prescribing healthcare professional, they may consider the side effects you’re experiencing, your other medical conditions, and specific cholesterol targets before recommending a switch. If you decide to switch from atorvastatin to rosuvastatin, your healthcare provider can explain the dosage conversion.

Side effects from stopping atorvastatin and starting rosuvastatin

Although there were no notable adverse effects when trial participants switched from atorvastatin to rosuvastatin in a clinical study, consult your prescribing healthcare professional about the best way to transition from one medication to another.

Can you take rosuvastatin and atorvastatin together?

It is not recommended that two statins be taken at the same time. Using atorvastatin together with rosuvastatin may increase the risk of nerve damage and other side effects. 

The bottom line

Although atorvastatin and rosuvastatin are both HMGCoA reductase inhibitors (commonly referred to as statins) and both have proven safe and effective in lowering cholesterol levels, there may be reasons, such as side effects or not reaching therapy goals, for you to consider switching to a different statin such as rosuvastatin. Because both are prescription-only medicines, you will need to discuss making the change with your prescribing healthcare professional. They can explain how to transition from atorvastatin to rosuvastatin, the equivalent doses, and any new side effect concerns to be aware of.