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Key takeaways
Atorvastatin and simvastatin are both statins used to lower “bad” cholesterol (LDL) and reduce the risk of heart attack and stroke, but they differ in potency, dosage, and side effects.
Atorvastatin, known as Lipitor, has a longer half-life, making it a more potent option than simvastatin. You can take atorvastatin anytime, whereas you should take Lipitor at night.
Simvastatin, known as Zocor, has a higher risk of causing muscle pain or weakness, especially at higher doses, and is a prodrug that becomes active after being metabolized in the liver.
Both medications have similar long-term treatment goals for managing cholesterol levels and preventing cardiovascular events. Still, the choice between them depends on individual patient factors, including potential side effects and how the drug is metabolized.
Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
Atorvastatin and simvastatin are two commonly prescribed statin drugs that treat high cholesterol. Your doctor may prescribe one of these medications if you have high levels of LDL (low-density lipoprotein) cholesterol, also known as the “bad” cholesterol. By lowering cholesterol levels, atorvastatin or simvastatin can help reduce the risk of heart attack and stroke.
More specifically, atorvastatin and simvastatin work as HMG-CoA reductase inhibitors. By blocking the HMG-CoA reductase enzyme, these statins decrease the production of cholesterol in the liver. With less cholesterol circulating in the blood, the body is able to reabsorb excess cholesterol and lower overall cholesterol levels.
Atorvastatin and simvastatin may work in similar ways but they have some differences in dosage, administration, and possible side effects.
What are the main differences between atorvastatin and simvastatin?
Atorvastatin is also known by its brand name, Lipitor, which was FDA-approved in 1996. Among other uses, it is prescribed to decrease the risk of heart attack or stroke in those with coronary heart disease.
Atorvastatin (What is Atorvastatin?) has a long half-life of 14 hours. The drug is active once it’s absorbed, and its lipid-lowering activity can last for 20 to 30 hours after administration. Along with rosuvastatin, or Crestor, atorvastatin is a more potent drug than other statins like simvastatin and pravastatin.
Atorvastatin is available in 10 mg, 20 mg, 40 mg, and 80 mg tablets. The recommended starting dose is 10 or 20 mg once daily although a regular dose can range from 10 to 80 mg once daily. Atorvastatin can be taken at any time of the day.
Simvastatin (What is Simvastatin?) is also known by its brand name, Zocor. Compared to atorvastatin, simvastatin is an older drug that was first FDA approved in 1991. Like other statins, it is used to decrease the risk of heart attack and stroke in those with cardiovascular risks.
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Unlike atorvastatin, simvastatin is a prodrug. Meaning, it is not active until it is metabolized, or processed, in the liver. After being processed, simvastatin turns into its active form, simvastatin acid, which has a half-life of around one to two hours.
Simvastatin is available in strengths of 5 mg, 10 mg, 20 mg, 40 mg, and 80 mg. The recommended starting dose is 10 or 20 mg once daily, and a normal dose can range from 5 to 40 mg per day. Simvastatin is recommended to be taken at night.
| Main differences between atorvastatin and simvastatin | ||
|---|---|---|
| Atorvastatin | Simvastatin | |
| Drug class | HMG-CoA reductase inhibitor Statin |
HMG-CoA reductase inhibitor Statin |
| Brand/generic status | Brand and generic version available | Brand and generic version available |
| What is the brand name? | Lipitor | Zocor |
| What form(s) does the drug come in? | Oral tablet | Oral tablet |
| What is the standard dosage? | 10 to 80 mg once daily | 5 to 40 mg once daily |
| How long is the typical treatment? | Treatment with atorvastatin is long-term to manage cholesterol levels and maintain a lower risk of heart attack and stroke. | Treatment with simvastatin is long-term to manage cholesterol levels and maintain a lower risk of heart attack and stroke. |
| Who typically uses the medication? | Adults; children and adolescents aged 10 to 17 years old with heterozygous familial hypercholesterolemia (HeFH) | Adults; children and adolescents aged 10 to 17 years old with heterozygous familial hypercholesterolemia (HeFH) |
Conditions treated by atorvastatin and simvastatin
Atorvastatin and simvastatin are used for similar purposes. They both treat high cholesterol levels (hypercholesterolemia), high lipid levels (hyperlipoproteinemia), and high triglyceride levels (hypertriglyceridemia). At the same time, statins can help increase HDL cholesterol, a type of “good” cholesterol that has protective effects against cardiovascular disease.
Atorvastatin and simvastatin can also reduce the risk of heart attack and stroke in the following:
- Adults without coronary heart disease (CHD) who have multiple risk factors
- Adults with Type 2 diabetes without CHD, but who have multiple risk factors
- Adults with diagnosed CHD
Risk factors for cardiovascular events may include high blood pressure (hypertension) and high blood sugar (diabetes).
Atorvastatin and simvastatin can reduce cholesterol and lipid levels in those with genetic lipid disorders, such as homozygous familial hypercholesterolemia (HoFH). These statins can also treat children and adolescents (10-17 years of age) with heterozygous familial hypercholesterolemia (HeFH).
The treatment of atherosclerosis, or fatty deposits on the blood vessel walls, is another reason why atorvastatin or simvastatin may be prescribed. By decreasing plaque on blood vessel walls, these statins can help alleviate symptoms such as chest pain (angina).
| Condition | Atorvastatin | Simvastatin |
| Hypercholesterolemia | Yes | Yes |
| Hyperlipoproteinemia | Yes | Yes |
| Hypertriglyceridemia | Yes | Yes |
| Heart attack and stroke prevention | Yes | Yes |
| Atherosclerosis | Yes | Yes |
Is atorvastatin or simvastatin more effective?
Atorvastatin and simvastatin are both effective statin medications. Studies have shown that those who take their statin medication at least 90% of the time have a 45% reduced risk of dying from a heart attack, stroke, or any cause. In general, statins are very effective at decreasing cholesterol levels and lowering the incidence of heart attack and stroke.
No strong head-to-head trials comparing atorvastatin and simvastatin have been conducted. However, atorvastatin is considered a more potent drug than simvastatin. In one recent comparative study, atorvastatin was found to be more effective at lowering LDL cholesterol (LDL-C) than simvastatin. This study compiled results from 50 randomized, clinical trials, and compared other statin drugs like fluvastatin, pravastatin, rosuvastatin, and lovastatin. Rosuvastatin had the highest potency for lowering LDL levels in the study.
In one systematic review, 75 different studies comparing statin medications were analyzed. According to study group results, a daily dose of atorvastatin 10 mg can decrease LDL cholesterol by 30%-40% while a daily dose of simvastatin 10 mg can decrease LDL cholesterol by 20%-30%. However, the clinical effects of this difference may not be significant.
Consult your healthcare provider to determine the best statin treatment for you. The effectiveness of statins will depend on your medical and family history, among other factors.
Coverage and cost comparison of atorvastatin vs. simvastatin?
Atorvastatin is available as a generic drug that is almost always covered by Medicare and other insurance plans. It is prescribed as a daily pill that can be dispensed in a 30-day or 90-day supply. The average cash price of atorvastatin can run up to $250. However, the price can be lowered to $15 with a SingleCare atorvastatin coupon.
Simvastatin is also available as a generic drug. As a commonly prescribed statin, simvastatin is usually covered by Medicare and insurance plans. The average retail price of simvastatin is around $470. However, with a discount card for simvastatin, like SingleCare, you can expect to pay less than $10 for a 30-day supply of 20 mg tablets at participating pharmacies.
| Atorvastatin | Simvastatin | |
| Typically covered by insurance? | Yes | Yes |
| Typically covered by Medicare Part D? | Yes | Yes |
| Standard dosage | 10 mg once daily (quantity of 30) | 20 mg once daily (quantity of 30) |
| Typical Medicare copay | $0–$16 | $0–$9 |
| SingleCare cost | $15+ | $10+ |
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Common side effects of atorvastatin vs. simvastatin?
The most common side effects of statins, such as atorvastatin and simvastatin, include digestive problems like diarrhea, indigestion, and nausea. Other side effects include dizziness and swelling of the hands, legs, or feet (edema). Statins may also cause muscle pain (myalgia) or muscle weakness (myopathy).
The risk of muscle pain increases with higher doses of statins. However, compared to atorvastatin, simvastatin is considered to have a higher risk of myalgia. Some people may also have a genetic predisposition to myalgia from simvastatin. Although all statins have a risk of causing muscle pain as a side effect, the FDA has limited the use of simvastatin 80 mg tablets because of increased risk.
Other common side effects can be found in the table below.
| Atorvastatin | Simvastatin | |||
| Side effect | Applicable? | Frequency | Applicable? | Frequency |
| Joint pain | Yes | 7% | Yes | 0.1% |
| Diarrhea | Yes | 7% | Yes | * |
| Constipation | No | – | Yes | 2% |
| Indigestion | Yes | 5% | Yes | * |
| Nausea | Yes | 4% | Yes | 6% |
| Muscle pain | Yes | 4% | Yes | 4% |
| Urinary tract infection | Yes | 6% | Yes | 3% |
| Nasopharyngitis | Yes | 8% | No | – |
| Dizziness | Yes | * | Yes | 5% |
| Edema | Yes | * | Yes | 3% |
*not reported
Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Atorvastatin), DailyMed (Simvastatin)
Drug interactions of atorvastatin vs. simvastatin
Atorvastatin and simvastatin are primarily processed in the liver by the CYP3A4 enzyme. Drugs that inhibit, or block, this enzyme can cause increased levels of atorvastatin or simvastatin in the blood. When taken with a CYP3A4 inhibitor like clarithromycin or itraconazole, atorvastatin may cause an increased risk of muscle pain (myalgia) or muscle weakness (myopathy). Grapefruit juice is also a CYP3A4 inhibitor that can increase levels of atorvastatin and simvastatin. On the other hand, drugs like rifampin and carbamazepine are CYP3A4 inducers that can decrease the levels of atorvastatin and simvastatin in the body.
Protease inhibitors, such as ritonavir and lopinavir, can cause increased levels of statins in the body. High statin levels in the blood can lead to an increased risk of adverse effects, including myalgia. Fibrate drugs and niacin can also increase the risk of myalgia when taken with atorvastatin or simvastatin.
Taking atorvastatin with oral contraceptives can cause increased blood levels of the contraceptive medication.
Taking statins with warfarin has been reported to cause increased levels of warfarin and an increased risk of bleeding. However, atorvastatin is not likely to interfere with the effects of warfarin.
| Drug | Drug class | Atorvastatin | Simvastatin |
| Clarithromycin Erythromycin Itraconazole Ketoconazole Grapefruit juice |
CYP3A4 inhibitors | Yes | Yes |
| Rifampin Carbamazepine |
CYP3A4 inducers | Yes | Yes |
| Ritonavir Lopinavir Simeprevir Darunavir |
Protease inhibitors | Yes | Yes |
| Gemfibrozil Fenofibrate |
Fibrates | Yes | Yes |
| Niacin | Antihyperlipidemic | Yes | Yes |
| Digoxin | Cardiac glycoside | Yes | Yes |
| Norethindrone Ethinyl estradiol |
Oral contraceptives | Yes | No |
| Warfarin | Anticoagulant | No | Yes |
Consult a healthcare professional for other possible drug interactions.
Warnings of atorvastatin and simvastatin
Both atorvastatin and simvastatin can cause adverse events involving muscle pain (myalgia) or muscle weakness (myopathy). In severe cases, these statins can also cause rhabdomyolysis, or the rapid breakdown of skeletal muscle. A rare form of myopathy, called immune-mediated necrotizing myopathy (IMNM) has also been reported with statin use.
Atorvastatin and simvastatin are mainly metabolized in the liver. Therefore, their use may cause abnormalities in liver enzyme levels. Liver enzymes should be monitored throughout statin therapy. People with liver disease should also be monitored or avoid statins altogether.
Atorvastatin and simvastatin should be avoided in pregnant women and mothers who are nursing. These statins may have an increased risk of birth defects.
Frequently asked questions about atorvastatin vs. simvastatin?
What is atorvastatin?
Atorvastatin, also known by its brand name Lipitor, is a statin medication used to lower cholesterol and decrease the risk of heart attack and stroke. The normal dose range of atorvastatin is between 10 to 80 mg per day. Atorvastatin has a long half-life of 14 hours and can be taken at any time of the day.
What is simvastatin?
Simvastatin is also known by its brand name, Zocor. It is a statin medication that can decrease cholesterol levels, which, in turn, can help decrease the risk of heart attack and stroke. The normal dose range of simvastatin is five to 40 mg per day. Simvastatin has a relatively short half-life and is recommended to be taken in the evening.
Are atorvastatin and simvastatin the same?
Atorvastatin and simvastatin both belong to a drug class called HMG-CoA reductase inhibitors, or statins. They are both used to lower LDL cholesterol levels. However, they have some differences in available strengths and how they’re taken.
Is atorvastatin or simvastatin better?
Atorvastatin and simvastatin are both effective statin drugs for lowering blood cholesterol. However, atorvastatin is considered a more potent statin. Atorvastatin lasts longer in the body and can be taken in the morning or at night. Simvastatin has a higher risk of muscle pain or weakness than atorvastatin, especially at higher doses. The prescribing doctor will determine the most effective statin on a case-by-case basis.
Can I use atorvastatin or simvastatin while pregnant?
Atorvastatin and simvastatin should not be used during pregnancy. Cholesterol levels may increase during pregnancy and are necessary to support a growing fetus. Therefore, there’s no benefit to taking these statins during pregnancy. They may also cause fetal harm during pregnancy.
Can I use atorvastatin or simvastatin with alcohol?
According to cardiology experts, alcohol consumption in moderation is generally safe with statin use. Excessive alcohol consumption that has led to liver disease is where problems may arise. Liver enzymes should be monitored throughout treatment with a statin.
Which statin has the least amount of side effects?
Statins are generally safe with minimal adverse side effects. According to the American Heart Association (AHA), the benefits of statins outweigh the potential risk of side effects. However, certain statins, such as pravastatin and fluvastatin, may have a lower risk of myalgia than simvastatin and atorvastatin. Compared to statins given in lower doses, high-dose statins are more likely to cause side effects. For instance, an 80 mg dose of simvastatin has the greatest risk of causing myalgia. For this reason, the FDA has limited this dose of simvastatin only to certain people.
What are the long-term side effects of atorvastatin?
Long-term side effects of atorvastatin and statin therapy can vary depending on the person. Long-term side effects of statins may include muscle pain, liver damage, increased blood sugar, and problems with memory. However, the risk of long-term side effects is considered low when the drug is prescribed and administered properly.
Is atorvastatin bad for your kidneys?
The dose of atorvastatin does not need to be adjusted in those with kidney problems. In some people with severe kidney problems, atorvastatin use may need to be monitored.
In general, atorvastatin is not dangerous for the kidneys. However, atorvastatin use may lead to an increased risk of rhabdomyolysis, which can then lead to acute renal failure in severe cases. Talk to your doctor if you have a history of kidney problems before starting on a statin drug.