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Key takeaways
Rosuvastatin is a potent statin drug capable of lowering cholesterol levels and reducing the risk of major cardiovascular events, like heart attacks.
If rosuvastatin is found to be suboptimal due to price or side effects, other statins may prove to be worthwhile substitutes.
Zetia is a popular prescription alternative to statins, even if its potency pales in comparison to rosuvastatin.
PCSK9 inhibitors and Nexletol are newer options that establish roles as effective remedies for cholesterol and cardiovascular disease, although their costs are a concern.
A healthy diet and exercise efforts pair well with rosuvastatin but typically do not replace it.
Rosuvastatin is a remarkable cholesterol medication with proponents rightfully touting the statin’s strength in reducing bad cholesterol or low-density lipoprotein (LDL) levels. Besides simply lowering LDL, the drug is approved by the Food and Drug Administration (FDA) for reducing the risk of cardiovascular events like heart attacks. The brand-name version, Crestor, has been around for years, and now, generic rosuvastatin is available as a lower cost option. Despite all the accolades, rosuvastatin is not always the right fit, perhaps due to adverse effects or price. Alternatives abound though, and we will cover them here.
What can I take in place of rosuvastatin?
If rosuvastatin does not agree with you due to side effects or cost, other types of statins may still be a good choice. Outside of the statin category, Zetia (ezetimibe) is a common pick. Fibrates, such as Tricor and Lopid, and bile acid sequestrants, like Welchol and Questran, have historically been drug classes that can substitute for statins, but they are not used as often anymore. PCSK9 inhibitors and bempedoic acid are newer drugs to consider when rosuvastatin and its fellow statins must be foregone.
Deciding between the options is not easy. It is important to know whether LDL alone in hyperlipidemia needs to be lowered or if triglycerides, which are circulating fats, should be reduced too, as in hypertriglyceridemia. Preventing cardiovascular events, such as heart attacks or strokes, from happening or recurring is another salient goal for cholesterol medication. Let’s dive into the details of the decisions about lipid management.
| Compare rosuvastatin (Crestor) alternatives | |||
|---|---|---|---|
| Drug name | Uses | Dosage | Savings options |
| Crestor (rosuvastatin) | Hyperlipidemia, hypertriglyceridemia, atherosclerotic disease, and cardiovascular event risk reduction | 5 to 40 mg orally once daily | Crestor coupons |
| Lipitor (atorvastatin) | Hyperlipidemia, hypertriglyceridemia, atherosclerotic disease, and cardiovascular event risk reduction | 10 to 80 mg orally once daily | Lipitor coupons |
| Pravastatin | Hyperlipidemia, hypertriglyceridemia, atherosclerotic disease, and cardiovascular event risk reduction | 10 to 80 mg orally once daily | Pravastatin coupons |
| Zocor (simvastatin) | Hyperlipidemia, hypertriglyceridemia, atherosclerotic disease, and cardiovascular event risk reduction | 5 to 40 mg orally once daily | Zocor coupons |
| Livalo (pitavastatin) | Hyperlipidemia | 1 to 4 mg orally once daily | Livalo coupons |
| Lovastatin | Hyperlipidemia, atherosclerotic disease, and cardiovascular event risk reduction | 20 to 80 mg orally once daily | Lovastatin coupons |
| Fluvastatin | Hyperlipidemia, atherosclerotic disease, and cardiovascular event risk reduction | 20 to 80 mg orally once daily | Fluvastatin coupons |
| Zetia (ezetimibe) | Hyperlipidemia | 10 mg orally once daily | Zetia coupons |
| Praluent (alirocumab) | Hyperlipidemia and cardiovascular event risk reduction | 75 to 150 mg subcutaneous injection every 2 weeks or 300 mg every 4 weeks | Praluent coupons |
| Repatha (evolocumab) | Hyperlipidemia and cardiovascular event risk reduction | 140 mg subcutaneous injection every 2 weeks or 420 mg every 4 weeks | Repatha coupons |
| Leqvio (inclisiran) | Hyperlipidemia | 284 mg subcutaneous injection every 3 months for 2 doses | Leqvio coupons |
| Tricor (fenofibrate) | Hyperlipidemia and hypertriglyceridemia | 48 to 145 mg orally once daily | Tricor coupons |
| Lopid (gemfibrozil) | Hyperlipidemia and hypertriglyceridemia | 600 mg orally twice daily | Lopid coupons |
| Nexletol (bempedoic acid) | Hyperlipidemia and cardiovascular event risk reduction | 180 mg orally once daily | Nexletol coupons |
| Welchol (colesevelam) | Hyperlipidemia and Type 2 diabetes mellitus | 3750 mg orally once daily | Welchol coupons |
| Questran (cholestyramine) | Hyperlipidemia | 4 to 8 g orally twice daily | Questran coupons |
Top 5 rosuvastatin alternatives
The following are some of the most common alternatives to rosuvastatin.
1. Lipitor
Rosuvastatin is the most potent statin, dropping LDL levels lower than any other. A close second, Lipitor is the other statin that is considered when high-intensity statin therapy is needed. The two are specifically suggested in cholesterol management guidelines when patients have atherosclerotic cardiovascular disease or severely elevated LDL cholesterol levels. In other words, if blockages and cholesterol build-up are already present in blood vessels or the LDL numbers are extreme, studies have found that these are the drugs of choice. At their lesser doses, rosuvastatin and atorvastatin can be used as moderate-intensity statins for less severe cases.
2. Pravachol
Pravachol is a lower potency statin, capable at its highest doses of providing moderate-intensity statin therapy. One reason some choose it over rosuvastatin is its tolerability. An individual may have side effects with one statin but not another. Although rosuvastatin tends to be well-tolerated by most people, pravastatin causes few problems as well, possibly because they are both more hydrophilic (dissolve in water) in the body than other statins. The primary adverse effects of statins are muscle pain and weakness, and liver enzyme monitoring may be advised to watch for any uncommon but serious side effects.
3. Zetia
Sometimes, despite trying multiple statins, an individual cannot tolerate them or is not able to get their cholesterol numbers low enough. In these situations, Zetia is often called upon as an alternative or an add-on to a statin. Instead of inhibiting the HMG-CoA reductase enzyme to stifle LDL creation like a statin, Zetia blocks the intestinal absorption of cholesterol. It is not as strong as rosuvastatin, but it can be used in conjunction with it if needed to reach treatment goals.
4. Repatha
Repatha is one of the new, powerful cholesterol-lowering medications from the PCSK9 inhibitor class. Injected every 2 to 4 weeks, Repatha acts by increasing LDL receptors in the liver, thereby pulling LDL out of circulation. If rosuvastatin proves intolerable or insufficient, Repatha can be a good pick for those with coronary heart disease. Aside from it requiring injections rather than tablets, Repatha’s hefty price is the biggest hold back with it. A SingleCare discount card is an easy way to save money on cholesterol medicine and simply needs to be presented to your pharmacist.
5. Nexletol
By blocking LDL synthesis, Nexletol can get the job done in the management of hyperlipidemia when statins turn out to be problematic for someone. The fact that it is new and only available as a brand-name product makes price a concern. In addition, the drug’s label warns about reports of gout and tendon rupture with Nexletol.
Natural alternatives to rosuvastatin
Taking medication is not the only option for the management of high cholesterol. A healthy diet, particularly one low in carbohydrates or following a Mediterranean-style, could be quite helpful. Exercise can be incorporated too. These lifestyle changes may not substitute for rosuvastatin in everyone’s case, but they are worth asking your healthcare provider about.
Supplements are a popular topic of conversation when alternatives to prescription treatments are sought, but proof from robust clinical trials is typically lacking. To lower cholesterol, berberine, red yeast rice extract, and omega-3 fatty acids are common considerations. Red yeast rice is essentially a very low-potency statin based on its mechanism of action. Omega-3 fatty acids are derived from fish oil and may be useful for lowering triglyceride levels. These options generally cannot replace rosuvastatin fully, and because they can have side effects and drug interactions, too, discussing them with your healthcare provider first is essential.
How to switch to a rosuvastatin alternative
Rosuvastatin can be a vital medicine for preventing a heart attack or stroke, and as such, any decisions about stopping it should be run past the healthcare professional prescribing it. The conversation should touch on treatment goals, what other prescription and over-the-counter meds and supplements are being taken, and what all health conditions are present. If it is mutually decided that a change is needed, rosuvastatin can be stopped abruptly without a taper. As you have seen, there are a number of worthy alternatives if rosuvastatin is not the answer for you
Sources
- Guideline on the management of blood cholesterol: A report of the American College of Cardiology and American Heart Association Task Force on Clinical Practice Guidelines, Circulation (2018)
- Current overview of statin-induced myopathy, American Journal of Medicine (2004)
- Rosuvastatin drug label, NIH DailyMed (2024)
- Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet, New England Journal of Medicine (2008)
- Meta-analysis of the effects and safety of berberine in the treatment of Type 2 diabetes mellitus, hyperlipidemia, and hypertension, Journal of Ethnopharmacology (2015)
- Dose-response effects of omega-3 fatty acids on triglycerides, inflammation, and endothelial function in healthy persons with moderate hypertriglyceridemia, American Journal of Clinical Nutrition (2010)
- Red yeast rice for dyslipidemia in statin-intolerant patients: A randomized trial, Annals of Internal Medicine (2009)