Lipitor (atorvastatin) vs. Crestor (rosuvastatin)

• Lipitor (atorvastatin) and Crestor (rosuvastatin) are HMG-CoA reductase inhibitors (“statin” drugs) that lower cholesterol levels in the blood. Lipitor and Crestor are also used to reduce the risk of heart attacks, stroke, and arterial revascularization procedures in patients with multiple risk factors for heart disease.
• Side effects of Lipitor and Crestor that are similar include diarrhea and headache.
• Side effects of Lipitor that are different from Crestor include constipation, fatigue, gas, heartburn, common cold, joint pain, pain in the extremities, and urinary tract infection (UTI).
• Side effects of Crestor that are different from Lipitor include nausea, vomiting, muscle pain, confusion, and memory problems.

Lipitor (atorvastatin) is an HMG-CoA reductase inhibitor (a “statin” drug) used to lower blood cholesterol levels. Lipitor reduces total cholesterol and LDL (“bad”) cholesterol, which is largely responsible for the development of coronary artery disease. Reducing LDL cholesterol slows progression and may reverse coronary artery disease. Lipitor also raises HDL ("good") cholesterol that protects against coronary artery disease and reduces the concentration of triglycerides (fats) in the blood. High blood concentrations of triglycerides are also associated with coronary artery disease. In individuals with coronary artery disease, Lipitor prevents angina, stroke, heart attack, hospitalization for congestive heart failure, and revascularization procedures.

Crestor (rosuvastatin) is an HMG-CoA reductase inhibitor (a “statin” drug) that reduces cholesterol levels by inhibiting HMG-CoA reductase, an enzyme that produces cholesterol in the liver. Crestor lowers blood total cholesterol as well as blood LDL (“bad”) cholesterol levels that increase the risk of coronary artery disease (atherosclerosis) and heart attacks. Statins also increase HDL (“good”) cholesterol, and reduce triglycerides. Crestor is also used to reduce the risk of heart attacks, stroke, and arterial revascularization procedures in patients without clinically evident coronary heart disease but with multiple risk factors for heart disease.

Lipitor

Lipitor is generally well tolerated. Minor side effects include:

• Constipation
• Diarrhea
• Fatigue
• Gas
• Heartburn
• Headache

Other commonly reported side effects include:

• Common cold (nasopharyngitis)
• Joint pain (arthralgia)
• Pain in the extremities
• Urinary tract infection

Lipitor may cause liver and muscle damage. Serious liver damage caused by statins is rare. Liver tests should be performed at the beginning of treatment then as needed thereafter.

Inflammation of the muscles caused by statins can lead to serious breakdown of muscle cells called rhabdomyolysis. Rhabdomyolysis causes the release of muscle protein (myoglobin) into the blood, and myoglobin can cause kidney failure and even death. When used alone, statins cause rhabdomyolysis in less than 1% of patients. To prevent the development of serious rhabdomyolysis, patients taking Lipitor should contact their doctor immediately if they develop unexplained muscle pain, weakness, or muscle tenderness.

Statins have been associated with increases in HbA1c and fasting serum glucose levels as seen in diabetes.

Post-marketing reports for Lipitor of adverse events include:

• Memory loss
• Forgetfulness
• Amnesia
• Confusion
• Memory impairment

Symptoms may start one day to years after starting treatment and resolve within a median of three weeks after stopping the statin.

Crestor

The most common side effects of Crestor are:

• Headache
• Nausea
• Vomiting
• Diarrhea
• Muscle pain

Other important side effects include:

• Post-marketing reports of memory loss
• Forgetfulness
• Amnesia
• Confusion
• Memory impairment

Symptoms may start one day to years after starting treatment and resolve within a median of three weeks after stopping the statin.

Lipitor

• Lipitor is prescribed once daily.
• The usual starting dose for adults is 10 to 20 mg per day, and the maximum dose is 80 mg per day. Adults who need more than a 45% reduction in LDL cholesterol may be started at 40 mg daily.
• Pediatric patients should receive 10 mg once daily up to a maximum dose of 20 mg daily.
• Lipitor may be taken with or without food and at any time of day.

Crestor

The starting dose for most adults is 5 mg once daily. The maximum dose is 40 mg daily, and this dose should be reserved for patients who do not adequately respond to a 20 mg dose.

Lipitor

Decreased elimination of Lipitor could increase levels of Lipitor in the body and increase the risk of muscle toxicity from Lipitor. Therefore, Lipitor should not be combined with drugs that decrease its elimination. Examples of such drugs include:

• erythromycin (E-Mycin)
• ketoconazole (Nizoral)
• itraconazole (Sporanox)
• clarithromycin (Biaxin)
• telithromycin (Ketek)
• cyclosporine (Sandimmune)
• nefazodone (Serzone)
• HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir)

Do not consume large quantities of grapefruit juice (>1.2 liters daily) as this will increase blood levels of Lipitor.

The following drugs also may increase the risk of muscle toxicity when combined with Lipitor.

• amiodarone (Cordarone)
• verapamil (Calan Verelan, Isoptin)
• cyclosporine (Sandimmune)
• niacin (Niacor, Niaspan, Slo-Niacin)
• gemfibrozil (Lopid)
• fenofibrate (Tricor)

Lipitor increases the effect of warfarin (Coumadin) and the concentration in blood of digoxin (Lanoxin). Patients taking Lipitor and warfarin or digoxin should be monitored carefully. Cholestyramine (Questran) decreases the absorption of Lipitor. Lipitor should be given at least two hours before and at least four hours after cholestyramine.
Rifampin increases breakdown of Lipitor. To reduce the likelihood of this interaction, both drugs should be given at the same time. Lipitor should not be given after rifampin.

Crestor

When administered with cyclosporine, the blood level of rosuvastatin increases sevenfold, and this could increase the side effects of rosuvastatin.

Rosuvastatin increases the action of the blood thinner warfarin (Coumadin) and could increase the risk of bleeding from warfarin.

Antacids reduce the absorption of rosuvastatin and should be administered two hours after rosuvastatin.

The use of rosuvastatin with nicotinic acid, gemfibrozil (Lopid), or other drugs that may cause liver or muscle injury may increase the incidence of the muscle injury.

Lipitor

• Lipitor should not be taken during pregnancy because the developing fetus requires cholesterol for development, and Lipitor reduces the production of cholesterol. Lipitor should only be administered to women of childbearing age if they are not likely to become pregnant.
• It is not known if Lipitor is secreted in breast milk. Because of the potential risk of adverse events, breastfeeding mothers should not use Lipitor.

Crestor

• Statins should not be used by pregnant women because there is a high risk of harm to the fetus.
• There is no information on whether rosuvastatin is excreted in human milk.