- A Visual Guide to Heart Disease
- Medical Illustrations of the Heart Image Collection
- Take the Heart Disease Quiz!
- Simvastatin vs. Crestor comparison
- What are simvastatin and Crestor?
- What are the uses for simvastatin and Crestor?
- What are the side effects of simvastatin and Crestor?
- How should simvastatin and Crestor be taken (dosage)?
- Which drugs interact with simvastatin and Crestor?
- Are simvastatin and Crestor safe to take during pregnancy or while breastfeeding?
Simvastatin vs. Crestor comparison
Zocor (simvastatin) and Crestor (rosuvastatin) are both members of the family of cholesterol-lowering drugs called statins, which revolutionized the management of cardiovascular diseases, many of which are caused by cholesterol plaque deposits in the arteries.
Crestor is the more potent cholesterol-lowering drug, and it's also newer than Zocor.
Aside from being better at lowering so-called "bad" cholesterol levels in the bloodstream, another advantage to rosuvastatin is that it has far fewer negative interactions with other medications than simvastatin, or most other statins, for that matter.
What are simvastatin and Crestor?
Simvastatin (Zocor) and Crestor (rosuvastatin) are both in the statin family of cholesterol-reducing drugs. They both work to lower "bad" cholesterol in the bloodstream, which comes in the form of low-density lipoprotein or LDL.
Cholesterol is vital for the body to function. It's used to provide cell structure, insulate nerve cells, enable digestion, and a host of other benefits. The body can make all the cholesterol it needs in the liver, but food also contains cholesterol that ends up in the bloodstream. There, it sticks to artery walls as a solid plaque, constricting blood flow. This can lead to debilitating or fatal heart attacks or strokes.
Statins like Zocor and Crestor lower LDL by hindering liver cells' ability to make cholesterol. The liver manufactures cholesterol from simpler molecules. The liver has to turn these molecules into a compound called HMG-CoA reductase, which turns into cholesterol after a few more steps. Statins (also called HMG-CoA reductase inhibitors) bind with HMG-CoA reductase to stop it from turning into cholesterol.
Because the body's natural impulse is to maintain a balanced level of cholesterol, the liver cells start to suck cholesterol out of the bloodstream, meaning it's no longer floating around to add to arterial plaque deposits.
Statins also raise levels of HDL, the so-called "good" cholesterol. HDL molecules act as scavenger molecules in the bloodstream, binding with LDL and taking to the liver for processing. Research isn't as clear on the mechanism by which statins raise HDL levels as it is on how the drugs lower LDL levels.
How are simvastatin and Crestor different?
Statins typically are very similar to one another, but rosuvastatin is a bit of an outlier. Rosuvastatin, aside from Lipitor (atorvastatin), is the most potent statin for lowering LDL. It's different than simvastatin and many other statins in several important ways.
First, simvastatin is a prodrug, meaning that the chemical sold in the pill won't lower cholesterol by itself; the body needs to break it down in the gut into a different form before it can do its job. Rosuvastatin is ready to go out of the package.
Second, simvastatin and most other statins can have bad interactions with a bunch of different drugs, whereas Crestor has relatively few.
Why? A specific system of enzymes found mostly in specialized liver cells break down simvastatin and other statins. This system is responsible for breaking down (metabolizing) all sorts of different foreign compounds, toxins, and toxic waste produced internally by our own cells. The enzyme system - created by a group of genes called CYP450 - is responsible for processing 70% to 80% of all drugs on the market.
Because different, more obscure enzymes break down rosuvastatin - enzymes only minimally involved with the powerhouse CYP450 system - Crestor doesn't interfere as much with other drugs.
Finally, because Crestor is has a tendency to dissolve or combine with water (it's "hydrophilic"), it has fewer muscle and nervous system side effects than simvastatin. Zocor is more likely to dissolve or combine with fats (it's "lipophilic"), meaning it can more easily enter nerve and muscle cells to cause problems.
What are the uses for simvastatin and Crestor?
- Simvastatin and rosuvastatin are used for reducing total cholesterol, LDL cholesterol, and triglycerides, and for increasing HDL cholesterol.
- In patients with coronary heart disease, diabetes, peripheral vascular disease, or history of stroke or other cerebrovascular disease, Zocor and Crestor are prescribed for reducing the risk of mortality by reducing death from coronary heart disease, reducing nonfatal myocardial infarction (heart attack) and stroke, and reducing the need for coronary and noncoronary revascularization procedures.
Latest Heart News
Daily Health News
What are the side effects of simvastatin and Crestor?
The potential side effects of both Zocor and Crestor are nearly identical and are similar to those seen in other statins. The most common side effects include headache, nausea, vomiting, diarrhea, and muscle pain. Rarely, forgetfulness and memory loss can happen with both these medications.
Doctors' chief worries when prescribing patients simvastatin and rosuvastatin are potential liver damage and muscle breakdown. Though serious liver damage is rare, doctors prescribing either Crestor or Zocor will closely monitor important chemical markers that show up in liver tests to make sure the levels are in the acceptable range. Abnormal liver tests usually return to normal after shortly after dosing starts, but if chemical markers remain three times higher than the normal accepted highest levels, your doctor will discontinue administering the medications.
Muscle breakdown is also a serious problem. If statins cause the muscle protein myoglobin to leech into the bloodstream, it can shut down the kidneys, which aren't equipped to filter out that protein. That condition is called rhabdomyolysis, and can be potentially fatal.
This isn't a full list of side effects. Consult your doctor for more information if you're taking either of these drugs.
IMAGESBrowse through our medical image collection to see illustrations of human anatomy and physiology See Images
How should simvastatin and Crestor be taken (dosage)?
- The recommended dose range of simvastatin is 10 mg to 40 mg, and it is administered once daily in the evening with or without food. Therapy usually is initiated with 10 or 20 mg daily, but individuals who have a high risk of heart disease can be started on 40 mg daily.
- Simvastatin 80 mg is restricted to patients who have been taking simvastatin 80 mg chronically (for example, for 12 months or more) without evidence of muscle toxicity because the 80 mg dose is associated with increased risk of muscle toxicity, including rhabdomyolysis. Patients who are currently tolerating the 80 mg dose of simvastatin who need to start an interacting drug that should not be taken with simvastatin or is associated with a dose cap for simvastatin should be switched to an alternative statin or statin-based regimen with less potential for the drug-drug interaction.
- Patients that require more than the 40 mg dose should be switched to an alternative drug.
- 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.
Which drugs interact with simvastatin and Crestor?
As mentioned earlier, rosuvastatin has far fewer harmful drug interactions that Zocor and other statins. Still, Crestor is not without dangers. Cyclosporine can exponentially increase rosuvastatin levels in the blood, increasing the chances of side effects. Also, you shouldn't take the blood thinner warfarin (Coumadin) with Crestor, nor should you combine it with drugs that could damage the liver, like nicotinic acid or gemfibrozil (Lopid).
Antacids reduce the body's ability to absorb Crestor, so don't take them within two hours of a dose of rosuvastatin.
Zocor, on the other hand, is similar to other statins in that is has a high number of adverse interactions with other drugs.
A number of drugs make it more difficult for the body to break down and get rid of Zocor, which can make simvastatin more toxic to muscle tissue. Some of these drugs include:
- erythromycin (E-Mycin),
- ketoconazole (Nizoral),
- itraconazole (Sporanox),
- clarithromycin (Biaxin),
- telithromycin (Ketek),
- cyclosporine (Sandimmune),
- nefazodone (Serzone),
- boceprevir (Victrelis),
- telaprevir (incivek),
- voriconazole (Vfend),
- posaconazole (Noxafil), and
- HIV protease inhibitors such as:
Other drugs that you shouldn't take with simvastatin include:
- Amiodarone (Cordarone),
- verapamil (Calan Verelan, Isoptin),
- amlodipine (Norvasc),
- danazol (Danocrine),
- ranolazine (Ranexa),
- niacin (Niacor, Niaspan, Slo-Niacin),
- gemfibrozil (Lopid) and
- fenofibrate (Tricor).
This isn't a full list of drugs that interact with simvastatin and rosuvastatin, so make sure you tell your doctor about all the medications you're taking if they prescribe you either of these drugs.
Are simvastatin and Crestor safe to take during pregnancy or while breastfeeding?
Neither Crestor nor Simvastatin should be taken during pregnancy or breastfeeding. Cholesterol is absolutely vital for the developing fetus and growing infant, so cholesterol reducing medications like Crestor and Zocor. Furthermore, statins are passed on in breastmilk, so either don't take them while nursing or feed your baby formula.
Multimedia: Slideshows, Images & Quizzes
High Cholesterol (Hyperlipidemia) Quiz: Test Your Medical IQ
High cholesterol can be a dangerous condition. Take the Cholesterol Quiz to understand what high cholesterol means in terms of...
Heart Disease Quiz: Test Your Medical IQ
Take our Heart Disease Quiz to get answers and facts about high cholesterol, atherosclerosis prevention, and the causes,...
Picture of Cholesterol
Cholesterol carried in particles of low density (LDL cholesterol) is referred to as the "bad" cholesterol because elevated levels...
Heart Disease: Symptoms, Signs, and Causes
What is heart disease (coronary artery disease)? Learn about the causes of heart disease. Symptoms of heart disease include chest...
Lower Your Cholesterol, Save Your Heart
Need to lower your cholesterol levels? Use these smart diet tips to quickly and easily lower your blood cholesterol levels....
Cholesterol Drugs: What to Expect With Heart Medication
When diet and exercise aren't enough, should you turn to drugs? Learn cholesterol basics, drug classes, and available drugs along...
Heart Disease: Causes of a Heart Attack
Learn about heart disease and heart attack symptoms and signs of a heart attack in men and women. Read about heart disease...
Am I Having a Heart Attack? Symptoms of Heart Disease
Heart attacks symptoms vary greatly for men and women, from anxiety and fatigue to nausea and sweating. Learn the warning signs...
Cholesterol Levels: What the Numbers Mean
Do you know the different cholesterol levels and what they mean? Learn the alphabet soup of cholesterol testing: LDL, HDL, good,...
Related Disease Conditions
Heart Disease: Sudden Cardiac Death
Second Source WebMD Medical Reference...
Stroke (Signs, Symptoms, Warning Signs)
A stroke is an interruption of the blood supply to part of the brain caused by either a blood clot (ischemic) or bleeding...
Fatty Liver (NASH)
Nonalcoholic fatty liver disease or NASH occurs due to the accumulation of abnormal amounts of fat within the liver. Fatty liver...
12 Congestive Heart Failure Symptoms, Stages, Causes, and Life Expectancy
Congestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease,...
Stroke is the third leading killer in the United States. Some of the warning signs of stroke include sudden confusion, trouble...
Heart disease (coronary artery disease) occurs when plaque builds up in the coronary arteries, the vessels that supply blood to...
Heart Disease in Women
Heart disease in women has somewhat different symptoms, risk factors, and treatment compared to heart disease in men. Many women...
HDL vs. LDL Cholesterol (Differences, Normal Ranges, Meanings)
HDL (high-density lipoprotein), or the "good" cholesterol, and LDL (low-density lipoprotein), or the "bad"...
Treatment & Diagnosis
Medications & Supplements
Health Solutions From Our Sponsors
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Pharmacy Times; March, 2005
Alexander Motylev, RPh, PhD
"Get to Know an Enzyme: CYP3A4"
Pharmacy Times, Sept. 2008
John R. Horn, PharmD, FCCP; Philip D. Hansten, PharmD
"Rosuvastatin: a highly effective new HMG-CoA reductase inhibitor"
Cardiovascular Drug Review; Winter, 2002
Olsson AG, McTaggart F, Raza A
Genetics Home Reference
U.S. National Library of Medicine
"Which Statin is Right for My Patient?"
Darrell Hulisz, PharmD
FDA Prescribing Information
"The 3-hydroxy-3-methylglutaryl coenzyme-A (HMG-CoA) reductases"
Jon A Friesen and Victor W Rodwell
Genome Biology, 2004
"Drug Class Review: HMG-CoA Reductase Inhibitors (Statins) and Fixed-dose Combination Products Containing a Statin: Final Report Update 5"
National Center for Biotechnology information
"Low-density lipoprotein receptor--its structure, function, and mutations"
Seminars in Vascular Medicine, 2004
"Statin inhibition of HMG-CoA reductase: a 3-dimensional view."
Atherosclerosis Supplements, 2003
"Effect of statins on HDL-C: a complex process unrelated to changes in LDL-C: analysis of the VOYAGER Database"
Philip J. Barter et. al
Journal of Lipid Research
"Good vs. Bad Cholesterol"
The American Heart Association