From the Guidelines
When switching from atorvastatin 20 mg to Crestor (rosuvastatin), the equivalent dose would be approximately 5-10 mg of rosuvastatin, as indicated in the most recent guidelines 1. This recommendation is based on the fact that atorvastatin 20 mg is considered a moderate-intensity statin therapy, which lowers LDL cholesterol by 30-49%, and the equivalent dose of rosuvastatin would be 5-10 mg, as shown in Table 10.2 of the guidelines 1.
Key Considerations
- Rosuvastatin is more potent than atorvastatin, with rosuvastatin being about 2-4 times more potent on a milligram-to-milligram basis.
- The exact conversion depends on individual patient factors such as cardiovascular risk, LDL cholesterol targets, and tolerance to statin therapy.
- When making this switch, it's generally recommended to start with the lower equivalent dose (5 mg of rosuvastatin) and then adjust based on lipid panel results after 4-6 weeks of therapy.
- Both medications should be taken once daily, preferably at the same time each day.
- The switch should be made immediately without a tapering period.
- Patients should be monitored for potential side effects such as muscle pain or weakness, which can occur with any statin.
Rationale
The reason for switching between statins may include better tolerance, improved efficacy in lowering LDL cholesterol, or insurance/formulary considerations.
- Rosuvastatin has a longer half-life than atorvastatin and may provide more consistent LDL reduction, as supported by the guidelines 1.
- The guidelines also emphasize the importance of individualizing statin therapy based on patient-specific factors, such as cardiovascular risk and LDL cholesterol targets 1, 2.
Clinical Implications
- The switch from atorvastatin to rosuvastatin should be made with caution, taking into account the patient's medical history, current medications, and potential interactions.
- Regular monitoring of lipid profiles and liver function tests is recommended after switching to rosuvastatin, as supported by the guidelines 1, 3.
From the FDA Drug Label
Rosuvastatin 20 mg reduced LDL-C significantly more than atorvastatin 20 mg Rosuvastatin was compared with the statins (atorvastatin, simvastatin, and pravastatin) in a multicenter, open-label, dose-ranging study of 2,240 patients with hyperlipidemia or mixed dyslipidemia. Table 11: Percent Change in LDL-C by Dose of Rosuvastatin, Atorvastatin, Simvastatin, and Pravastatin From Baseline to Week 6 Rosuvastatin-46 2-52 3-55 4--- Atorvastatin-37-43-48-51 In a study of adult patients with HeFH (baseline mean LDL of 291 mg/dL), patients were randomized to rosuvastatin 20 mg or atorvastatin 20 mg. Table 12: LDL-C Percent Change from Baseline Rosuvastatin (n=435) LS Mean 1(95%CI) Atorvastatin (n=187) LS Mean 1(95% CI) Week 620 mg-47% (-49%, -46%)-38% (-40%, -36%) The answer to switching from atorvastatin 20 to rosuvastatin (Crestor) is that rosuvastatin 20 mg may be more effective in reducing LDL-C than atorvastatin 20 mg 4.
- Rosuvastatin 20 mg reduced LDL-C by 47%, while atorvastatin 20 mg reduced LDL-C by 38%.
- This suggests that switching from atorvastatin 20 mg to rosuvastatin 20 mg may provide additional LDL-C lowering benefits.
From the Research
Atorvastatin to Crestor (Rosuvastatin) Comparison
- The efficacy of atorvastatin and rosuvastatin in reducing low-density lipoprotein cholesterol (LDL-C) levels has been compared in several studies 5, 6, 7.
- A study found that switching from rosuvastatin to atorvastatin led to fewer patients attaining LDL-C goal and a greater risk for major adverse cardiovascular events (MACE) 5.
- Another study compared the effects of rosuvastatin and atorvastatin on plasma lipid profiles and found that rosuvastatin 10 mg/day was more efficacious than atorvastatin 20 mg/day in reducing plasma LDL-C levels 7.
- The addition of ezetimibe to ongoing simvastatin, atorvastatin, or rosuvastatin monotherapy has been shown to offer greater reduction in LDL-C among patients at high risk of cardiovascular disease compared to doubling the initial statin dose 8.
Dosing and Efficacy
- A study compared the anti-inflammatory effects and lipid profiles of quadruple-dose rosuvastatin and rosuvastatin combined with ezetimibe, and found that both therapies exerted similar anti-inflammatory effects under an equal LDL-C reduction 9.
- The efficacy of atorvastatin 20 mg/day and rosuvastatin 10 mg/day in reducing plasma LDL-C levels has been compared, with rosuvastatin showing a significantly greater reduction 7.
- The safety and tolerability of atorvastatin and rosuvastatin have been evaluated, with both treatments being well tolerated over 48 weeks 7.
Clinical Implications
- The choice between atorvastatin and rosuvastatin should be based on individual patient characteristics and response to treatment 5, 6, 7.
- The addition of ezetimibe to statin therapy may be considered for patients who do not achieve target LDL-C levels with statin monotherapy 8.
- Further studies are needed to fully understand the clinical implications of switching from atorvastatin to rosuvastatin or vice versa 5.