What is the dose-equivalent of simvastatin 40 mg with other statins?

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Last updated: October 28, 2026 • View editorial policy

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Statin Dose Equivalency to Simvastatin 40 mg

Based on the 2018 ACC/AHA cholesterol guidelines, simvastatin 40 mg is classified as moderate-intensity statin therapy (30-49% LDL-C reduction), and the equivalent doses are: atorvastatin 10-20 mg or rosuvastatin 5-10 mg 1.

Guideline-Based Equivalencies

The 2018 ACC/AHA guidelines provide the most authoritative framework for statin equivalency 1:

Moderate-Intensity Statins (30-49% LDL-C reduction):

  • Simvastatin 20-40 mg
  • Atorvastatin 10 mg (20 mg)
  • Rosuvastatin 5 mg (10 mg)
  • Pravastatin 40 mg (80 mg)

This classification is based on the VOYAGER meta-analysis data and FDA-approved product labeling, with doses in parentheses representing the upper range of moderate intensity 1.

Research-Supported Dose Conversions

The VOYAGER meta-analysis (38,052 patient exposures) provides more granular dose equivalencies 2:

For simvastatin 40 mg achieving approximately 37-40% LDL-C reduction:

  • Atorvastatin 15-20 mg produces equivalent LDL-C lowering
  • Rosuvastatin 5-7 mg produces equivalent LDL-C lowering

The CURVES study demonstrated that atorvastatin 10 mg produced LDL-C reductions comparable to or greater than simvastatin 40 mg 3, and a direct comparison study showed simvastatin 40 mg and atorvastatin 20 mg produced similar 35-42% LDL-C reductions 4.

Critical Caveats

FDA restriction: Simvastatin 80 mg should NOT be initiated or up-titrated due to myopathy risk; it's restricted only to patients already taking it chronically (≥12 months) without muscle toxicity 5. For patients requiring greater LDL-C reduction than simvastatin 40 mg provides, switch to an alternative high-intensity statin rather than increasing simvastatin dose 5.

Potency hierarchy: Rosuvastatin is approximately 3-3.5 times more potent than atorvastatin, and 7-8 times more potent than simvastatin on a milligram-per-milligram basis 2.

Drug interactions: Simvastatin requires dose adjustments with multiple medications. When co-administered with verapamil, diltiazem, or dronedarone, do not exceed simvastatin 10 mg daily. With amiodarone, amlodipine, or ranolazine, do not exceed simvastatin 20 mg daily 5.

References

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