Equivalent Dose of Atorvastatin for 10 mg Rosuvastatin
Atorvastatin 20 mg is equivalent to rosuvastatin 10 mg based on their relative LDL-lowering potency. 1
Statin Equivalence Based on LDL-C Lowering
According to the 2018 AHA/ACC Cholesterol Management Guidelines, statins are categorized by their LDL-C lowering capacity:
- Rosuvastatin 10 mg is classified as a moderate-intensity statin that reduces LDL-C by 30-49% 1
- Atorvastatin 10-20 mg is also classified as moderate-intensity, with similar LDL-C reduction range 1
However, when looking at the specific potency comparison:
| Statin Comparison | LDL-C Reduction |
|---|---|
| Rosuvastatin 10 mg | 45-46% reduction |
| Atorvastatin 10 mg | 37-40% reduction |
| Atorvastatin 20 mg | 43-47% reduction |
Evidence from Clinical Studies
The STELLAR trial demonstrated that rosuvastatin is more potent than atorvastatin on a milligram-to-milligram basis 2. Specifically:
- Rosuvastatin 10 mg reduced LDL-C by approximately 46.7%
- Atorvastatin 10 mg reduced LDL-C by approximately 36.4%
- Atorvastatin 20 mg achieved reductions closer to rosuvastatin 10 mg
The VOYAGER meta-analysis, which analyzed data from over 38,000 patient exposures, found that rosuvastatin 10 mg reduced LDL-C by 44% and non-HDL-C by 40%, which required approximately atorvastatin 29 mg to achieve equivalent LDL-C reduction 3.
In South Asian populations specifically, the IRIS trial showed rosuvastatin 10 mg reduced LDL-C by 45% compared to 40% with atorvastatin 10 mg (p=0.0023) 1, 4.
Practical Dosing Considerations
When switching between statins, it's important to consider:
- Potency ratio: Rosuvastatin is approximately 2-3 times more potent than atorvastatin on a milligram-to-milligram basis 3
- Intensity classification: Both rosuvastatin 10 mg and atorvastatin 20 mg fall within the moderate-intensity statin category in clinical guidelines 1
Clinical Implications
For patients requiring a switch from rosuvastatin 10 mg to atorvastatin:
- Atorvastatin 20 mg would be the most appropriate equivalent dose to maintain similar LDL-C lowering effects
- For patients with diabetes or established ASCVD, this equivalent dosing is particularly important to maintain risk reduction benefits 1
Potential Pitfalls
- Using too low a dose of atorvastatin (e.g., 10 mg) when switching from rosuvastatin 10 mg may result in suboptimal LDL-C reduction
- Using too high a dose unnecessarily may increase the risk of statin-associated side effects
- Some Asian populations may have greater response to certain statins, but South Asians specifically appear to require similar dosing to non-Hispanic whites 1
Remember that while 20 mg atorvastatin is the closest equivalent to 10 mg rosuvastatin, individual patient response may vary, and monitoring lipid levels after switching is advisable.