Rosuvastatin to Atorvastatin Equivalent Dosing
Based on the 2019 ACC/AHA Cholesterol Management Guidelines, rosuvastatin 5 mg is equivalent to atorvastatin 10-15 mg, rosuvastatin 10 mg is equivalent to atorvastatin 20-30 mg, and rosuvastatin 20 mg is equivalent to atorvastatin 40-70 mg. 1
Statin Intensity Equivalence Chart
| Rosuvastatin Dose | Atorvastatin Equivalent Dose | Intensity Level | LDL-C Reduction |
|---|---|---|---|
| 5 mg | 10-15 mg | Moderate | 30-49% |
| 10 mg | 20-30 mg | Moderate-High | 40-44% |
| 20 mg | 40-70 mg | High | ≥50% |
| 40 mg | >80 mg (not achievable) | High | ≥55% |
Evidence-Based Conversion Rationale
The VOYAGER meta-analysis, which analyzed data from 38,052 patient exposures, provides the most comprehensive evidence for statin dose equivalence. This analysis found that:
- Rosuvastatin 5 mg reduces LDL-C by approximately 39%, which is equivalent to atorvastatin 15 mg 2
- Rosuvastatin 10 mg reduces LDL-C by approximately 44%, which is equivalent to atorvastatin 29 mg 2
- Rosuvastatin 20 mg reduces LDL-C by approximately 50%, which is equivalent to atorvastatin 70 mg 2
- Rosuvastatin 40 mg reduces LDL-C by approximately 55%, which exceeds what can be achieved with even the maximum 80 mg dose of atorvastatin 2
These findings demonstrate that rosuvastatin is approximately 3-3.5 times more potent than atorvastatin on a milligram-to-milligram basis for LDL-C reduction 2.
Clinical Application
When switching a patient from rosuvastatin to atorvastatin:
- Determine the current rosuvastatin dose and its intensity level (low, moderate, or high)
- Match to the appropriate atorvastatin dose based on the equivalent LDL-C lowering effect
- Consider monitoring lipid levels 4-12 weeks after switching to ensure therapeutic equivalence 3
Special Considerations
- For high-risk patients requiring ≥50% LDL-C reduction, rosuvastatin 20-40 mg or atorvastatin 40-80 mg should be used 1
- For moderate-risk patients requiring 30-49% LDL-C reduction, rosuvastatin 5-10 mg or atorvastatin 10-20 mg is appropriate 1
- The DISCOVERY Alpha study demonstrated that rosuvastatin 10 mg produced significantly greater LDL-C reductions than atorvastatin 10 mg (44.7% vs 33.9%, p<0.001) 4
Practical Tips
- When converting from rosuvastatin to atorvastatin, consider starting at the lower end of the equivalent dose range and titrating up if needed
- Monitor for statin-associated muscle symptoms after switching, especially when moving to higher doses
- Remember that individual patient responses to statins can vary, so post-conversion lipid monitoring is essential
By following these evidence-based conversion guidelines, you can maintain appropriate lipid-lowering efficacy when switching patients from rosuvastatin to atorvastatin while minimizing the risk of adverse effects.