Simvastatin 80 mg is Equivalent to Rosuvastatin 20 mg
Simvastatin 80 mg is equivalent to rosuvastatin 20 mg in terms of LDL-cholesterol lowering efficacy, as both are classified as high-intensity statins that reduce LDL-C by ≥50%. 1
Statin Intensity Comparison
High-intensity statins are defined as those that lower LDL-C by ≥50% from baseline:
- Simvastatin 80 mg is categorized as a high-intensity statin 1
- Rosuvastatin 20 mg is categorized as a high-intensity statin 1
Both medications achieve similar clinical outcomes in terms of LDL-C reduction:
- Rosuvastatin 20 mg reduces LDL-C by approximately 50-55% 1, 2
- Simvastatin 80 mg reduces LDL-C by approximately 50% 1
Clinical Considerations
Efficacy Comparison
- In the STELLAR trial, rosuvastatin demonstrated greater LDL-C reduction compared to equivalent doses of other statins, with rosuvastatin 20 mg showing superior efficacy to simvastatin 80 mg 2
- Across-dose analyses showed that rosuvastatin reduced LDL cholesterol by 12-18% more than equivalent simvastatin doses 2
Safety Considerations
- Important safety note: Although simvastatin 80 mg was evaluated in clinical trials, the FDA no longer recommends initiating or titrating to this dose due to increased risk of myopathy and rhabdomyolysis 1
- Rosuvastatin 20 mg has a better safety profile than simvastatin 80 mg while providing similar or greater LDL-C reduction 2
Metabolic Effects
- Both medications effectively treat atherogenic dyslipidemia in patients with metabolic syndrome characteristics 3
- Rosuvastatin tends to have more favorable effects on HDL-C (7.7-9.6% increase) compared to simvastatin (8-10% increase) 2
Practical Application
For patients requiring high-intensity statin therapy:
- Rosuvastatin 20 mg is the preferred option compared to simvastatin 80 mg due to safety concerns with the latter 1
- If a patient is currently on simvastatin 80 mg, consider switching to rosuvastatin 20 mg for similar efficacy with improved safety profile 1
Common Pitfalls to Avoid
- Never initiate simvastatin 80 mg in new patients due to FDA warnings about myopathy risk 1
- Don't assume equivalent milligram doses across different statins provide equivalent LDL-C reduction - rosuvastatin is more potent on a milligram-per-milligram basis 2, 4
- Avoid overlooking potential drug interactions, particularly with amiodarone, ranolazine, and other medications that may increase statin-associated adverse effects 1
In summary, while simvastatin 80 mg and rosuvastatin 20 mg both provide similar LDL-C reduction of ≥50%, rosuvastatin 20 mg is the safer choice with potentially greater efficacy for patients requiring high-intensity statin therapy.