What are the doses of moderate intensity statins, such as atorvastatin (Lipitor), rosuvastatin (Crestor), simvastatin (Zocor), and pravastatin (Pravachol)?

Moderate Intensity Statin Doses

Moderate intensity statins, which lower LDL cholesterol by 30-49%, include atorvastatin 10-20 mg, rosuvastatin 5-10 mg, simvastatin 20-40 mg, pravastatin 40-80 mg, lovastatin 40 mg, fluvastatin XL 80 mg, and pitavastatin 1-4 mg. 1

Specific Moderate Intensity Statin Dosages

Atorvastatin

• 10 mg daily 1
• 20 mg daily 1

Rosuvastatin

• 5 mg daily 1
• 10 mg daily 1

Simvastatin

• 20 mg daily 1
• 40 mg daily 1
  • Note: Although simvastatin 80 mg was evaluated in clinical trials, this dose is not recommended by the FDA due to increased risk of myopathy, including rhabdomyolysis 1

Pravastatin

• 40 mg daily 1
• 80 mg daily 1

Other Moderate Intensity Statins

• Lovastatin 40 mg daily 1
• Fluvastatin XL 80 mg daily 1
• Pitavastatin 1-4 mg daily 1

Clinical Effectiveness of Moderate Intensity Statins

• Moderate intensity statins reduce LDL cholesterol by 30-49% from baseline 1
• These statins are recommended for primary prevention in patients with diabetes aged 40-75 years without additional ASCVD risk factors 1
• For patients who cannot tolerate high-intensity statins, the maximum tolerated dose of moderate-intensity statins should be used 1

Comparative Effectiveness

• Rosuvastatin tends to be more effective at equivalent doses compared to other statins, with rosuvastatin 10 mg reducing LDL-C by approximately 45-49% 2, 3
• Atorvastatin 10-20 mg typically reduces LDL-C by 30-38% 4, 2
• Simvastatin and pravastatin at moderate intensity doses generally achieve reductions at the lower end of the 30-49% range 2, 5

Special Considerations

• For adults >75 years of age with diabetes, moderate-intensity statin therapy is recommended regardless of ASCVD risk factors 1
• The risk-benefit profile should be routinely evaluated in older patients, with downward titration of dose performed as needed 1
• Patients who do not tolerate the intended intensity of statin should receive the maximum tolerated statin dose 1
• Recent evidence suggests that high-intensity statins may increase the risk of new-onset diabetes compared to moderate-intensity statins (36% vs 10% relative increase) 1

Target LDL-C Reduction

• For primary prevention in moderate-risk patients, the goal is typically a 30-49% reduction in LDL-C 1
• For high-risk patients, if moderate-intensity statins don't achieve LDL-C goals, consider adding ezetimibe or a PCSK9 inhibitor rather than increasing to high-intensity statins if there are tolerability concerns 1

By selecting the appropriate moderate-intensity statin and dose, clinicians can effectively reduce cardiovascular risk while minimizing adverse effects in patients who cannot tolerate or do not require high-intensity statin therapy 1.