What is the equivalent dose of atorvastatin (Lipitor) for a patient taking rosuvastatin (Crestor) 5mg?

Conversion of Rosuvastatin 5 mg to Atorvastatin

Rosuvastatin 5 mg is equivalent to approximately 15 mg of atorvastatin based on LDL-C lowering efficacy. 1

Statin Potency Comparison

• Rosuvastatin is more potent than atorvastatin on a milligram-to-milligram basis, with each rosuvastatin dose being equivalent to approximately 3-3.5 times higher doses of atorvastatin 1
• Rosuvastatin 5 mg reduces LDL-C by approximately 39% and non-HDL-C by 35%, which is equivalent to the effect achieved with atorvastatin 15 mg 1
• According to the VOYAGER meta-analysis, which analyzed 38,052 patient exposures to various statins, rosuvastatin is consistently more potent than atorvastatin at comparable doses 1

Evidence-Based Conversion Guidelines

• The American College of Cardiology/American Heart Association guidelines classify rosuvastatin 5-10 mg as moderate-intensity statin therapy, comparable to atorvastatin 10-20 mg 2
• Statin intensity is defined by the percentage reduction in LDL-C:
  • Moderate-intensity: 30-49% LDL-C reduction (rosuvastatin 5-10 mg, atorvastatin 10-20 mg) 2
  • High-intensity: ≥50% LDL-C reduction (rosuvastatin 20-40 mg, atorvastatin 40-80 mg) 2

Clinical Considerations for Conversion

• When switching between statins, consider the patient's:

  • Current LDL-C levels and target goals 2
  • Risk factors for cardiovascular disease 2
  • Potential for drug interactions 2
  • Previous statin tolerance 2

• For patients with renal impairment (CrCl <30 mL/min), both medications require dose adjustments:

  • Rosuvastatin should not exceed 10 mg daily 2
  • Atorvastatin generally requires no dose adjustment for renal impairment alone 2

Practical Conversion Algorithm

1. For patients on rosuvastatin 5 mg:

   • Convert to atorvastatin 15 mg for equivalent LDL-C lowering 1
   • If atorvastatin 15 mg is not available as a tablet strength, consider atorvastatin 10 mg (slightly less potent) or 20 mg (slightly more potent) 1

2. Monitor lipid levels 4-12 weeks after conversion to ensure equivalent efficacy 2

3. Adjust dose as needed based on:

   • LDL-C response 2
   • Tolerability 2
   • Cardiovascular risk status 2

Common Pitfalls to Avoid

• Underestimating the potency difference between rosuvastatin and atorvastatin can lead to inadequate lipid lowering 1
• Failing to consider patient-specific factors such as age, renal function, and concomitant medications when converting between statins 2
• Not monitoring lipid levels after conversion to ensure therapeutic equivalence 2
• Overlooking potential differences in side effect profiles between the two medications 3