Simvastatin Dose Equivalent to Rosuvastatin 10 mg
Simvastatin 40 mg is the equivalent dose to rosuvastatin 10 mg in terms of LDL-C lowering effect. 1
Statin Intensity Comparison
- According to the American College of Cardiology/American Heart Association guidelines, rosuvastatin 10 mg is classified as a moderate-intensity statin that reduces LDL-C by approximately 30-49% 1
- Simvastatin 20-40 mg is also classified as moderate-intensity statin therapy with similar LDL-C reduction of 30-49% 1
- The intensity classification is based on the percentage reduction in LDL-C from baseline, with moderate-intensity statins reducing LDL-C by 30-49% 1
Specific Equivalence Data
- Based on the ACC/AHA guidelines, rosuvastatin 10 mg and simvastatin 40 mg are both considered moderate-intensity statins with comparable LDL-C lowering effects 1
- The VOYAGER meta-analysis demonstrated that rosuvastatin 10 mg reduces LDL-C by approximately 44%, which would require simvastatin 72 mg to achieve an equivalent reduction 2
- Since simvastatin 80 mg is no longer recommended due to increased myopathy risk, simvastatin 40 mg is the highest practical dose that can be considered equivalent to rosuvastatin 10 mg 1, 3
Clinical Considerations
- Rosuvastatin is more potent on a milligram-to-milligram basis compared to simvastatin, requiring lower doses to achieve similar LDL-C reductions 2, 4
- In clinical trials, rosuvastatin 10 mg reduced LDL-C by 44% while simvastatin 20 mg reduced LDL-C by only 37%, indicating that higher doses of simvastatin are needed for equivalence 5
- The STELLAR trial showed that rosuvastatin was more efficacious in improving overall lipid profiles compared to milligram-equivalent doses of other statins including simvastatin 6
Safety Considerations
- The FDA no longer recommends initiating or titrating to simvastatin 80 mg due to increased risk of myopathy and rhabdomyolysis 1, 3
- When considering statin equivalence, it's important to note that simvastatin has more drug interactions than rosuvastatin, which may affect the practical equivalence in certain patient populations 1
- If a patient requires the LDL-C lowering effect of rosuvastatin 10 mg but cannot take it, simvastatin 40 mg would be the appropriate alternative, though it may have a slightly lower efficacy 1, 2
Common Pitfalls to Avoid
- Avoid using simvastatin 80 mg as an equivalent to rosuvastatin 10 mg despite potentially similar LDL-C lowering effects, as the FDA has warned against initiating this dose due to myopathy risk 1, 3
- Don't overlook potential drug interactions when switching between statins, particularly with simvastatin which has more significant interactions with medications like amiodarone and ranolazine 1
- Remember that while dose equivalence tables are helpful, individual patient response to statins can vary, and monitoring lipid levels after switching between statins is important 1