What is the equivalent dose of rosuvastatin (Crestor) to atorvastatin (Lipitor) 80mg?

Equivalent Dose of Atorvastatin 80mg to Rosuvastatin

Atorvastatin 80 mg is approximately equivalent to rosuvastatin 20-40 mg, with rosuvastatin 20 mg being the most appropriate clinical equivalent based on both drugs being classified as high-intensity statins that reduce LDL-C by ≥50%. 1, 2

Statin Intensity Classification

Both atorvastatin 80 mg and rosuvastatin 20 mg are classified as high-intensity statins by the ACC/AHA guidelines, defined as achieving ≥50% reduction in LDL-C from baseline. 1, 2

• Atorvastatin 80 mg reduces LDL-C by approximately 50-55% 1
• Rosuvastatin 20 mg reduces LDL-C by approximately 50-55% 1, 2
• Rosuvastatin 40 mg reduces LDL-C by approximately 55-63% 1, 3

Direct Comparative Evidence

The VOYAGER meta-analysis, which analyzed 38,052 patient exposures, provides the most robust dose-equivalence data: 3

• Rosuvastatin 20 mg reduced LDL-C by 50%, which required atorvastatin 70 mg to achieve equivalent reduction 3
• Rosuvastatin 40 mg reduced LDL-C by 55%, which was not achieved even with atorvastatin 80 mg 3
• Each rosuvastatin dose is equivalent to doses 3-3.5 times higher for atorvastatin 3

Head-to-head trials consistently demonstrate rosuvastatin's superior potency: 4, 5, 6

• Rosuvastatin 40 mg was significantly more effective than atorvastatin 80 mg in reducing LDL-C (-52% vs -50%, p<0.01) 4
• Across dose ranges, rosuvastatin reduced LDL-C by a mean of 8.2% more than atorvastatin at comparable doses 5
• A 2023 meta-analysis of 44 studies confirmed rosuvastatin 40 mg was statistically more effective than atorvastatin 80 mg in reducing LDL 7

Clinical Recommendation Algorithm

For patients currently on atorvastatin 80 mg:

1. If maintaining high-intensity therapy: Switch to rosuvastatin 20 mg as the standard equivalent 1, 2
2. If maximal LDL reduction needed: Consider rosuvastatin 40 mg, which provides greater LDL-C lowering than atorvastatin 80 mg 4, 3, 7
3. If tolerability concerns exist: Rosuvastatin 20 mg provides similar efficacy with potentially better safety profile than atorvastatin 80 mg 2

Important Safety Considerations

Rosuvastatin 20 mg is the preferred high-intensity statin over atorvastatin 80 mg in many clinical scenarios because: 2

• Both achieve the high-intensity threshold of ≥50% LDL-C reduction 1, 2
• Rosuvastatin has fewer drug interactions than atorvastatin 8
• Individual patient response varies, so lipid monitoring 4-12 weeks after switching is essential 1

Common Pitfalls to Avoid

• Do not assume 1:1 dose equivalence between atorvastatin and rosuvastatin—rosuvastatin is approximately 3-3.5 times more potent 3
• Do not overlook drug interactions when switching statins, particularly with medications metabolized by CYP3A4 (affects atorvastatin more than rosuvastatin) 8
• Do not forget to recheck lipid panel 4-12 weeks after switching to confirm adequate LDL-C reduction, as individual responses vary 1
• Do not use rosuvastatin 10 mg as equivalent to atorvastatin 80 mg—this is only moderate-intensity therapy (30-49% LDL-C reduction) and would represent significant de-escalation 1, 8