What is the equivalent dose of rosuvastatin (Crestor) for a patient taking atorvastatin (Lipitor) 40 mg?

Equivalent Rosuvastatin Dosing for Atorvastatin 40 mg

When switching from atorvastatin 40 mg, the equivalent dose is rosuvastatin 10 mg, as both are classified as high-intensity statin therapy that achieve ≥50% LDL-C reduction. 1

Statin Intensity Classification

Both atorvastatin 40 mg and rosuvastatin 10 mg are categorized as high-intensity statin therapy, defined by their ability to lower LDL-C by ≥50% from baseline. 1

• High-intensity options include:

  • Atorvastatin 40-80 mg 1
  • Rosuvastatin 20-40 mg 1

• Note on atorvastatin 40 mg: While this dose achieves approximately 50% LDL-C reduction, it was only evaluated in one RCT as a down-titration option for patients unable to tolerate atorvastatin 80 mg. 1

Evidence-Based Conversion

The VOYAGER meta-analysis (38,052 patient exposures) provides the most robust data on statin equipotency: 2

• Rosuvastatin 10 mg reduces LDL-C by 44% and non-HDL-C by 40% 2
• Atorvastatin 29 mg would be required for equivalent LDL-C reduction 2
• Atorvastatin 27 mg would be required for equivalent non-HDL-C reduction 2

Since atorvastatin 40 mg exceeds these calculated equivalent doses, rosuvastatin 10 mg represents a conservative and appropriate conversion that maintains high-intensity therapy status. 3, 2

Alternative Consideration

If the patient requires maximum LDL-C lowering or has established ASCVD, consider rosuvastatin 20 mg: 2

• Rosuvastatin 20 mg reduces LDL-C by 50% and non-HDL-C by 45% 2
• This would require atorvastatin 70 mg for equivalent LDL-C reduction 2
• Multiple trials demonstrate rosuvastatin 20 mg provides 8.2-8.4% greater LDL-C reduction than equivalent atorvastatin doses 4, 5

Clinical Monitoring

After conversion: 3

• Check lipid panel at 4-12 weeks to verify therapeutic equivalence 3
• Adjust dose based on:
  • LDL-C response and goal achievement 3
  • Patient tolerability 3
  • Cardiovascular risk status 3

Important Caveats

Renal impairment considerations: 3

• If CrCl <30 mL/min, rosuvastatin should not exceed 10 mg daily 3
• Atorvastatin generally requires no dose adjustment for renal impairment alone 3

Common pitfall: Failing to account for rosuvastatin's greater potency per milligram can lead to over-treatment if converting on a milligram-to-milligram basis. 3, 2