Is it safe to take atorvastatin (Lipitor) and rosuvastatin (Crestor) daily?

Taking Atorvastatin and Rosuvastatin Together is Not Recommended

You should not take atorvastatin and rosuvastatin together daily—this represents unnecessary duplication of therapy from the same drug class (both are statins) and increases the risk of adverse effects without additional cardiovascular benefit. 1

Why Combining Two Statins is Inappropriate

Same Mechanism of Action

• Both atorvastatin and rosuvastatin work by inhibiting HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis 1
• Using two statins simultaneously provides no additional LDL-lowering benefit beyond what a single high-intensity statin achieves 1
• The ACC/AHA guidelines define statin therapy by intensity categories (high, moderate, low) and recommend selecting one statin at the appropriate dose to achieve the desired LDL-C reduction 1

Increased Risk Without Benefit

• Combining statins would expose you to the adverse effect profile of both medications, particularly increasing the risk of:
  • Myopathy and muscle-related symptoms 1
  • Elevated creatine kinase levels 2
  • Potential liver enzyme abnormalities 3
  • Rhabdomyolysis in rare cases 1

The Correct Approach: Choose One High-Intensity Statin

If You Need Maximum LDL-C Lowering (≥50% reduction)

• Select either rosuvastatin 20-40 mg OR atorvastatin 40-80 mg—not both 1, 4
• Rosuvastatin 20 mg provides slightly greater LDL-C reduction than atorvastatin 40 mg at equivalent doses 5, 6, 7
• A recent 2024 multi-database cohort study found rosuvastatin associated with marginally lower all-cause mortality compared to atorvastatin (difference in 6-year cumulative incidence: -1.03% to -1.38%), though differences were small 6

Comparative Efficacy Data

• At a 1:2 dose ratio (rosuvastatin 10 mg vs. atorvastatin 20 mg), rosuvastatin achieved significantly greater LDL-C reduction (44.6% vs. 42.7%, p<0.05) and higher goal attainment rates (68.8% vs. 62.5% for NCEP ATP III goals) 7
• Meta-analysis of head-to-head trials showed rosuvastatin provides additional LDL-lowering at 1:1 and 1:2 dose ratios compared to atorvastatin without increased adverse events 3

What to Do If Currently Taking Both

Immediate Action Required

• Discontinue one of the two statins immediately after consulting with your prescribing physician 1
• Continue with the single statin that provides adequate LDL-C lowering for your cardiovascular risk profile 1

Selection Criteria for Which Statin to Continue

• If you need high-intensity therapy: Choose rosuvastatin 20-40 mg OR atorvastatin 40-80 mg based on:
  • Previous tolerance to either medication 2, 8
  • Cost considerations 7
  • Drug-drug interaction profile with your other medications 1
• Monitor creatine kinase and liver enzymes 4-12 weeks after any dose adjustment 2

Common Pitfall to Avoid

Do not assume that "more is better" with statins—the guidelines clearly establish that cardiovascular benefit comes from achieving adequate LDL-C reduction with a single appropriately-dosed statin, not from combining multiple statins 1. The only appropriate add-on therapy to statins for further LDL lowering would be non-statin agents like ezetimibe or PCSK9 inhibitors, not a second statin 1.