Do rosuvastatin and atorvastatin (HMG-CoA reductase inhibitors) have similar side effect profiles?

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Last updated: April 9, 2025 • View editorial policy

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From the Guidelines

Rosuvastatin and atorvastatin have similar side effect profiles, with common side effects including muscle pain or weakness, liver enzyme elevations, headache, digestive issues, and mild joint pain, as reported in the 2022 ACC expert consensus decision pathway 1.

Side Effects Comparison

The side effects of rosuvastatin and atorvastatin are similar due to their classification as statin medications.

  • Common side effects for both drugs include:
    • Muscle pain or weakness
    • Liver enzyme elevations
    • Headache
    • Digestive issues (nausea, diarrhea, constipation)
    • Mild joint pain
  • Both medications carry a small risk of more serious side effects such as rhabdomyolysis (severe muscle breakdown) and diabetes, though these are rare.

Statin Intensity and Side Effects

According to the 2019 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1, the intensity of statin therapy can impact the risk of side effects.

  • High-intensity statin therapy, which includes atorvastatin 40-80 mg and rosuvastatin 20-40 mg, is associated with a higher risk of side effects compared to moderate- or low-intensity therapy.
  • However, the benefits of high-intensity statin therapy in reducing cardiovascular risk often outweigh the risks of side effects.

Patient Factors and Side Effects

Patient factors, such as advanced age, female gender, small body frame, kidney or liver disease, and concomitant medication use, can increase the risk of side effects with both rosuvastatin and atorvastatin 1.

  • Patients should be monitored closely for side effects and report any persistent muscle pain, weakness, or brown urine to their healthcare provider immediately.
  • Dose adjustment or alternative statin therapy may be necessary to minimize the risk of side effects while maintaining the benefits of statin therapy.

From the Research

Similarities and Differences in Side Effects

  • Rosuvastatin and atorvastatin have been compared in several studies to determine their effectiveness and safety [ 2, 3,4,5,6 ].
  • A study published in the Annals of Internal Medicine found that rosuvastatin conferred lower risks for major adverse cardiovascular events and major adverse liver outcomes compared to atorvastatin [ 2 ].
  • However, the same study found that the risk for development of type 2 diabetes mellitus was higher with rosuvastatin, and the two medications carried similar risks for development of chronic kidney disease and other statin-related adverse effects [ 2 ].
  • A meta-analysis of head-to-head randomized controlled trials found no significant differences between rosuvastatin and atorvastatin at any dose ratio for adverse events 3.
  • Another study found that rosuvastatin was more efficacious in improving lipid profile, atherogenic index, and modulation of inflammatory biomarkers in dyslipidemic type 2 diabetic patients compared with atorvastatin 5.
  • However, both statins were equivalent as cardioprotective agents in dyslipidemic type 2 diabetic patients 5.

Specific Side Effects

  • Myalgias are common with statin use, but myositis and rhabdomyolysis are rare 4.
  • The risk of hepatic injury caused by statins is estimated to be about 1 percent, similar to that of patients taking a placebo 4.
  • Coexisting elevations of transaminase levels from nonalcoholic fatty liver disease and stable hepatitis B and C viral infections are not contraindications to statin use 4.
  • Clinically important drugs that interact with statins and increase the risk of adverse effects include fibrates, diltiazem, verapamil, and amiodarone 4.

Comparison of Effects on Inflammatory Biomarkers and LV Function

  • A study found that rosuvastatin resulted in significant reduction in HbA1c %, LDL-C, triglycerides, total cholesterol, atherogenic index, hs-CRP, sortilin, and leptin, but increased adiponectin and HDL-C compared with baseline 5.
  • The same study found that left ventricular functions were correlated with adiponectin, lipids, HbA1c %, and hs-CRP 5.
  • Another study found that rosuvastatin inhibited Rho kinase activity to a greater extent than atorvastatin 6.
  • The inhibition of Rho kinase activity by statins was associated with improvement in flow-mediated dilation of the brachial artery 6.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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